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Plan Compare Comparing 3 Plans


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Plan Name 1Plan Name 2Plan Name 3
BenefitYou PayYou PayYou Pay
Monthly Plan Premium$40 in addition to your Medicare Part B premium$40 in addition to your Medicare Part B premium$40 in addition to your Medicare Part B premium
Annual Maximum Out-of-Pocket LimitIn-Network: $6,700 Combined in- and out-of-network: $10,000
Annual Out-of-Pocket DeductibleCombined in- and out-of-network: $1,250
Primary Care Doctor Visit CopayIn-Network: $10 (deductible does not apply) Out-of-Network: $40 after deductible
Specialist Doctor Visit CopayIn-Network: $50 (deductible does not apply) Out-of-Network: $60 after deductible
Inpatient Hospital CopayIn-Network: $200 after deductible Out-of-Network: 30% of the cost after deductible
See More Benefits View Plan DetailsEnroll View Plan DetailsEnroll View Plan DetailsEnroll
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Out-of-network/non-contracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. 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.

The UPMC for Life Medicare Advantage HMO and PPO plans are available to persons entitled to Medicare Part A and enrolled in Part B. You must continue to pay your Medicare Part B premium, reside in the service area, and not have end-stage renal disease (ESRD).

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 1-800-361-2629). We are available October 1 through February 14, seven days a week from 8 a.m. to 8 p.m. From February 15 through September 30, we are available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m.

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

The Silver&Fit program is a product of American Specialty Health Fitness, Inc., (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit® is a federally registered trademark of ASH and used with permission herein.

*Our hours of operation change twice a year.

You can call us:

October 1 through February 14:
seven days a week from 8 a.m. to 8 p.m.

February 15 through September 30:
Monday through Friday: 8 a.m. to 8 p.m.
Saturday: 8 a.m. to 3 p.m.

Y0069_18_1122 Approved

Last Updated: 10/01/2017
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