Dual-eligible Medicare and Medicaid plans
With the UPMC for Life Shop Healthy Card, members get $60 every month to pay for OTC and home safety products. Members who qualify for Special Supplemental Benefits for the Chronically Ill will receive two additional allowances: $110 per month for healthy foods and $40 per month for household utilities.
This benefit is part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. To be eligible, you must qualify for 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 your condition. All applicable eligibility requirements must be met before the benefit is provided. For details, please contact us.
- $0 copay for two oral cleanings and exams every year
- $3,995, $5,000 or $8,250 yearly allowance (depending on your plan) for additional dental services
- $0 copay for two oral cleanings and exams every year
- Restorations (fillings) and simple tooth removal
- Up to a $500 yearly allowance for certain dental services
UPMC for Life Complete Care:
- Unlimited FREE gym memberships through SilverSneakers® to participating fitness facilities plus one free personal training session each year
- The option to work out from the safety of home with in-home fitness kits
- $0 for one hearing exam and hearing aid fitting each year
- $0 copay per ear every year or every three years (depending on your plan) for hearing aids through Amplifon.
UPMC Community HealthChoices: Additional home safety products may be covered for those with Medicaid long-term services and supports based on your service plan.
- $0 copay for inpatient medical services
- $0 copay for outpatient medical services
- $0 copay for inpatient medical services
- $0 copay for outpatient medical services
UPMC for Life Complete Care prescription coverage:
- $0 copay for Tier 1 and Tier 2 prescription drugs
- Depending on the level of Extra Help you receive, you will have a $0, $1.60, $4.90, $5.10, or $12.65 copay for Tier 3, Tier 4, and Tier 5 prescription drugs
UPMC for Life Complete Care: Transportation to and from medical approved locations, including doctor’s offices, health care facilities, pharmacies, and fitness centers. Members who qualify for Special Supplemental Benefits for the Chronically Ill (SSBCI) can use some of their trips for nonmedical locations like grocery stores, places of worship, salons, banks, funeral homes, libraries, and adult day/community centers.
Depending on your plan, you get:
- 20 one-way trips to medical approved locations. For members who qualify for SSBCI, 8 of these 20 one-way trips may be to nonmedical locations. For members who qualify for SSBCI, 34 of these 60 one-way trips may be to nonmedical locations.**
UPMC Community HealthChoices: Nonmedical trips may be covered for those with Medicaid long-term services and supports based on your service plan.
- $0 copay for one routine vision exam and contact lens fitting each year
- $575 yearly allowance for eyewear or contact lenses
- $0 copay for two routine vision exams each year
- Specialist eye exam with PCP prescription
- Up to a $100 allowance every 12 months for one pair of glasses or contacts
- $0 copay for 24/7 medical advice over the phone from experienced registered nurses
- $0 copay for an online virtual visit with a UPMC provider***
- $0 copay for 24/7 medical advice over the phone from experienced registered nurses
- $0 copay for an online virtual visit with a UPMC provider***