UPMC for Life Medicare | Compare our plans in Pennsylvania, Ohio, and West Virginia

Compare UPMC for Life 2010 Plans

	Choose where you live from the list below.
	Pennsylvania Ohio West Virginia

	Compare up to 3 UPMC for Life plans by choosing plans from columns 2a, 2b, and 2c below.

Choose a plan from this column.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 2 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 3 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Benefit:

Monthly Plan Premium
Annual Maximum Out-of-Pocket Limit
Annual Out-of-Pocket Deductible
Primary Care Doctor Visit Copay
Specialist Doctor Visit Copay
Inpatient Hospital Copay

UPMC for Life HMO

You Pay:

In-network: $3,400
Out-of-network: n/a

n/a

$15

$30

$250 per stay:
$750 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$53

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$141

In-network: $3,200
Out-of-network: n/a

n/a

$30

$200 per stay;
$400 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$3,400

$2,000

In-Network: $16*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$211.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

In-network: $3,400
Out-of-network: n/a

n/a

$15

$30

$250 per stay:
$750 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$53

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$141

In-network: $3,200
Out-of-network: n/a

n/a

$30

$200 per stay;
$400 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$3,400

$2,000

In-Network: $16*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$211.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

In-network: $3,400
Out-of-network: n/a

n/a

$15

$30

$250 per stay:
$750 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$53

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$141

In-network: $3,200
Out-of-network: n/a

n/a

$30

$200 per stay;
$400 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$3,400

$2,000

In-Network: $16*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$211.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

Compare up to 3 UPMC for Life plans by choosing plans from columns 2a, 2b, and 2c below.

Choose a plan from this column.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 2 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 3 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMOOH)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Benefit:

Monthly Plan Premium
Annual Maximum Out-of-Pocket Limit
Annual Out-of-Pocket Deductible
Primary Care Doctor Visit Copay
Specialist Doctor Visit Copay
Inpatient Hospital Copay

UPMC for Life HMO

You Pay:

$107.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$141.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$125.60

$3,400

$1,000

In-Network: $25*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$223.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

$107.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$141.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$125.60

$3,400

$1,000

In-Network: $25*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$223.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

$107.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$141.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$125.60

$3,400

$1,000

In-Network: $25*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$223.50

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

Compare up to 3 UPMC for Life plans by choosing plans from columns 2a, 2b, and 2c below.

Choose a plan from this column.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 2 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Choose a different plan from this column to compare 3 plans.

	UPMC for Life HMO
	UPMC for Life HMO Rx (HMO)
	UPMC for Life HMO Rx Enhanced (HMO)
	UPMC for Life PPO High Deductible with Rx (PPO)
	UPMC for Life PPO Rx Enhanced (PPO)

Benefit:

Monthly Plan Premium
Annual Maximum Out-of-Pocket Limit
Annual Out-of-Pocket Deductible
Primary Care Doctor Visit Copay
Specialist Doctor Visit Copay
Inpatient Hospital Copay

UPMC for Life HMO

You Pay:

$108.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$142.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$124

$3,400

$1,000

In-Network: $15*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$219.90

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

$108.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$142.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$124

$3,400

$1,000

In-Network: $15*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$219.90

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

UPMC for Life HMO

You Pay:

$108.60

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay:
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx (HMO)

You Pay:

$142.50

In-network: $3,400
Out-of-network: n/a

n/a

$15

$40

$275 per stay;
$825 maximum

Click here for more
details on this plan's benefits.

UPMC for Life HMO Rx Enhanced (HMO)

You Pay:

$157.70

In-network: $3,200
Out-of-network: n/a

n/a

$30

$125 per stay;
$250 maximum

Click here for more
details on this plan's benefits.

UPMC for Life PPO High Deductible with Rx (PPO)

You Pay:

$124

$3,400

$1,000

In-Network: $15*
Out-of-Network: 20% of the cost*

In-Network: $0**
Out-of-Network: 20% of the cost**

Click here for more
details on this plan's benefits.

UPMC for Life PPO Rx Enhanced (PPO)

You Pay:

$219.90

In-network: $3,200
Out-of-network: n/a

In-network: n/a
Out-of-network: $250

In-Network: $5
Out-of-Network: $45

In-Network: $30
Out-of-Network: $45

In-Network:
$100 per stay; $200 maximum
Out-of-Network:
20% of the cost per stay

Click here for more
details on this plan's benefits.

Questions?

Call us toll-free at 1-866-400-5077
Hours: 8 a.m. to 8 p.m.,* seven days a week
TTY/TDD: 1-800-361-2629

Please note: Not all benefits are listed in this grid. For complete benefit information, please reference the Summary of Benefits for the plan in which you are interested. Click here to go back to our 2010 Medicare Plan Options page and review the Summaries of Benefits for each plan.

If you have any questions or would like to receive this information by mail, please call us toll-free at 1-866-400-5077 from 8 a.m. to 8 p.m., seven days a week or click on one of the links below. TTY/TDD users should call 1-800-361-2629. From March 2 through November 14, you may receive a messaging service on weekends and holidays. Please leave a message and your call will be returned the next business day.

*This cost is excluded from the annual deductible. You pay only the cost shown. The annual deductible applies to your overall costs spent, not just the amount spent on each specific benefit.

**You pay the cost shown after the annual deductible is met.

⁺The products and services described are neither offered nor guaranteed under contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any dispute regarding these products and services may be subject to the UPMC for Life grievance process.