Advantage U Medicare Advantage U

U of Utah Retirees

Notice: This Medicare plan won’t be offered in 2024

This is a courtesy notice to let you know that beginning January 1, 2024, Advantage U Signature (PPO), Advantage U Signature Buyback (PPO) and Advantage U for University of Utah Retirees (PPO) will not be offered. This means you will need to obtain coverage from another Medicare plan for 2024.

Welcome to Advantage U for University of Utah Retirees (PPO)

With so many Medicare coverage options out there, it can be hard to know which plan to choose.
Thankfully, there’s a plan you can trust that was born right in our backyard, created for U of U Retirees like you. A new plan developed by Utahns with extensive health care experience and a dedication to providing Utahns like you with affordable coverage, benefits designed with you in mind and a network of doctors and hospitals you already know and trust.

That plan is Advantage U for University of Utah Retirees.

Advantage U for University of Utah Retirees (PPO) is available for Medicare beneficiaries that are eligible retirees of the University of Utah residing in Davis, Salt Lake, Tooele, Utah, and Weber Counties.

Resources for Coronavirus

CORONAVIRUS UPDATES AND COVERAGE DETAILS

During the national public health emergency period, Screening and/or testing for COVID-19 is covered in-network and out-of-network for a $0 copay.

Learn More

Advantage U for University of Utah Retirees (PPO) includes

    •  

      Hospital and Medical Coverage

      Advantage U offers the $0 Premium Advantage U Signature (PPO) plan.

       

      • $0 Monthly Premium (you must continue to pay your Part B Premium)
      • $0 Copay for In-network Primary Care Physician (PCP)
      • $25 Copay for In-network Specialist Visit

      For a complete listing of benefits please see Summary of Benefits.

    •  

      Prescription Drug Coverage

      Our plan features a formulary (or drug list) with a broad number of prescription drugs on Tier 1 and Tier 2, so you can save more.

      See Summary of Benefits for additional prescription drug coverage information.

       

      Retail Cost-Sharing
      Tier 30-Day Supply 60-Day Supply 100-Day Supply
      Tier 1 (Preferred Generics) $3 copay $6 copay $0 copay
      Tier 2 (Generics) $10 copay $20 copay $20 copay
      Tier 3 (Preferred Brands) $47 copay $94 copay $141 copay
      Tier 4 (Non-Preferred Drugs) $100 copay $200 copay $300 copay
      Tier 5 (Specialty Medications) 29% coinsurance Not offered Not Offered

      Senior Savings Model: For Select Insulins, $28 copay for one-month supply is applicable in the Deductible, Initial Coverage and Coverage Gap phases of the Part D Benefit.

    •  

      Dental

      Our plan includes preventive dental coverage with a $0 copay and comprehensive dental coverage for fillings, extractions, crowns, implants or adjunctive periodontal care. Up to $1,500 annual benefit for comprehensive coverage. Authorization rules apply.

      See Summary of Benefits for additional dental benefits.

    •  

      Vision

      We offer a $0 copay for routine vision exam along with coverage for eyeglasses or contact lenses ($120 limit on eyeglasses and contacts).

      See Summary of Benefits for additional vision benefits.

      Search Eye Doctors

    •  

      Hearing

      Our plan includes a $0 copay for routine hearing exams through TruHearing along with hearing aid coverage.

      See Summary of Benefits for additional hearing benefits.

    •  

      Fitness

      Enjoy a Fitness Center Membership to participating fitness centers and choose to receive Home Fitness Kit.

      You can visit a participating fitness center near you. You also have access to a variety of Home Fitness Kits.

      The Silver&Fit® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver &Fit® is a federally registered trademark of ASH and used with permission herein. Kits are subject to change. Participating facilities and fitness chains may vary by location and are subject to change.

    •  

      Over-the-Counter (OTC)

      With our plan, members receive a $50 allowance each quarter to use for the purchase of select OTC products.

    •  

      Hospital and Medical Coverage

      Advantage U offers the $0 Premium Advantage U Signature (PPO) plan.

       

      • $0 Monthly Premium (you must continue to pay your Part B Premium)
      • $0 Copay for In-network Primary Care Physician (PCP)
      • $25 Copay for In-network Specialist Visit

      For a complete listing of benefits please see Summary of Benefits.

    •  

      Prescription Drug Coverage

      Our plan features a formulary (or drug list) with a broad number of prescription drugs on Tier 1 and Tier 2, so you can save more.

      See Summary of Benefits for additional prescription drug coverage information.

       

      Retail Cost-Sharing
      Tier 30-Day Supply 60-Day Supply 100-Day Supply
      Tier 1 (Preferred Generics) $3 copay $6 copay $0 copay
      Tier 2 (Generics) $10 copay $20 copay $20 copay
      Tier 3 (Preferred Brands) $47 copay $94 copay $141 copay
      Tier 4 (Non-Preferred Brands) $100 copay $200 copay $300 copay
      Tier 5 (Specialty Medications) 29% coinsurance Not offered Not Offered

      Senior Savings Model: For Select Insulins, $28 copay for 30-day supply is applicable in the Deductible, Initial Coverage and Coverage Gap phases of the Part D Benefit.

    •  

      Dental

      Our plan includes preventive dental coverage with a $0 copay and comprehensive dental coverage for fillings, extractions, crowns, implants or adjunctive periodontal care. Up to $1,500 annual benefit for comprehensive coverage. Authorization rules apply.

      See Summary of Benefits for additional dental benefits.

    •  

      Vision

      We offer a $0 copay for routine vision exam along with coverage for eyeglasses or contact lenses ($120 limit on eyeglasses and contacts).

      See Summary of Benefits for additional vision benefits.

      Search Eye Doctors

    •  

      Hearing

      Our plan includes a $0 copay for routine hearing exams through TruHearing along with hearing aid coverage.

      See Summary of Benefits for additional hearing benefits.

    •  

      Fitness

      Enjoy a Fitness Center Membership to participating fitness centers and choose to receive Home Fitness Kits.

      You can visit a participating fitness center near you. You also have access to a variety of Home Fitness Kits.

      The Silver&Fit® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver &Fit® is a federally registered trademark of ASH and used with permission herein. Kits are subject to change. Participating facilities and fitness chains may vary by location and are subject to change.

    •  

      Over-the-Counter (OTC)

      With our plan, members receive a $30 allowance each quarter to use for the purchase of select OTC products.

Documents and Notices

Plan Benefits and Coverage Details

2023 Summary of Benefits View PDF 

 
2023 Evidence of Coverage View PDF 

 
2023 Provider Directory View PDF 

 
2023 Pharmacy Directory View PDF 

 
2023 Formulary View PDF 

 
Supplies for Diabetes View PDF 

 
LIS Premium Summary Chart View PDF 

 
Medical Claim Reimbursement Form View PDF