Frequently Asked Questions

On this page, you’ll find a list of some of the most frequently asked UPMC Medicare Specialty Program questions, including questions about Original Medicare, Medicare Advantage Plans, Medicare Part D prescription drug coverage, and enrollment deadlines.

Please click on the bolded sections below to see an entire page of questions pertaining to that category. You can also click on the questions listed under each section to look at a specific topic.

Section 1 — Medicare Defined

1. What is Medicare?
2. What are the basic parts of Medicare (Part A, Part B, Part C, and Part D)?
3. Does Original Medicare cover prescription drug costs?
4. What are some services or items that Original Medicare doesn’t cover?

Section 2 — Medicare Part D Prescription Drug Plans

1. Does Medicare pay for prescription drugs?
2. What is a prescription drug formulary?
3. What are prescription drug tiers and how does a tier status affect my copay?
4. What are mail-order drugs and how does their copay vary?
5. What are generic drugs and how are they different?
6. Which prescription drugs are excluded from Medicare coverage?

Section 3 — Medicare Advantage Plans

1. What is a Medicare Advantage Plan?
2. What is an HMO?
3. What is a PPO?
4. What is a Private Fee-for-Service plan?

Section 4 — Enrolling in Original Medicare and Medicare Advantage Plans

1. What is the eligibility criterion for an individual that wants to join UPMC for You Advantage (HMO SNP), our UPMC for Life Specialty Plan (HMO SNP), or UPMC for Life Options (HMO SNP)?
2. Can I switch plans?

Section 5 — Low Income Assistance

1. What does low income assistance or Medical Assistance mean?
2. How do I apply for Medical Assistance in Pennsylvania?
3. What type of Literature is available for my reference?
4. What Government Resources are available?
5. What resources are available in Pennsylvania for low income members?

Section 6 — Frequently Asked Questions for Members

1. What is the process for a member enrolled in UPMC for You Advantage, UMPC for Life Specialty Plan, and UPMC for Life Options if they no longer have full Medical Assistance?
2. What type of formulary does our Medicare Specialty Program offer to its members?
3. How many pharmacies are in the network?
4. Does the Plan meet access requirements?
5. Are Jobst Stockings covered?
6. How is the shingles vaccine (Zostavax) covered?
7. What do I do if I need a drug that is not on the prescription drug formulary?
8. How do I request an exception to the prescription drug formulary?
9. What should I do before I talk to my doctor about changing my prescription drugs or requesting an exception to the formulary?
10. What is the criteria for a member to be eligible for the medication management program?
11. How does UPMC Health Plan manage drug utilization?
12. How does UPMC Health Plan help members who take many medications?
13. Am I covered for a scooter? How do I get a scooter?
14. Do routine tests performed for members require prior authorizations?
15. What is my vision care benefit?
16. What is my dental benefit?
17. What is my routine hearing coverage?
18. Why am I not always able to talk to my Health Care Concierge?