Navigating UCLA Health Medicare Advantage Plans
Choosing the right Medicare Advantage plan is a crucial decision for ensuring comprehensive healthcare coverage. UCLA Health offers several Medicare Advantage plans designed to provide comprehensive coverage, including hospital care, medical services, and prescription drugs. This article provides an overview of UCLA Health Medicare Advantage plans, focusing on the Principal and Prestige plans, their benefits, costs, and enrollment information. It is important to remember that UCLA Health Medicare Advantage Plan (HMO) has a contract with Medicare and enrollment in the plan depends on contract renewal. Also, UCLA Health Medicare Advantage Plan includes Part D drug coverage.
Understanding Medicare Advantage Plans
Medicare Advantage plans, also known as Medicare Part C, are offered by private companies that contract with Medicare to provide Part A and Part B benefits. Many Medicare Advantage plans also offer additional benefits such as vision, hearing, and dental coverage. These plans provide an alternative way to receive Medicare benefits, often with lower out-of-pocket costs and extra services.
UCLA Health Medicare Advantage Plans Overview
UCLA Health Medicare Advantage offers two primary plans: the Principal Plan and the Prestige Plan. Both plans are Health Maintenance Organization (HMO) plans, which generally require members to use in-network providers, except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from UCLA Health Medicare Advantage Plan, neither Medicare nor UCLA Health Medicare Advantage Plan will be responsible for the costs.
UCLA Health Medicare Advantage Principal Plan (HMO)
The UCLA Health Medicare Advantage Principal Plan (HMO) is designed to deliver comprehensive coverage, including hospital care, medical services, and prescription drugs, all under one roof. CMS recognizes this plan as H4647-001-0.
Key Facts and Costs (2026):
- Plan ID: H4647-001-0
- Medicare Advantage Plan Type: HMO
- Plan Year: 2026
- Monthly Premium: \$0.00 (plus your Medicare Part B premium)
- Health Plan Deductible: \$0.00
- Annual Out-of-Pocket Maximum (In-Network): \$2499.00
- Part B Give Back: Not offered
- Part D Drug Plan Benefit: Enhanced, \$250.00 deductible
- Additional Benefits: Dental, Vision, Hearing
- Availability: See List
- Insured By: UCLA Health Medicare Advantage Plan
Plan Availability:
UCLA Health Medicare Advantage Principal Plan (H4647-001-0) is available in specific locations within California.
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Benefits and Coverage:
The Principal Plan includes the core benefits of Medicare Part A and Part B, plus drug coverage to manage ongoing prescriptions. Like most HMO plans, you’ll be asked to use in-network providers unless it’s an emergency.
- Primary Care Visits: \$0 copay (in-network)
- Specialist Visits: \$0 copay (in-network)
- Urgent Care Services: \$15 copay
- Ambulance Transportation: \$200 copay
These costs all apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of \$2499.00. Once you hit that threshold, in-network services are fully covered for the rest of the year.
Out-of-Pocket Costs:
UCLA Health Medicare Advantage Principal Plan includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services.
- Doctor's Office Visits:
- Primary: In-network: \$0 copay
- Specialist: In-network: \$0 copay
- Preventive & Wellness:
- Annual wellness exam: In-network: \$0 copay
- Telehealth benefit: In-network: \$0 copay
- Routine chiropractic: In-network: \$0 copay
- Fitness benefits: In-network: \$0 copay
- Over the counter drug benefits: In-network: \$0 copay
- Health transportation (non-emergency): In-network: \$0 copay
- Emergency, Urgent, and Inpatient Hospital Coverage:
- Emergency room care: \$150 copay
- Worldwide emergency care: \$150 copay
- Urgent care: \$15 copay
- Inpatient hospital care: Tier 1 | \$200 per stay
- Skilled Nursing Facility: Tier 1 | \$0 per day for days 1-20 | \$100 per day for days 21-100
- Ground ambulance: In-network: \$200 copay
- Mental Health Services:
- Outpatient individual therapy: In-network: \$15 copay
- Outpatient group therapy: In-network: \$15 copay
- Inpatient psychiatric hospital care: Tier 1 | \$200 per stay
- Rehabilitation Services:
- Physical therapy and speech and language therapy: In-network: \$0 copay
- Occupational therapy: In-network: \$0 copay
- Medical Equipment and Supplies:
- Diabetes supplies: In-network: 0%-20% coinsurance
- Durable medical equipment: In-network: 20%-50% coinsurance
- Prosthetics: In-network: 0%-20% coinsurance
- Diagnostics, Lab Services, and Imaging:
- Diagnostic radiology services: In-network: \$0-\$50 copay
- Lab services: In-network: \$0 copay
- Outpatient x-rays: In-network: \$0 copay
- Diagnostic tests and procedures: In-network: \$0 copay
- Medicare Part B Drugs:
- Chemotherapy: In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered): In-network: 0%-20% coinsurance
- Dental Services:
- Oral exam: In-network: \$0 copay
- Dental x-rays: In-network: \$0 copay
- Cleaning: In-network: \$0 copay
- Periodontics: In-network: \$0-\$130 copay
- Endodontics: In-network: \$12-\$154 copay
- Restorative services: In-network: \$7-\$410 copay
- Oral/Maxillofacial surgery: In-network: \$3-\$152 copay
- Hearing Aids and Services:
- Hearing exam: In-network: \$0 copay
- Fitting/evaluation: In-network: \$0 copay
- Prescription hearing aids: In-network: \$295-\$1495 copay
- Vision Services:
- Routine eye exam: In-network: \$0 copay
- Contact lenses: In-network: \$0 copay
- Eyeglasses (frames & lenses): In-network: \$0 copay
Part D Prescription Drug Costs & Benefits:
UCLA Health Medicare Advantage Principal Plan includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. This plan has a \$250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UCLA Health Medicare Advantage Plan starts contributing towards your prescription costs.
UCLA Health Medicare Advantage Prestige Plan (HMO)
UCLA Health Medicare Advantage Prestige Plan is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that combines hospital, medical, and drug coverage into one streamlined option. This plan is listed by CMS as H4647-002-0.
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Key Facts and Costs (2026):
- Plan ID: H4647-002-0
- Medicare Advantage Plan Type: HMO
- Plan Year: 2026
- Monthly Premium: \$45.00 (plus your Medicare Part B premium)
- Health Plan Deductible: \$0.00
- Annual Out-of-Pocket Maximum (In-Network): \$1499.00
- Part B Give Back: Not offered
- Part D Drug Plan Benefit: Enhanced, \$250.00 deductible
- Additional Benefits: Dental, Vision, Hearing
- Availability: See List
- Insured By: UCLA Health Medicare Advantage Plan
Plan Availability:
UCLA Health Medicare Advantage Prestige Plan (H4647-002-0) is available in specific locations within California.
Benefits and Coverage:
With a monthly premium of \$45.00, it includes all benefits under Medicare Part A and Part B, along with built-in prescription drug coverage. You’ll typically need to use doctors and providers in the plan’s network, except for emergency situations.
- Primary Care Visits: \$0 copay (in-network)
- Specialist Visits: \$0 copay (in-network)
- Urgent Care Services: \$15 copay
- Ambulance Transportation: \$100 copay
These costs all apply toward the plan’s maximum out-of-pocket (MOOP) limit of \$1499.00. Once that limit is met, all in-network healthcare services are fully covered for the rest of the year.
Out-of-Pocket Expenses:
UCLA Health Medicare Advantage Prestige Plan has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services.
- Doctor's Office Visits:
- Primary: In-network: \$0 copay
- Specialist: In-network: \$0 copay
- Preventive & Wellness:
- Annual wellness exam: In-network: \$0 copay
- Telehealth benefit: In-network: \$0 copay
- Routine chiropractic: In-network: \$0 copay
- Fitness benefits: In-network: \$0 copay
- Over the counter drug benefits: In-network: \$0 copay
- Health transportation (non-emergency): In-network: \$0 copay
- Emergency, Urgent, and Inpatient Hospital Coverage:
- Emergency room care: \$75 copay
- Worldwide emergency care: \$75 copay
- Urgent care: \$15 copay
- Inpatient hospital care: Tier 1 | \$0 per stay
- Skilled Nursing Facility: Tier 1 | \$0 per day for days 1-20 | \$75 per day for days 21-100
- Ground ambulance: In-network: \$100 copay
- Mental Health Services:
- Outpatient individual therapy: In-network: \$15 copay
- Outpatient group therapy: In-network: \$15 copay
- Inpatient psychiatric hospital care: Tier 1 | \$0 per stay
- Rehabilitation Services:
- Physical therapy and speech and language therapy: In-network: \$0 copay
- Occupational therapy: In-network: \$0 copay
- Medical Equipment and Supplies:
- Diabetes supplies: In-network: 0%-20% coinsurance
- Durable medical equipment: In-network: 20%-50% coinsurance
- Prosthetics: In-network: 0%-20% coinsurance
- Diagnostics, Lab Services, and Imaging:
- Diagnostic radiology services: In-network: \$0-\$50 copay
- Lab services: In-network: \$0 copay
- Outpatient x-rays: In-network: \$0 copay
- Diagnostic tests and procedures: In-network: \$0 copay
- Medicare Part B Drugs:
- Chemotherapy: In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered): In-network: 0%-20% coinsurance
- Dental Services:
- Oral exam: In-network: \$0 copay
- Dental x-rays: In-network: \$0 copay
- Cleaning: In-network: \$0 copay
- Periodontics: In-network: \$0-\$130 copay
- Endodontics: In-network: \$12-\$154 copay
- Restorative services: In-network: \$7-\$410 copay
- Oral/Maxillofacial surgery: In-network: \$3-\$152 copay
- Hearing Aids and Services:
- Hearing exam: In-network: \$0 copay
- Fitting/evaluation: In-network: \$0 copay
- Prescription hearing aids: In-network: \$195-\$1395 copay
- Vision Services:
- Routine eye exam: In-network: \$0 copay
- Contact lenses: In-network: \$0 copay
- Eyeglasses (frames & lenses): In-network: \$0 copay
Part D Prescription Drug Costs & Benefits:
UCLA Health Medicare Advantage Prestige Plan includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. This plan has a \$250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UCLA Health Medicare Advantage Plan starts contributing towards your prescription costs.
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Enrollment Information
Eligibility Requirements
To enroll in a UCLA Health Medicare Advantage Plan, you must:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan's service area, Los Angeles County.
Enrollment Periods
Knowing when you can enroll in UCLA Health Medicare Advantage Plan is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan. This is your yearly opportunity to review your current Medicare options and make any desired changes. These changes will take effect on Jan. 1 of the following year.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
How to Enroll
Joining UCLA Health Medicare Advantage Plan is straightforward. Here are the steps you can take:
- Online: Use the online enrollment partner's Secure Online Enrollment Form to sign up. To compare plans online, go to PlanEnroll.com, a third-party site where you can connect with a licensed insurance agent.
- By Phone: Reach out to HealthCompare (a trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Medicare.gov: Visit Medicare.gov, log in or create an account, and follow the steps to join UCLA Health Medicare Advantage Plan.
- Direct Enrollment: You can also choose to enroll directly with UCLA Health Medicare Advantage Plan. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
2026 Medicare Star Ratings for UCLA Health Medicare Advantage Plans:
It’s important to note that for 2026, many measures are marked as "Plan too new to be measured." However, drug plan customer service ratings are available:
- Drug Plan Customer Service: ☆☆☆☆☆
Additional Resources and Information
Connect America Smartwatch
More than a modern-day alternative to traditional medical alert systems, the stylish Connect America Smartwatch is designed to support healthy and active lifestyles. In addition to providing easy and fast access to assistance with the simple press of a button, the Connect America Smartwatch offers step tracking and heart rate measurement to empower individuals to live their best lives while staying safe and connected. Designed to work on a cellular network, this all-in-one system offers two-way communication via the integrated speaker and microphone allowing users to speak directly with a trained care specialist when assistance is needed. Embedded GPS and Wi-Fi location technology enables us to deliver assistance wherever the user is located. Built-in fall detection is available at no extra cost.
Health Insurance Accepted at UCLA Health Hospitals
UCLA Health Hospitals accept a range of insurance plans at Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center. Blue Shield offers several plans that may cover care at UCLA Health. Call Blue Shield at 888-626-6780 for more information.
Health Insurance for Transplants
Health plans often designate medical centers of excellence where they cover transplants of organs or stem cells. UCLA Health has relationships with Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, Health Net of California, INTERLINK, LifeTrac, and Optum Transplant Centers of Excellence.
Health Insurance for Behavioral Health
Not all health plans provide coverage for treating mental health and other behavioral health needs.
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