UPMC for Life Announces 2026 Benefits for Its Medicare Advantage Plans

Contact:

Denise Hughes 

UPMC Health Plan 

Phone: 412-983-3836 

Email: Hughesdr2@upmc.edu 

 

Gloria Kreps

UPMC Public Relations

Phone: 412-417-2582

Email: Krepsga@upmc.edu

Affordable Coverage, Extra Benefits, Trusted Care: UPMC for Life Continues to Deliver 
High-Quality Affordable Coverage 

PITTSBURGH (Oct. 1, 2025)—UPMC Health Plan announced its 2026 UPMC for Life Medicare Advantage plan offerings today. These plans highlight UPMC for Life’s ongoing commitment to offering stability, affordability, and value to its members through robust medical and supplemental benefits, including vision, dental, hearing, coverage while traveling, and a UPMC for Life Flex Spend Card.

“Whether Medicare consumers are looking for affordability, extra benefits such as vision and dental, or more comprehensive coverage and support, choosing the right Medicare plan is an important decision, and UPMC for Life has options designed with our members in mind,” said Angela Perri, president, UPMC Medicare Products for UPMC Health Plan. “Best of all, every plan provides access to trusted, high-quality care and award-winning satisfaction* with our health care concierge team. For 2026 we’re focusing on the affordability and care coordination that our HMO plans provide. These plans are designed specifically to offer members integrated care with our participating network of doctors and hospitals.”

When members enroll in a UPMC for Life HMO plan, they choose a primary care provider (PCP). The PCP is their main doctor and point of contact for care. The PCP gets to know the member’s health history, medications, specialists, and overall health care needs. Instead of the member having to manage multiple doctors and medical care needs on their own, the PCP acts like the “quarterback,” making sure the member has the right doctors providing their care and helping to avoid conflicting treatments or medications.

UPMC clinicians and UPMC for Life work together to provide members with high-quality, well-coordinated care. This integrated model puts the member’s health at the center by connecting clinicians, care teams, and coverage so members get the right care at the right time. This approach supports the whole person—including physical and emotional health, nutrition, fitness, home safety, and caregiver support—while helping avoid unnecessary tests and procedures. With the member’s PCP leading the team and UPMC for Life offering resources and affordable coverage, members benefit from care that is seamless, personalized, and focused on keeping them as healthy as possible.

Medicare-eligible individuals can select a Medicare Advantage plan during the Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7, 2025. During that time, new and existing beneficiaries can enroll in a Medicare Advantage or Part D plan or change their current coverage. New plans become effective Jan. 1, 2026.

UPMC for Life’s benefits and features for 2026 include:

  • Stable plan premiums, with decreases on the HMO Rx Choice plan in Allegheny County, Southwest PA (Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, and Washington counties in Pennsylvania and Harrison and Jefferson counties in Ohio), Erie County, and Northwest PA (Cameron, Clarion, Clearfield, Crawford, McKean, Mercer, Venango, and Warren counties). Many plans had a decrease in copays for urgent care visits, preferred lab visits, and outpatient surgery at an ambulatory surgery center.  
  • The HMO Premier Rx (HMO) and HMO Rx Choice (HMO) plans in Erie, which will now offer qualified members four healthy food kits per year and eight one-way trips to medically approved locations, such as doctors’ offices, hospitals, outpatient facilities, pharmacies, and fitness centers at no cost. These benefits are part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. To be eligible, members must qualify for a Low-Income Subsidy (LIS) and have one of the following chronic illnesses: chronic/disabling mental health conditions, metabolic disorders, cardiovascular disorders, substance use disorders, diabetes, or other eligible conditions not listed. Eligibility for this benefit cannot be guaranteed based solely on the member’s condition. All applicable eligibility requirements must be met before the benefit is provided. For details, current or prospective members should contact UPMC for Life.
  • Veteran plan options designed by veterans for veterans: 
    • HMO No Rx (HMO) offers a $125 monthly Part B premium reduction and low specialist visit, lab, and x-ray copays.
    • PPO Salute (PPO) works with TRICARE For Life and offers a $0 copay for most medical benefits, plus additional coverage for vision, dental, and hearing services. These plans do not offer Part D prescription drug coverage.
  • The PPO Essential Care Rx (PPO) plan, which provides basic care and coverage with a $0 premium and a $100 monthly Part B premium reduction. Members receive supplemental benefits, including vision, dental, hearing, free fitness memberships at participating locations, and a UPMC for Life Flex Spend Card.
  • Prescription coverage changes. UPMC for Life will continue to offer $0 copays for Tier 1 and Tier 2 covered prescriptions at preferred pharmacies. Members who use insulins will also have low copays: $35 for a 30-day supply at retail pharmacies; $87.50 for a 100-day supply from preferred mail-order pharmacies; $96.25 for a 100-day supply at preferred retail pharmacies; and $105 for a 100-day supply at standard pharmacies.
  • All members with the UPMC for Life Flex Spend Card maintain the ability to use their card for out-of-pocket costs at a doctor’s office or medical facility; over-the-counter products at participating retail stores; premier fitness locations; home safety products; and dental, vision, and hearing services.
  • Qualified UPMC for Life Complete Care (HMO D-SNP) members receive allowance dollars on their Shop Healthy Card, including $60 per month for over-the-counter and home safety products. Members who qualify also receive an additional $110 per month for healthy foods and $40 per month for utilities (gas, water, electricity, heating, sewage, and trash). These benefits are part of the SSBCI program. To be eligible, members must qualify for a LIS and have one of the following chronic illnesses: chronic/disabling mental health conditions, metabolic disorders, cardiovascular disorders, substance use disorders, diabetes, or other eligible conditions not listed. Eligibility for this benefit cannot be guaranteed based solely on the member’s condition. All applicable eligibility requirements must be met before the benefit is provided. For details, current or prospective members should contact UPMC for Life.
  • For all plans, members continue to receive rewards for getting the preventive care they need. Reward dollars are automatically loaded on to their UPMC for Life Flex Spend Card when they complete certain preventive screenings by Dec. 31 each year. UPMC for Life mails eligible members about the preventive screenings they need at the beginning of the year.

Additionally, UPMC for Life members have the support of health care concierges who consistently rank at the top of quality and customer service surveys. Concierge team members direct beneficiaries to customized services, assist with medical appointment scheduling, help members access digital health tools and resources, and resolve coverage questions and concerns.

Individuals who are eligible for Medicare and are interested in UPMC for Life can enroll by phone or online. Those who want personal help understanding their plan benefits can contact the UPMC for Life Medicare Advisor team at 1-877-381-3765 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. Medicare members can also go to upmchealthplan.com/medicare to shop for plans, learn more about 2026 plan offerings, find information about community meetings, and chat with a Medicare Advisor. 

*J.D. Power recently named UPMC for Life No. 1 in Member Satisfaction among Medicare Advantage Plans in Pennsylvania. UPMC for Life received the highest score in the state in the J.D. Power 2023-2025 U.S. Medicare Advantage Studies of members' satisfaction with their Medicare Advantage health plan experience. Results are based on award-eligible plans in Pennsylvania by J.D. Power. Visit jdpower.com/awards for details.

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc. 

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About UPMC Insurance Services

The UPMC Insurance Services Division serves more than 4.1 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. The UPMC Insurance Services Division provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers' compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); special needs plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children's Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation's largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.

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