2025 Plans Offered in Your Area

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University of Michigan Health Advantage (HMO-POS)
Covenant Advantage (HMO-POS)
University of Michigan Health Advantage Plus (HMO-POS)
Covenant Advantage Plus (HMO-POS)
University of Michigan Health Advantage Flex (PPO)

Medical & Hospital

Monthly Premium

$0

$25

$0

Maximum Out-of-Pocket (MOOP)

$3,900

$3,900

$5,500

Annual Deductible

No Medical or Rx Deductible

No Medical or Rx Deductible

No Medical or Rx Deductible

Preventive Care/Screenings

$0 Copay

$0 Copay

$0 Copay

Primary Care Visits

$0 Copay

$0 Copay

$0 Copay

Specialist Visit

$35 Copay

$30 Copay

$35 Copay

Urgent Care

$60 Copay

$60 Copay

$55 Copay

Emergency Care

$140 Copay

$140 Copay

$125 Copay

Lab Services

$0 Copay

$0 Copay

$0 Copay

Home Healthcare

100% Coverage

100% Coverage

100% Coverage

Chiropractic Care

$20 Copay

$20 Copay

$20 Copay

Inpatient Hospital

$175 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond

$175 Per Day for Days 1-7,
$0 Per Day for Day 8 and Beyond

$350 Per Day for Days 1-5,
$0 Per Day for Day 6 and Beyond

Outpatient Surgery at Hospital

$150 Copay

$150 Copay

$200 Copay

Outpatient Surgery at Ambulatory Surgery Center

$100 Copay

$100 Copay

$150 Copay

Extra Benefits

Vision Care By EyeMed

$200 allowance per year

$400 allowance per year

$200 allowance per year

Dental Care By Delta Dental

Preventive and Comprehensive services combined annual allowance $1,000

Preventive and Comprehensive services combined annual allowance $2,000

Preventive and Comprehensive services combined annual allowance $1,500

Over-the-Counter (OTC) Items

$85 Per Quarter

$120 Per Quarter

$105 Per Quarter

Hearing By TruHearing

$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)

$1,500 allowance for up to 2 hearing aids every 2 years (both ears combined)

$1,000 allowance for up to 2 hearing aids every 2 years (both ears combined)

Transportation Assistance

$0 copay for 20 one-way trips to approved locations per year

$0 copay for 30 one-way trips to approved locations per year

$0 copay for 20 one-way trips to approved locations per year

SilverSneakers®

Included at no additional cost

Included at no additional cost

Included at no additional cost

Travel Benefits

Emergency or urgent care coverage if you are making a trip out of state or country

Emergency or urgent care coverage if you are making a trip out of state or country

Emergency or urgent care coverage if you are making a trip out of state or country

Part D Prescription Drug Coverage

Annual Deductible

No Deductible

No Deductible

No Deductible

Tier 1 Preferred Generic

$0 copay

$0 copay

$0 copay

Tier 2 Non-Preferred Generics

$10 copay

$10 copay

$10 copay

Tier 3 Preferred Brand Names

$45 copay

$45 copay

$47 copay

Tier 4 Non-Preferred Brand Names

$95 copay

$95 copay

$100 copay

Tier 5 Specialty Drugs

33% Co-insurance

33% Co-insurance

33% Co-insurance

Mail Order 90-Day Supply

Tier 1: $0 copay

Tier 2: $0 copay

Tier 3: $135 copay

Tier 4: $285 copay

Tier 1: $0 copay

Tier 2: $0 copay

Tier 3: $135 copay

Tier 4: $285 copay

Tier 1: $0 copay

Tier 2: $0 copay

Tier 3: $141 copay

Tier 4: $300 copay

What Medications Are Covered

* 30-Day Supply
** Medicare-covered services are deemed to be medically necessary. These can include services and/or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms.

Important Plan Documents
Select a document name to download.

Annual Notice of Change

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Annual Notice of Change

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Annual Notice of Change

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Evidence of Coverage

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Evidence of Coverage

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Evidence of Coverage

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Prescription Drug Formulary

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Prescription Drug Formulary

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Prescription Drug Formulary

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Provider Directory

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Provider Directory

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Provider Directory

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Star Ratings

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Star Ratings

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New to 2025

- New Plan -

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Summary of Benefits

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Summary of Benefits

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Summary of Benefits

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Formulary Change Notice

Coming Soon

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Formulary Change Notice

Coming Soon

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Formulary Change Notice

Coming Soon

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Low Income Subsidy Information

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Low Income Subsidy Information

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Low Income Subsidy Information

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