UPMC Health Plan


Denise Hughes
UPMC Health Plan

UPMC for Life Plans Earn Excellent 5 Out-of-5 Star Rating from Medicare

Plans among the highest rated nationally for care quality and patient satisfaction

Pittsburgh (Oct. 11, 2023) – UPMC Health Plan announced today that its Medicare Advantage HMO and PPO plans have again earned Excellent star ratings for 2024, according to star ratings released by the Centers for Medicare & Medicaid Services (CMS). This is the third consecutive year these plans have received this top quality-related "five star" rating from CMS. UPMC for Life received a 5-star rating for both its HMO and PPO plans in 2022, 2023, and 2024.

"This year's CMS five-star quality rating confirms what our members already know: UPMC Health Plan is committed to providing them access to high quality care, high quality coverage, and award-winning customer service* each and every time," said Diane Holder, president and CEO, UPMC Health Plan. "And those looking for a new Medicare Advantage plan will know that UPMC for Life plans are among the highest ranked in the nation by CMS for member experience with their health plan."

In addition, UPMC for Life's Special Needs Plan (SNP) in Western and Central Pennsylvania earned a star rating of 4.5. That means all UPMC for Life HMO, PPO, and Western and Central PA SNP members will be enrolled in plans with an Above Average overall rating.

The Star Ratings program measures plans in member-focused areas that include person-centered care, equity, safety, affordability and efficiency, treatment of chronic conditions, wellness and prevention, seamless care coordination, and behavioral health. These criteria follow five broad categories that emphasize and promote patient perspectives of care including: Outcomes, Intermediate Outcomes, Patient Experience, Access, and Process.

"We are honored to have earned CMS' five-star rating, because we focus on quality care that directly meets the needs of our members," said Carrie Whitcher, Chief Quality Officer and Vice President of Quality and Performance, UPMC Insurance Services. "Our commitment to clinical quality and top-notch member services are part of our community-based, clinical evidence-driven approach to care that helps our members live their healthiest lives."

Enrollment Help and Support
The 2024 Annual Election Period is Oct. 15 through Dec. 7, 2023. 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, 2024. UPMC for Life's 5-star rating means that Medicare beneficiaries can also 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, 2023, and Nov. 30, 2024.

Medicare beneficiaries interested in UPMC for Life can enroll by phone or online from the comfort and safety of home. For plan information, go to upmchealthplan.com/medicare or call UPMC for Life toll-free at 1-877-381-3765 (TTY: 711) seven days a week from 7 a.m. to 9 p.m.

Out-of-network/Non-contracted providers are under no obligation to treat Plan 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.

How Plans Are Rated
Plans are rated on a one to five scale, with one star representing a poor performance and five stars representing excellent performance. Star Ratings are released annually and reflect the experiences of individuals enrolled in Medicare Advantage and Part D prescription drug plans. The Star Ratings system supports CMS' efforts to empower Medicare beneficiaries to make health care decisions that are best for them. The document describing the methodology for creating the Part C & D Star Ratings is displayed on the Medicare Plan Finder (MPF) at medicare.gov and on CMS's website.

*UPMC Health Plan was a GRAND STEVIE winner for overall best Sales and Customer Service at the 17th annual Stevie Awards in 2023. For more information, visit upmchp.us/awards. Every year, Medicare evaluates plans based on a 5-star rating system. For more information on UPMC for Life's star ratings visit upmchp.us/star-ratings. 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.



About UPMC Insurance Services

UPMC Insurance Services serves nearly 4.5 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. UPMC Insurance Services provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers' compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); special needs plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children's Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation's largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.