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UPMC for You Advantage, UPMC for Life Specialty Plan, and UPMC for Life Options have a network of doctors and hospitals. You must use plan providers except in emergent or out-of-area urgent care, and out-of-area kidney dialysis.  If you obtain routine care from out-of-network providers neither Medicare, UPMC for You Advantage, UPMC for Life Specialty Plan, or UPMC for Life Options will be responsible for the costs. 

Medicare Advantage Exclusions:
Click here for exclusions that apply to Original Medicare also apply to our plans.   

Prescription Drug Information:
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies.

Medicare beneficiaries may be enrolled in only one Part D plan at a time. If enrolled in an HMO, a PPO, or a PFFS plan with Medicare prescription drug coverage, the enrollee may not enroll in a Prescription Drug Plan (PDP) unless he or she disenrolls from the HMO, PPO, or PFFS plan. Enrollees in a PFFS plan that does not provide Medicare prescription drug coverage or a Medicare Advantage Medical Savings Account plan may enroll in a PDP.

If a beneficiary is already enrolled in a Medicare Advantage Prescription Drug (MAPD) plan, the enrollee must receive his or her Medicare prescription drug benefit through that plan.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
• Your state Medical Assistance office.

Medicare Specialty Programs Eligibility and Contracting Statements:
UPMC Health Plan is a health plan with a Medicare contract. To qualify for UPMC for You Advantage, UPMC for Life Options, and UPMC for Life Specialty Plan, individuals must all have Medicare Part A, Part B, and must have full Medical Assistance Coverage for UPMC for You Advantage and UPMC for Life Specialty Plan at the time of enrollment.

UPMC for You Advantage, UPMC for Life Options, and UPMC for Life Specialty Plan members must reside in the service area. Individuals with end-stage renal disease (ESRD) are not eligible to enroll in this plan, unless you are currently enrolled in a UPMC Health Plan product or were enrolled (with ESRD) in a Medicare Advantage plan that no longer provides coverage for the area you live. Members cannot be institutionalized for the UPMC for Life Specialty Plan.

UPMC Health Plan's contract with CMS is renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. UPMC for You Advantage, UPMC for Life Options, and UPMC for Life Specialty Plan are products of and operated by UPMC Health Plan, Inc., UPMC Health Network, Inc., and UPMC.

Enrollment Limitations:
UPMC for You Advantage, UPMC for Life Options, and UPMC for Life Specialty Plan eligible beneficiaries can enroll at any time.

Alternative Formats:
You have the right to get your questions answered. Our plan has individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. If you need plan documents in other formats, please contact us at the number below.

For full information on UPMC Medicare Specialty Plans benefits, call our Medicare Specialty Plan Sales Hotline at 1-866-405-8762, seven days a week, from 8 a.m. to 8 p.m. TTY/TDD users should call 1-866-407-8762. 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.