Plan Benefit Comparison
Below are overviews of the three exclusive medical and drug plan options available to Medicare-eligible member retirees. These benefits are effective January 1 – December 31, 2025. Once you have had a chance to compare and choose an option that works best for you — or if you have questions — please give us a call at (855) 855-6942.
MEDICARE ADVANTAGE SILVER PPO
2025 MONTHLY PREMIUM
$43.68
MEDICAL BENEFITS
Maximum Out‐of‐Pocket
$7,500
Deductible
$350
Inpatient Hospital
$295 (days 1‐7)
Primary Care Physician (PCP) Visit
$10
Specialist Visit
$55
Surgery
$300
Emergency Room
$100
Non‐Medicare Covered Services
Hearing, Vision, Dental, Podiatry, Routine Chiropractic
RX BENEFITS
Formulary Type
Group Plus 5 Tier (Open)
Deductible
$200 Brand Only
Out-of-Pocket Max
$2,000
30 Day Retail / Mail
$7 / $8 / $30 / $80 / 30%
90 Day Retail / Mail
3 x 30 Day / 2 x 30 Day
Click here for full 2025 Silver plan details.
MEDICARE ADVANTAGE GOLD PPO
2025 MONTHLY PREMIUM
$123.43
MEDICAL BENEFITS
Maximum Out‐of‐Pocket
$6,000
Deductible
$300
Inpatient Hospital
$250 (days 1‐7)
Primary Care Physician (PCP) Visit
$5
Specialist Visit
$45
Surgery
$250
Emergency Room
$100
Non‐Medicare Covered Services
Hearing, Vision, Dental, Podiatry, Routine Chiropractic
RX BENEFITS
Formulary Type
Group Plus 5 Tier (Open)
Deductible
$200 Brand Only
Out-of-Pocket Max
$2,000
30 Day Retail / Mail
$5 / $10 / $40 / $80 /30%
90 Day Retail / Mail
3 x 30 Day / 2 x 30 Day
Click here for full 2025 Gold plan details.
MEDICARE ADVANTAGE PLATINUM PPO
2025 MONTHLY PREMIUM
$199.87
MEDICAL BENEFITS
Maximum Out‐of‐Pocket
$4,000
Deductible
$250
Inpatient Hospital
$225 (days 1‐7)
Primary Care Physician (PCP) Visit
$0
Specialist Visit
$40
Surgery
$175
Emergency Room
$100
Non‐Medicare Covered Services
Hearing, Vision, Dental, Podiatry, Routine Chiropractic, OTC, Transportation, Wigs
RX BENEFITS
Formulary Type
Group Plus 5 Tier (Open)
Deductible
$0
Out-of-Pocket Max
$2,000
30 Day Retail / Mail
$5 / $10 / $40 / $80 / 30%
90 Day Retail / Mail
3 x 30 Day / 2 x 30 Day
Click here for full 2025 Platinum plan details.
For a list of in-network Humana providers, click here
For a list of in-network Humana pharmacies, click here
For a full list of covered drugs, click here
We’re here for you every step of the way
EASY PHONE ENROLLMENT & SUPPORT
Our concierge customer support team is available to answer questions, help you enroll in a plan, and provide support post-enrollment.
NO WAIT TO ENROLL
Since PROMISE is a new product available to union retirees, you can enroll at any time of the year — not just during the Annual Enrollment Period (AEP).