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Dental, Vision, and Hearing Coverage

UPMC for Life plans include dental, vision, and hearing benefits. Plus, some plans offer the UPMC for Life Flex Spend Card with additional dollars to spend however you like on dental, vision, and hearing services. You get this additional allowance on top of the coverage allowances below.

Coverage changes based on your plan, and not all plans have the same benefits. You can search and compare available UPMC for Life plans in your area using our Medicare shop tool.

UPMC for Life Complete Care (HMO SNP) plans include dental, vision, and hearing benefits. Plus, these plans offer the UPMC for Life Complete Care Shop Healthy Card with additional dollars every quarter to pay for over-the-counter (OTC) products, healthy foods, pet care supplies, pest control, and household utilities.

You can search and compare available UPMC for Life Complete Care plans with dental, vision, and hearing coverage in your area using our Medicare shop tool.

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Preventive dental coverage

Visit one of our participating UPMC for Life Dental Advantage providers for the following preventive benefits:

  • Two oral exams and cleanings per year
  • One bitewing x-ray per year
  • One panoramic x-ray every 36 months
  • Dental allowance for many dental services, like fillings, tooth extractions, bridges, crowns, and much more — some plans now include DENTURE coverage (not all plans include a dental allowance)
  • One comprehensive oral exam every 36 months

Remember, if your plan includes the UPMC for Life Flex Spend Card, you can use it to pay for non-covered services like teeth whitening and dental implants.

In most cases, you are responsible for all other charges beyond preventive care. Preventive care copays and the dental allowance are excluded from the yearly medical deductible, if applicable, and do not count toward the annual maximum out-of-pocket. Copay and dental allowance amounts vary by plan.

Find a participating dental provider

Members have dental coverage for cleanings, exams, and x-rays. This coverage is available to you on a rolling six-month basis starting from the date you last used services. Members also have an allowance for additional dental services that must be used by the end of each calendar year.

See one of our participating dental providers to take advantage of the benefits below:

  • $0 copay for two cleanings and two oral exams every year
  • $0 copay for one x-ray every six months
  • A yearly allowance for additional services like dentures, bridges, root canals, crowns, fillings, and simple tooth extractions

Routine vision care

Members can see any provider they like, even if the provider is not in our vision provider network. Find a participating vision provider for the following benefits:

  • One routine vision exam
  • One contact lens fitting
  • Routine vision allowance: The routine vision allowance can be used toward the cost of contact lenses or eyewear, including progressive and transitional lens.

How does the routine vision benefit work?

  • If routine vision services are received from a participating provider, the vision provider will bill the plan.
  • If you receive routine vision services from a nonparticipating provider, you may have to pay the cost of the service at the time of the appointment. You can submit a claim for reimbursement for up to the vision allowance amount for your plan.
  • To submit a claim for reimbursement, you will need to complete a vision claim reimbursement form and fax or mail it to us.

The routine vision allowance does not apply to glasses after cataract surgery. It is excluded from the yearly deductible, if applicable, and does not count toward the annual out-of-pocket maximum. Routine vision allowance amounts vary by plan.

Members can receive routine vision coverage and an allowance for eyewear or contact lenses. See one of our participating vision providers to take advantage of the benefits below:

  • $0 for one routine vision exam every year
  • A yearly allowance for contact lenses or eyewear, including lenses and frames (excludes eyeglasses or contact lenses after cataract surgery). Eyewear now includes lens types, like transition and progressive lenses.

Hearing benefits and hearing aid discount

Members enrolled in a plan with hearing coverage get the following benefits:

  • One hearing exam per year.
  • One hearing aid fitting exam every year.
  • $690-$1,890 for one hearing aid per ear per year. You can choose from different types of hearing aids based on quality and cost. To get this important discount, make sure to use an Amplifon hearing provider.

In most cases, you are responsible for all other charges beyond routine care. Hearing care copays and the hearing aid discount are excluded from the yearly deductible, if applicable, and do not count toward the annual maximum out-of-pocket.

Routine hearing benefits

Members get routine hearing services, including an exam, hearing aid fitting, and hearing aids. These services also include an allowance to use toward the cost of hearing aids.

See one of our participating Amplifon hearing providers to take advantage of the benefits below:

  • $0 copay for one routine hearing exam every year
  • $0 copay for one hearing aid fitting every year
  • $0 copay for one hearing aid per ear every three years through Amplifon
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.

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Last Updated: 1/19/2024