UPMC Health Plan


Denise Hughes
UPMC Health Plan

UPMC for Life Earns Perfect 5 Out of 5 Star Rating from CMS and Respected NCQA Accreditation

UPMC for Life is the ONLY plan in PA to earn NCQA Accreditation and a 5-star rating from CMS for BOTH its HMO and PPO plans.

Pittsburgh (Oct. 18, 2021) – UPMC for Life, UPMC Health Plan’s Medicare Advantage plan, today announced that it has earned an excellent 5 out of a possible 5 overall star rating for its HMO and PPO plans for 2022, according to ratings released by the Centers for Medicare & Medicaid Services (CMS).

With this designation, UPMC for Life is the largest HMO plan in Pennsylvania with a 5-star rating and among the highest-rated Medicare plans in the nation. That means all UPMC for Life HMO and PPO members will be enrolled in plans with the highest overall rating.

Additionally, UPMC for Life received National Committee for Quality Assurance (NCQA) Accreditation and a rating of 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 for 2021. This makes UPMC for Life the ONLY plan in PA to have achieved both NCQA Accreditation and a 5-star rating from CMS for both its HMO and PPO products.

“These strong quality ratings reflect UPMC for Life’s commitment to helping our more than 200,000 members across Pennsylvania live their fullest, healthiest lives,” said Carrie Whitcher, Chief Quality Officer and VP Quality Performance at UPMC Health Plan. “The strong partnership between the members, their doctors, and UPMC Health Plan as their health insurance carrier helps our members receive the highest quality of care. We hope our NCQA Accreditation and CMS star ratings resonate with our members and the communities we serve as we continue to expand our benefits and innovative, personalized care programs.”

These strong quality-focused ratings help UPMC for Life maintain strong benefits and programs offered to its members and reflect the strength and stability consumers expect from UPMC Health Plan. In fact, UPMC for Life reports an excellent member retention rate of 96% for its Medicare plans over the last year.

How CMS and NCQA Calculate Quality Ratings
CMS rates all Medicare Advantage and prescription drug plans each year 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. Ratings range from a low of 1 star, which is “poor,” to the highest possible 5 stars, which is “excellent.” Every year, Medicare evaluates plans on a 5-star rating system.

Among the areas CMS reviews to determine its ratings include:

The 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. NCQA's website (ncqa.org) contains information to help consumers, employers, and others make informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org, and on LinkedIn at linkedin.com/company/ncqa. NCQA’s industry-leading accreditation is a rigorous assessment of health plans’ structure and process, clinical quality, and patient satisfaction.

CMS contracted with NCQA to develop a strategy to evaluate the quality of care provided by Medicare plans. NCQA established HEDIS measures specifically for Medicare Advantage plans. HEDIS is a comprehensive set of standardized performance measures designed to provide consumers with the information they need for reliable comparison of health plan performance. HEDIS measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. Medicare plans can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans.

Enrollment Help and Support
The 2022 Annual Election Period is Oct. 15 through Dec. 7, 2021. Medicare beneficiaries can add or drop Part D prescription coverage, switch their current plan, change to a Medicare Advantage plan, or change to Original Medicare. Changes in coverage will be effective Jan. 1, 2022. UPMC for Life’s 5-star rating means that Medicare beneficiaries also have the ability to enroll in a UPMC for Life HMO or PPO plan even after the Annual Election Period is over through a Special Election Period. Medicare beneficiaries can use this Special Election Period only once between Dec. 8, 2021, and Nov. 30, 2022.

Medicare beneficiaries interested in UPMC for Life can enroll by phone or online from the comfort and safety of home. For information on the 2022 plans, go to upmchealthplan.com/medicare or call UPMC for Life toll-free at 1-877-381-3765 seven days a week from 7 a.m. to 9 p.m. TTY users should call 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.



About UPMC Insurance Services

Serving 4 million members, UPMC Insurance Services is owned and operated by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. UPMC Insurance Services includes commercial products from UPMC Health Plan for groups as well as individuals. Commercial products also include workers' compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage (UPMC for Life); special needs plans for those eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); Medical Assistance (UPMC for You); and Children's Health Insurance Program (UPMC for Kids). Community Care Behavioral Health, one of the nation's largest nonprofit managed care behavioral health organizations, offers a full range of services to Commercial and Medical Assistance members. For more information, visit upmchealthplan.com.