CalPERS created a list of frequently asked questions (FAQ), to help communicate the differences between the Anthem Blue Cross, Blue Shield, and UnitedHealthcare Combination plans and how they are set up in the myCalPERS system.
The FAQ also includes information on the Medicare plans no longer be available as of Jan. 1, 2025: the UnitedHealthcare Group Medicare Advantage Edge and the Western Health Advantage MyCare Select Plans.
Anthem Blue Cross
Is the Blue Shield Medicare PPO plan an HMO or a PPO plan?
The Anthem Medicare Preferred plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare.
I am enrolled in the Anthem Medicare Preferred PPO Plan and my dependent(s) is/are enrolled in the Anthem Blue Cross Traditional HMO plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?
You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The Anthem Basic Plan in the COMBO is the Anthem Blue Cross Traditional HMO plan. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMO’s.
I am enrolled in Anthem Medicare Preferred plan. Am I limited to only seeking services from providers that contract with Anthem?
Your Medicare Advantage plan through CalPERS has open access to all Medicare providers. This means that you can seek services from any provider that is currently contracted with Medicare regardless of whether they are contracted with your specific health plan.
Blue Shield of California
Is the Blue Shield Medicare PPO plan an HMO or a PPO plan?
The Blue Shield Medicare PPO plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare.
I am enrolled in the Blue Shield Medicare PPO Plan and my dependent(s) is/are enrolled in the BSC Basic HMO Plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?
You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The Blue Shield Basic Plans in the COMBO are Blue Shield Access+, Blue Shield EPO and Blue Shield Trio HMO plans. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMOs.
Blue Shield of California will be the new Third Party Administrator for the PERS Gold Supplement and PERS Platinum Supplement to Original Medicare Plan. Will there be any changes to the benefit with this transition?
There are no changes to copays, coinsurance, or deductibles with this transition to BSC. Provider networks and care coordination by your doctor will not change. Most CalPERS PPO members will be able to continue seeing their existing doctor as an in-network provider since BSC has virtually all the same hospitals, facilities, and systems, and significant overlap of physicians and clinicians as the current plan.
I am enrolled in Blue Shield Medicare PPO plan. Am I limited to only seeking services from providers that contract with Blue Shield?
Your Medicare Advantage plan through CalPERS has open access to all Medicare providers. This means that you can seek services from any provider that is currently contracted with Medicare regardless of whether they are contracted with your specific health plan.
UnitedHealthcare
Is the UnitedHealthcare Group Medicare Advantage plan an HMO or a PPO plan?
The UnitedHealthcare Group Medicare Advantage plan is a PPO plan; however, it has copays just like you would find in an HMO plan. Though, unlike an HMO plan, you can go to any provider that accepts Medicare and the plan.
I am enrolled in the UnitedHealthcare Group Medicare Advantage PPO Plan and my dependent(s) is/are enrolled in the UHC Basic HMO Plan, but when I log in to myCalPERS it shows that I am enrolled in an HMO plan. Why?
You are enrolled in what CalPERS calls a “COMBO” plan, meaning, you are enrolled in a Medicare Plan and one or more of your dependents is enrolled in a Basic Plan. The UnitedHealthcare Basic Plan in the COMBO is the UnitedHealthcare SignatureValue Alliance or UnitedHealthcare SignatureValue Harmony HMO plan. The CalPERS system is currently set up with a limited number of display settings and it shows these COMBO plans as HMOs.
Will the UnitedHealthcare Group Medicare Advantage Edge plan be available in 2025?
No, the UnitedHealthcare Group Medicare Advantage Edge (PPO) plan will no longer be available effective Jan. 1, 2025. If you are currently enrolled in the UnitedHealthcare Group Medicare Advantage Edge (PPO) plan, you do not need to take any action. Your current coverage will end, and you will be automatically enrolled into the UnitedHealthcare Group Medicare Advantage (PPO) plan for coverage effective Jan. 1, 2025, unless you elect a different plan during the Open Enrollment period from Sept. 16 through Oct. 11.
I am enrolled in UnitedHealthcare Group Medicare Advantage PPO plan. Am I limited to only seeking services from providers that contract with UnitedHealthcare?
Your Medicare Advantage plan through CalPERS has open access to all Medicare providers. This means that you can seek services from any provider that is currently contracted with Medicare regardless of whether they are contracted with your specific health plan.
Western Health Advantage
Will the Western Health Advantage MyCare Select plan be available in 2025??
No, the Western Health Advantage MyCare Select plan will no longer be available effective January 1, 2025. CalPERS members currently enrolled in the Western Health Advantage MyCare Select plan will need to choose another CalPERS Medicare Plan to be effective January 1, 2025.
CalPERS members, enrolled as an individual and residing in Napa County, who do not request an open enrollment change will be transferred into the United Health Care Medicare Advantage Plan. The remaining CalPERS members, and residing outside of NAPA county, will be enrolled into the Blue Shield Medicare plan.
CalPERS members, enrolled in a combo plan and residing in Napa County, who do not request an open enrollment change will be transferred into the Blue Shield Medicare plan. The remaining CalPERS members, enrolled in a combo plan and residing outside of NAPA county, will be enrolled into the Blue Shield Medicare plan and Blue Shield Access+ plan.