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University of Michigan Health Advantage Flex (PPO)

H6727 - 001 - 0
Plan Not Rated

University of Michigan Health Advantage Flex (PPO) is a Medicare Advantage Plan by University of Michigan Health Plan.

This page features plan details for 2025 University of Michigan Health Advantage Flex (PPO) H6727 – 001 – 0 available in Central and Southern Michigan.

Locations

University of Michigan Health Advantage Flex (PPO) is offered in the following locations.

Bay County, Michigan
Calhoun County, Michigan
Clinton County, Michigan

Click to see more locations

Plan Overview

University of Michigan Health Advantage Flex (PPO) offers the following coverage and cost-sharing.

Insurer:University of Michigan Health Plan
Health Plan Deductible:$0
MOOP:$5,500 In and Out-of-network
$5,500 In-network
Drugs Covered:Yes

Ready to sign up for University of Michigan Health Advantage Flex (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

University of Michigan Health Advantage Flex (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

University of Michigan Health Advantage Flex (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

University of Michigan Health Advantage Flex (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: 50 Coins – No Co pay (Limits Apply)
  • Endodontics
    • In-Network: 40 Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: 40-50 Coins – No Co pay (Limits Apply)
  • Periodontics
    • In-Network: 0-40 Coins – No Co pay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: 40-50 Coins – No Co pay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: 40-50 Coins – No Co pay (Limits Apply)
  • Restorative Services
    • In-Network: 40-50 Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: 0-50 Coins – No Copay
    • Out-of-Network: 50-75% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50-75% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50-75% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50-75% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-10 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-100 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $35 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 30% coinsurance (Authorization Required)

Doctor visits

  • Specialist
    • In-Network: $35 copay per visit (Authorization Required)
  • Primary
    • Out-of-Network: $25 copay per visit
  • Specialist
    • Out-of-Network: $40 copay per visit (Authorization Required)
  • Primary
    • In-Network: $0 copay

Emergency care/Urgent care

  • Urgent care
    • $55 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $35 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: $40 copay

Ground ambulance

    • Out-of-Network: $275 copay
    • In-Network: $275 copay

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • Out-of-Network: 30% coinsurance
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 30% coinsurance (Limits Apply)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $25 copay
  • Hearing aids
    • Out-of-Network: 30% coinsurance (Limits Apply)
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • In-Network: $350 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 30% per stay (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $5,500 In and Out-of-network
      $5,500 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $350 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 30% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $30 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $30 copay
  • Inpatient hospital – psychiatric
    • Out-of-Network: 30% per stay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $25 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 30% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: Yes

Outpatient hospital coverage

    • In-Network: $200 copay per visit (Authorization Required)
    • Out-of-Network: 30% coinsurance per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $25 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 30% coinsurance
    • In-Network: $25 copay
  • Occupational therapy visit
    • Out-of-Network: 30% coinsurance

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $150 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 30% per stay (Authorization Required)

Transportation

    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Vision

  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 30% coinsurance (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for University of Michigan Health Advantage Flex (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on University of Michigan Health Advantage Flex (PPO)? See 2025 University of Michigan Health Advantage Flex (PPO) at MedicareAdvantageRX.com.

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