The University of Pittsburgh Medical Center provide UPMC Medicare plans, which are available in parts of several states and throughout Pennsylvania.
Most of the company’s UPMC for Life plans include preventive dental coverage for services such as X-rays, cleaning, and oral examinations.
Keep reading to learn more about UPMC and their Medicare plans, including the coverage, costs, and enrollment.
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.
The Pittsburgh-based company UPMC Health Plan, which the UPMC own, provide services to almost 4 million people.
The company’s insurance service division offers several health plans, including Medicare, and its provider network includes more than 29,000 doctors and 140 hospitals in parts of Maryland, West Virginia, and Ohio, as well as throughout Pennsylvania.
Medicare is a federal insurance program that provides healthcare coverage for older people in the United States. Some younger people with certain conditions and disabilities may also be eligible.
The program consists of:
- Original Medicare (Part A and Part B), which provides hospital and medical insurance
- Part C, also known as Medicare Advantage, which provides an alternative to original Medicare and often includes additional benefits
- Part D, which covers prescription drugs
Medicare Advantage
Medicare-approved private companies administer Medicare Advantage plans, many of which offer additional benefits, such as vision, hearing, and dental care.
There are several types of Medicare Advantage plans, including the four most common ones:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
Less common Advantage plans include HMO Point of Service (HMO-POS) plans and Medicare savings account (MSA) plans.
UPMC for Life offer several Advantage plans, but only to people who qualify for Medicare and live in Pennsylvania or certain areas of Ohio, including Harrison and Jefferson. Not all UPMC Advantage plans are available in all of these areas. A person can check for Medicare plans in their area using this online tool.
The company’s Medicare Advantage plans include HMOs and PPOs.
Most plans include basic preventive dental coverage.
Some UPMC for Life Complete Care Advantage plans offer additional benefits, including:
- in-home safety test
- routine podiatry (foot doctor) services
- fitness benefits
- funds for healthful foods for members with diabetes
- meal services following an inpatient hospital stay
- nursing advice line available 24-7
Medicare Advantage plans must offer the same basic coverage as original Medicare (parts A and B), including:
- outpatient doctor and specialist visits
- inpatient stays in a hospital or skilled nursing facility
- preventive care and vaccinations
- mental health services
- laboratory and diagnostic services
- physical and occupational therapy
- durable medical equipment
- emergency care
- some transportation services
UPMC for Life Medicare Advantage plans offer additional benefits, which vary among plans. The benefits include prescription drug coverage; podiatric, chiropractic, and diabetes healthcare services; and routine hearing, vision, and dental care.
HMO
UPMC have six different HMO plans. Out-of-pocket maximums range from $3,400 to $7,550. The monthly premiums range from zero upward.
HMO-SNP
The UPMC for Life Complete Care plan (HMO-SNP) offers additional benefits for a person who qualifies for both Medicare and Medicaid. The plan provides 100% coverage for urgent care and emergency room visits, inpatient hospital treatment, and outpatient surgery. It also includes preventive dental coverage, plus additional benefits.
PPO
UPMC’s two PPO plans have maximum out-of-pocket costs of $6,700. The estimated monthly plan premiums are $35 for the PPO High Deductible Rx plan and $47 for the PPO Rx Enhanced plan.
All UPMC for Life Advantage plans include preventive dental coverage.
UPMC for Life HMO-SNP plans also include coverage, on a rolling 6-month basis, for preventive oral examinations, cleaning, and X-rays. In addition, the plans offer yearly amounts ranging from $3,000 or $5,000, depending on the plan, for services such as fillings, extractions, root canals, dentures, bridges, and crowns.
UPMC for Life Advantage plan costs vary depending on a person’s location, and not all plans are available in all counties.
Costs include premiums, copays, coinsurance, and deductibles. A person must also pay their Medicare Part B monthly premium, which is $148.50 in 2021.
The table below shows the costs of some of the company’s Medicare Advantage plans available in zip code 15120, Allegheny County, PA.
| Plan | Premium (monthly | Deductible (annual) | Maximum out-of-pocket (annual) |
|---|---|---|---|
| HMO No Rx | $0 | $0 | $7,500 |
| HMO Premier Rx | $0 | $0 | $7,500 |
| HMO Deductible Rx | $22 | $750 | $7,500 |
| HMO Rx Choice | $40 | $0 | $7,500 |
| HMO Rx | $81 | $0 | $7,500 |
| HMO Rx Enhanced | $302 | $0 | $7,500 |
| PPO High Deductible Rx | $35 | $1,250 | $7,500 |
| PPO Rx Enhanced | $136 | $500 (out-of-network only) | $7,500 |
A person can enroll in the UPMC for Life Medicare Advantage plans during several Medicare enrollment periods. During these periods, they may also take other actions, such as enrolling in original Medicare (Part A and Part B), changing Advantage plans, or enrolling in new plans.
The Medicare enrollment periods include
- initial enrollment period (IEP)
- general enrollment period (GEP)
- open enrollment period (OEP)
- special enrollment period (SEP)
The University of Pittsburgh Medical Center offer UPMC Medicare Advantage plans, which include HMO and PPO plans. An HMO dual-eligibility SNP plan is available for people enrolled in Medicare and Medicaid.
UPMC for Life plans offer preventive dental benefits with coverage for exams, cleanings, and X-rays. Additional coverage may be available for bridges, crowns, or tooth removal.