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University of Michigan Health Advantage Flex (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for University of Michigan Health Advantage Flex (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on University of Michigan Health Advantage Flex (PPO) in 2025, please refer to our full plan details page.
University of Michigan Health Advantage Flex (PPO) is a PPO plan offered by University of Michigan Health available for enrollment in 2025 to people living in Central and Southern Michigan. The overall rating for this plan is not yet available for 2025.
It's important to know that University of Michigan Health Advantage Flex (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about University of Michigan Health Advantage Flex (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For University of Michigan Health Advantage Flex (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The University of Michigan Health Advantage Flex (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The University of Michigan Health Advantage Flex (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $30 to $200. Emergency services have a $125 copay, and ambulance services have a $275 copay. The plan also includes coverage for primary care, hearing, vision, and dental services. Primary care visits have copays between $20 and $35, while hearing exams have a $25 copay, and vision exams have a $35 copay. Dental services have a $1,500 annual maximum, with copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital-Acute has a copay of $350 for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a copay of $350 for days 1-4, and no copay for days 5-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stay and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a $200 copay, observation services with a $200 copay, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $30 copay for individual sessions and a $25 copay for group sessions. Outpatient blood services are also covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered under the University of Michigan Health Advantage Flex (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the University of Michigan Health Advantage Flex (PPO) plan. Ground and air ambulance services have a $275 copay, and transportation services to a plan-approved health-related location are covered for 20 one-way trips per year via taxi, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency coverage, are covered. Emergency services have a $125 copay, urgently needed services have a $55 copay, and worldwide emergency coverage has a $125 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The University of Michigan Health Advantage Flex (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $30 copay for individual sessions and a $25 copay for group sessions, Psychiatric Services with a $30 copay for individual sessions and a $25 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0 and $30, and Opioid Treatment Program Services with a $30 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, kidney disease education services, and other preventive services. The plan also covers fitness benefits. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, and fitting/evaluation for a hearing aid. Prescription hearing aids are covered up to a maximum of $1,000 every two years, but prescription hearing aids for the inner and outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The University of Michigan Health Advantage Flex (PPO) plan covers vision services including eye exams with a $35 copay, and eyewear, with a combined maximum of $200 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, but upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit. Medicare Dental Services require a $35 copay, while Oral Exams are limited to two per year, and Dental X-Rays have a 0% to 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the University of Michigan Health Advantage Flex (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for all other covered drugs.
Dialysis Services See details
Dialysis Services are covered by the University of Michigan Health Advantage Flex (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the University of Michigan Health Advantage Flex (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $100, Therapeutic Radiological Services have a $35 copay, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the University of Michigan Health Advantage Flex (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the University of Michigan Health Advantage Flex (PPO) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $150. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The "Other Services" benefit covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, but does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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