The University of Pittsburgh Medical Center (UPMC) offer health insurance coverage, including Medicare Advantage plans, to Pennsylvania and Ohio residents.
The UPMC Advantage plans provide the same coverage for hospital and medical services as original Medicare (Part A and Part B), as well as additional benefits. These may include prescription drug coverage and vision, hearing, and dental care.
This article looks at the UPMC Medicare Advantage plans in more detail, including the coverage and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
UPMC stands for the University of Pittsburgh Medical Center. UPMC began offering health plans in 1994 and now provide health services to more than 3.9 million people throughout Pennsylvania and parts of Maryland, West Virginia, and Ohio. However, the company’s Advantage plans are only available to residents of Pennsylvania and some parts of Ohio.
In addition to Medicare Advantage plans, UPMC provide group health insurance, employee assistance, workers’ compensation products, and children’s health insurance programs (CHIP).
The company’s plan networks include more than 140 hospitals and in excess of 29,000 physicians.
The government funds Medicare to help people aged 65 years and over with their healthcare costs. Younger people may qualify if they have certain conditions or disabilities.
The program consists of four parts:
- Part A: Medical insurance.
- Part B: Hospital insurance.
- Part C: Also known as Medicare Advantage, it offers the same basic coverage as original Medicare plus some extra benefits.
- Part D: Prescription drug coverage.
Medicare Advantage plan categories include:
- Health Maintenance Organization (HMO) plans: HMO plans use a network of preferred providers. A person chooses a primary care doctor to coordinate their care and specialist referrals.
- Preferred Provider Organization (PPO) plans: PPO plans also use a provider network, but a person does not need to choose a primary care doctor. A person can also choose a specialist without a referral from a doctor.
- Private Fee-For-Service (PFFS): With a PFFS plan, a person pays a fixed amount for their care when they visit a healthcare provider.
- Special Needs Plans (SNP): Medicare tailors SNPs to support people with disabilities or chronic health conditions that require special care and medication. These plans may offer the best coverage for individuals with complex health needs.
A person can use this online tool to compare Medicare Advantage plans.
People who qualify for Medicare and live in Pennsylvania and some parts of Ohio, including Harrison and Jefferson, can choose from several types of UPMC for Life Medicare Advantage plans, including HMO and PPO plans and SNPs.
Each UPMC for Life plan offers the same basic coverage as original Medicare, which includes:
- inpatient stays in a hospital or skilled nursing facility
- outpatient doctor and specialist visits
- laboratory and diagnostic services
- preventive care and vaccinations
- mental health services
- physical and occupational therapy
- durable medical equipment, such as wheelchairs
- emergency care
- some transportation services
In addition, the UPMC for Life Medicare Advantage plans offer other benefits, which vary by plan but may include:
- prescription drug coverage
- routine hearing, vision, and dental care
- allowance for contact lenses or eyeglasses
- podiatry services
- chiropractic care
- diabetic services
- over-the-counter (OTC) medicines
Health Maintenance Organization (HMO)
The plan options are:
- HMO No Rx (does not include prescription drug coverage)
- HMO Premier Rx
- HMO Deductible Rx
- HMO Rx Choice
- HMO Rx
- HMO Rx Enhanced
Preferred Provider Organization (PPO)
UPMC offer two PPO plans: PPO High Deductible Rx and PPO Rx Enhanced.
The monthly premium for the PPO High Deductible Rx is $35, while the PPO Rx Enhanced plan’s monthly premium is $136. The maximum out-of-pocket amount for both plans is $7,550.
People can find these costs using the UPMC plan search tool.
Special Needs Plans (SNP)
The UPMC for Life Complete Care plan (HMO SNP) is available for people who qualify for Medicare and Medicaid.
The plan offers additional benefits, such as an OTC medication and healthful groceries allowance, wellness counseling, and home-delivered meals.
UPMC do not offer Part D prescription drug coverage as a stand-alone plan. However, most of the company’s Medicare Advantage plans include Part D coverage, with the exception of HMO No Rx.
The Advantage plans that include prescription drug coverage are:
- HMO Premier Rx
- HMO Deductible Rx
- HMO Rx Choice
- HMO Rx
- HMO Rx Enhanced
- PPO Rx Enhanced
- PPO High Deductible Rx
People with original Medicare who want prescription drug coverage will need to enroll in a separate Part D prescription drug plan.
A person can use this online tool to find and compare Medicare Part D plans.
UPMC plans’ associated costs include:
- Monthly Advantage plan premium: The monthly premium costs for Medicare Advantage plans vary, partly according to location. UPMC offer some zero-cost plans.
- Original Medicare premiums: A person enrolled in an Advantage plan may also have to pay a monthly premium for Medicare Part A and Part B. For 2021, the Part B premium is $148.50 for a person with an annual income of $88,000 a year or less.
- Copays and coinsurance: A copay is a set amount that someone pays when they receive healthcare. Alternatively, they may pay coinsurance, which is a percentage cost.
- Deductible: Individuals must spend an amount of money out-of-pocket before their UPMC plan covers any costs.
The table below shows examples of 2021 costs for UPMC Medicare Advantage plans for a person in Beaver County, PA, with zip code 15001.
|HMO No Rx||HMO Premier Rx||HMO Deductible Rx||PPO High Deductible Rx||PPO Rx Enhanced|
|Annual medical deductible||$0||$0||$750||$1,250||$500 out-of-network (in-network services do not apply to the deductible)|
|Maximum out-of-pocket amount||$7,550||$7,550||$7,550||$7,550||$7,550|
|Primary care visit copay||$0||$0||$0 (deductible does not apply)||$10 in-network; $40 out-of-network||$5 in-network; $30 out-of-network|
|Specialist visit copay||$45||$40||$35 (deductible does not apply)||$50 in-network; $60 out-of-network||$40 in-network; $50 out-of-network|
UPMC provide Medicare Advantage plans to residents across Pennsylvania and some parts of Ohio.
Plans include HMO and PPO Advantage plans, as well as SNPs for people who qualify for both Medicare and Medicaid. The plans may offer additional benefits, such as prescription drug coverage, fitness benefits, and vision, hearing, and dental care.
The costs and covered services vary by plan. Individuals can use the Medicare plan finder to research each plan’s costs and benefits.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.