Eligible for Medicare and Medicaid? UPMC Health Plan has two plans that work together to provide you with your health care coverage. You can enroll in these plans if you are eligible for Medicare and Medical Assistance (Medicaid). Enrolling in both plans can help you save time. Plus, you get extra benefits to help you stay healthy and independent.
- UPMC for Life Dual (HMO SNP) is a Medicare Advantage plan that gives you coverage for medical and prescription drug services. UPMC for Life Dual acts as your primary health care coverage. You will also get additional benefits like vision, dental, hearing, transportation, and an over-the-counter wellness card at no additional cost.
- UPMC Community HealthChoices is a Medicaid plan that provides secondary coverage for most of your medical, prescription, vision, and dental services. If you are eligible for long-term services and supports (LTSS), UPMC Community HealthChoices will coordinate and pay for these services along with your secondary medical coverage.
If your Medicare coverage with UPMC for Life Dual does not fully cover something you need, UPMC Community HealthChoices may help cover the cost. Being a member of both plans will also help us to better manage your health care so you get the most from your benefits. We want to help you be as healthy and independent as possible.
Here’s how these plans work together to help you get the most out of your health care coverage.
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UPMC for Life Dual:
- $0 copay for one dental cleaning and x-rays, and additional dental services every six months
- $2,500 yearly allowance for additional dental services
UPMC Community HealthChoices: $500 yearly allowance for certain dental services
UPMC for Life Dual:
- $0 copay for one routine vision exam each year
- Up to a $250 yearly allowance for eyewear or contacts
UPMC Community HealthChoices: Up to a $100 yearly allowance for eyewear or contacts
UPMC for Life Dual: One FREE gym membership at a participating facility
OR Work out at home with your choice of FREE fitness kits
UPMC for Life Dual: $500 yearly allowance to buy health and wellness items you use every day
UPMC for Life Dual: 50 one-way trips to and from plan-approved locations like medical providers and pharmacies.
UPMC Community HealthChoices: Non-medical trips may be covered for those with Medicaid long-term services and supports based on your service plan.
UPMC for Life Dual: Select up to six bathroom safety products per year
UPMC Community HealthChoices: Additional bathroom safety products may be covered for those with Medicaid long-term services and supports based on your service plan.
UPMC for Life Dual:
- $0 copay for one hearing aid screening each year
- Up to a $1,500 yearly allowance for hearing services and hearing aids every three years
UPMC Community HealthChoices: Additional hearing services may be covered for those with Medicaid long-term services and supports based on your service plan.
UPMC for Life Dual:
- $0 copay for inpatient medical services
- $0 copay for outpatient medical services
UPMC Community HealthChoices (Pays secondary to your Medicare coverage):
- $0 copay for outpatient medical services
- $0 copay for outpatient medical services
UPMC for Life Dual:
- $0 copay for Part D prescription drug coverage
- Some individuals may not qualify for $0 prescription drug copays. This is based on your household income level and institutional status.
UPMC for Life Dual:
- $0 copay for medical advice over the phone from experienced, registered nurses
- $0 copay for an online virtual visit with a UPMC provider
UPMC Community HealthChoices:
- $0 copay for medical advice over the phone from experienced, registered nurses
- $0 copay for an online virtual visit with a UPMC provider
UPMC Community HealthChoices:
- $0 copay for assistance with daily personal care activities, such as preparing meals, eating, dressing, and using the bathroom
- These services may be covered for people awaiting a final eligibility determination for LTSS or as part of your Medicaid long-term services and supports service plan.
Learn more about UPMC for Life Dual
Learn more about UPMC Community HealthChoices