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Medicare Star Ratings


US News and World Report recognition

UPMC for Life has earned an excellent 5 out of a possible 5 overall star rating for both its HMO and PPO plans from the Centers for Medicare & Medicaid Services (CMS) for 2022. We've also received National Committee for Quality Assurance (NCQA) Accreditation! Plus, U.S. News & World Report recognized us as one of the Best Medicare Advantage Plans in PA for 2022.

These awards place us among the highest-rated Medicare plans in the nation. They are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, customer service, and member satisfaction. You can use these scores to see how we are doing on quality and performance compared to other Medicare plans.

There is still time to join our 5-star Medicare plan!

If you missed the Annual Election Period (AEP), it’s not too late to get better coverage from UPMC for Life. Because UPMC for Life received 5 stars from Medicare, you could be eligible for a Special Election Period (SEP) to enroll in a UPMC for Life plan from Dec. 8, 2021, to Nov. 30, 2022. You can change from another Medicare Advantage plan, Original Medicare, or a Part D Prescription drug plan.

Find a UPMC for Life Medicare plan that best fits your needs

How do Medicare Star Ratings work?

5 out of 5 Stars for HMO and PPO

5 out of 5 Stars for HMO and PPO

Every year, Medicare (CMS) evaluates plans based on a 5-star rating system to assist Medicare beneficiaries and their families in comparing plans based on quality and performance. The Medicare star ratings are based on how well Medicare Advantage plans deliver medical coverage, prescription drug services, and customer service. The score also includes how current members rate their satisfaction with the plan.

CMS uses up to 40 quality and performance measures to rate plans. Ratings range from a low “1” star, which is poor, to the highest possible “5” stars, which is excellent. Medicare’s 5-star rating is given by CMS, the federal program that governs all Medicare plans, which means it cannot be paid for—it must be earned.

The areas CMS uses to determine star ratings include:

  • Feedback from members about the plan’s service and care
  • The number of members who left or stayed with the plan
  • The number of complaints Medicare got about the plan
  • Data from doctors and hospitals that work with the plan

Why are the star ratings important?

More stars mean a better plan–members get better care, better quality, and better customer service. Medicare beneficiaries can use this score to compare quality and performance of Medicare plans. This important tool can help beneficiaries choose the best Medicare plan to fit their needs.

NCQA Accreditation

NCQA-Health Plan Accreditation

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality.* NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. HEDIS measures performance in health care where improvements can make meaningful differences in people’s lives including effectiveness and availability of care and utilization.

NCQA-Health Plan Accreditation

Among the areas NCQA uses to determine accreditation include:

  • Quality management and improvement
  • Members’ rights and responsibilities
  • Network management
  • Care and service performance

Why is accreditation important?

When a health plan is accredited, it means that they demonstrate their commitment to quality in several key areas included safety, operational efficiency, and patient care coordination and satisfaction.

These ratings also help UPMC for Life maintain the strong benefits and programs currently offered to members and reflect the strength and stability of our products over the last several years.

Best Service

UPMC Health Plan earned 12 awards during the 16th annual Stevie® Awards for Sales & Customer Service event for outstanding customer service and innovation in 2022.

The Stevie Awards for Sales & Customer Service are the world’s top honors for customer service, contact center, business development, and sales professionals across organizations of all sizes and in virtually every industry.

For the second year in a row, UPMC Health Plan was a GRAND STEVIE winner for overall best Sales and Customer Service!

To our members…

Thank you to our members for helping us achieve these awards! You may not realize it, but our excellent star rating and accreditation is thanks in large part to you! These scores reflect our commitment to offering the best possible care and coverage to our members every day. We could not have accomplished such a great score without you, and we are so thankful to serve each and every one of you!

*UPMC for Life was rated 4 out of 5 stars for its HMO plans and 4.5 out of 5 stars for its PPO plans in NCQA’s Medicare Health Plan Ratings 2021.

This information is not a complete description of benefits. Call 1-866-400-5077 (TTY: 711) for more information. Out-of-network/Noncontracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 711).

UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO 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., and UPMC Health Coverage Inc.

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UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m., Saturday from 8 a.m. to 3 p.m.

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077
TTY: 711

Jan. 1 – Sept. 30:
Seven days a week from 8 a.m. to 8 p.m.

Oct. 1 – Dec. 31:
Seven days a week from 7 a.m. to 9 p.m.


Last Updated: 10/01/2022