at a glance
- UPMC Medicare Advantage plans offer the same coverage as original Medicare, plus additional services.
- UPMC offers HMO, PPO, PFFS, and SNP plan options.
- These plans are available to people who live in certain counties in Pennsylvania and Ohio.
- Prescription drug coverage can be added to some UPMC plans.
- UMPC has more than 190,000 members enrolled in their Medicare Advantage plans.
UPMC for Life is a Medicare Advantage program offered by UPMC Health Plan. UPMC Health Plan is owned by the University of Pittsburgh Medical Center and offers its Medicare Advantage plans to residents of Pennsylvania and Ohio.
These plans offer a number of coverage choices that extend beyond original Medicare.
Different companies offer a variety of extra coverage options. Costs depend on where you live and how much you want to pay.
Keep reading to learn about UPMC’s Medicare Advantage plan options in 2021.
Several different types of Medicare Advantage plans can replace original Medicare. These plans vary based on their coverage and what options you choose for your coverage. These UPMC Advantage plan options include:
UPMC Health Maintenance Organization (HMO)
HMO plans may offer the most cost savings; however, you must receive care from healthcare providers and hospitals within the network of the plan you choose. Some HMO plans, called HMO Point-of-Service (HMO-POS) plans, may allow you to see out-of-network providers for a higher fee.
UPMC Preferred Provider Organization (PPO)
PPO plans generally offer more flexibility. Depending on the plan you choose, you may go outside your plan’s network for healthcare. However, this expanded choice usually costs more. You’ll likely pay higher premiums for these plans, and higher copays if you choose to see an out-of-network provider.
UPMC Special Needs Plan (SNP)
Medicare SNPs are Medicare Advantage plans designed to help individuals with specific conditions by providing greater coverage and reduced fees.
SNPs are available to individuals meet specific criteria, such as:
- living in an inpatient facility, such as a nursing home
- having a chronic condition or disability that Medicare states qualifies you for an SNP
- being eligible for both Medicare and Medicaid
Medicare requires that all SNPs provide prescription drug coverage.
At this time, UPMC doesn’t have a stand-alone prescription drug plan, but some of its Medicare Advantage plans include prescription drug coverage.
With original Medicare (parts a and b), you have to choose a separate Part D prescription drug plan. If you don’t sign up for drug coverage when you’re first eligible for Medicare and instead add it later, you’ll pay a penalty.
By choosing a Medicare Advantage plan that includes prescription drug coverage, you’ll get all these “parts” bundled together into one plan. Plus, you won’t face a penalty if you’ve had coverage through Medicare Advantage but choose a separate Part D plan later.
All Medicare Advantage plans must offer the basic services covered under original Medicare. Typically, Medicare Advantage plans include additional services as well. These may vary based on the plan you choose.
Each UPMC for Life Medicare Advantage plan includes the following standard services:
- inpatient hospital stays
- limited skilled nursing care
- outpatient doctor’s office visits
- diagnostic services and lab tests
- preventive care and vaccines
- mental health services
- physical and occupational therapy
- durable medical equipment
- emergency and urgent care
- some transportation services for medical care
- fitness services
Each UPMC Medicare Advantage plan also includes extra services beyond basic preventive, inpatient, and outpatient care. These vary by plan but may include:
Plan availability and prices vary. Plans are grouped into tiers, and not every plan is offered in every county. Plans typically include a monthly premium, annual deductible, copayments, and coinsurance costs.
The following table shows some of the costs for a few of UPMC’s Medicare Advantage plans in Allegheny County, Pennsylvania.
|UPMC for Life HMO Premier Rx||UPMC for Life HMO Rx||UPMC for Life PPO Rx Enhanced||UPMC for Life PPO High Deductible with Rx|
|Annual health deductible||$0||$0||$500||$1,250|
|Out-of-pocket maximum||$7,550 in network||$7,550 in network||$11,300 in and out of network, $7,550 in network only||$11,300 in and out of network, $7,550 in network only|
|Primary care copayment|
Medicare Advantage (Part C) plans are health plans offered through private insurance providers. Part C combines all the parts of original Medicare — inpatient care through Medicare Part A and outpatient care through Medicare Part B — plus extra products and services like prescription drug coverage.
Plan availability and prices vary based on where you live. You can tailor your Medicare Advantage plan to fit your specific healthcare needs and budget.
Additional coverage and services will cost more, and there may be limitations set by your plan on which providers, services, and products you can use.
You can compare several different Medicare Advantage plans in your area using Medicare’s plan finder tool.
When should I enroll?
You can sign up for a Medicare Advantage plan during specific enrollment periods. You first need to enroll in Medicare parts A and B, then you can enroll in Medicare Advantage during open enrollment periods.
Medicare’s open enrollment period is from October 15 through December 7. Medicare Advantage open enrollment is from January 1 through March 31.
- UPMC is a private health insurance company that offers Medicare Advantage plans to residents of most counties in Pennsylvania plus some parts of Ohio.
- Costs and services vary based on how much you want to pay and what services you want included.
- Consider your present and future healthcare needs, plus potential penalties for late Part D enrollment, when considering a Medicare Advantage plan.