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UPMC for Life Offers Affordable Medicare Advantage Plans with Broad In-network Access to UPMC Doctors and Hospitals

Significantly expands benefits for members, including dental, vision, hearing, and an allowance to buy health care products

Pittsburgh (October 1, 2020) – UPMC Health Plan is pleased to offer UPMC for Life, the largest individual Medicare Advantage plan in Western Pennsylvania. In 2021, UPMC for Life will include enhanced benefits that aim to expand our members’ ability to receive the highest quality health care services in the most affordable way.

UPMC for Life was awarded 4.5 out of a possible 5 Overall Star Rating for its HMO and PPO plans for 2020 according to ratings released by the Centers for Medicare & Medicaid Services (CMS). Every year, Medicare evaluates plans based on a 5-star rating system. This ranking places UPMC for Life among the highest-rated Medicare plans in the nation. Every UPMC for Life plan provides members with a patient-centric model of care that focuses on delivering quality by caring for the “whole person,” attending to both the physical and emotional health of members in all settings, whether in person or through virtual care in the comfort of their homes.

“In 2021, UPMC for Life will continue to place the health and well-being of our members as our top priority, offering them access to the best doctors and hospitals, affordability, quality services, and protections in place, like no cost preventive care and clinical management programs, to help members manage their health and avoid large, unexpected medical costs,“ said April Golenor, Chief Medicare Officer for UPMC Health Plan. “We understand that out-of-pocket costs are as important as monthly premiums, so we want to give our members maximum value in term of benefits and services, like telehealth, low costs for medications, an allowance to buy health care products, and dental and vision care. We know that keeping costs low for these services is important to our members as they try to stay within their monthly budgets.”

Reducing Out-of-pocket Costs

In addition to disease-related stress, UPMC for Life understood the many financial stresses that the pandemic created during 2020, and worked to alleviate those stresses by waiving deductibles, copays, and other cost-sharing for coronavirus testing and treatment. UPMC for Life also increased member access to medications by waiving early refill limits on prescriptions. In 2021, UPMC for Life will continue that commitment to reducing the financial stresses on members when accessing the health care system through the following:

• $0 Monthly Premium Plans—UPMC for Life offers plans with zero-dollar monthly premiums, making access to great benefits and services more affordable.
• Access to UPMC—UPMC for Life members have broad, in-network access to the best doctor’s and hospitals with UPMC’s world renowned network that includes 700 doctors’ offices, and 40 hospitals and outpatient sites. Members also have access to a large network of high-quality community doctors and hospitals.
• $0 Preventive Care Visits—UPMC for Life members will have no copays for recommended preventive care, such as an annual wellness visit, mammograms, colorectal screenings, and diabetic retinal eye exams.
• $0 Telehealth Copays—Most UPMC for Life members will not have copays when seeing their in-network PCP through a video visit. Members also have a reduced copay when seeing in-network specialists through telehealth.
• $0 Preferred Generic Prescriptions—Medications on Tier 1 of the UPMC for Life formulary have a $0 copay when filled at preferred pharmacies or through our mail-order pharmacy.
• Cost-Savings for Diabetic Prescriptions—All brand diabetes medications on Tier 2 of the UPMC for Life formulary continue to have copays as low as $10 for a 30-day supply when they are filled at a preferred pharmacy. Plus, in 2021, UPMC for Life members will now be able to save hundreds of dollars when they fill covered diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays ($35 for a 30-day supply and $87.50 for a 90-day supply) in the Part D Initial Coverage and Coverage Gap donut hole stages. This applies to covered insulins filled at standard, preferred, or mail-order pharmacies.
• Additional Donut Hole Coverage for HMO Rx Members—Members of the UPMC for Life HMO Rx (HMO) plan will have additional donut hole coverage for generic Tier 1 and 2 drugs through the Medicare Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays in the Part D Initial Coverage and Coverage Gap donut hole stages. When filled at a preferred pharmacy, Tier 1 generic medications will have copays as low as $0 for a 30-day or 90-day supply and Tier 2 generic medications will have copays as low as $10 for a 30-day supply or $20 for a 90-day supply.
• Dental Services—Members of UPMC for Life’s most popular plans can receive an increased allowance of up to $3,000 per year for comprehensive dental services like fillings, simple tooth extractions, root canals, bridges, crowns, dentures, and periodontal work.
• OTC Allowance—Members of some plans will receive an allowance of up to $50 per quarter to buy approved health care products through our mail-order catalog.

Additional Benefits