Health care that works together for you
UPMC Health Plan has two plans that work together to provide you with your health care coverage—UPMC for Life Complete Care and UPMC Community HealthChoices. You can enroll in these plans if you are eligible for Medicare and Medical Assistance (Medicaid). When you’re a member of both UPMC for Life Complete Care and UPMC Community HealthChoices, we can more effectively coordinate your health care and make it less confusing. Plus, you get extra benefits to help you stay healthy and independent.
- UPMC for Life Complete Care (HMO SNP) is a Medicare Advantage plan that gives you medical and prescription drug coverage. UPMC for Life Complete Care acts as your primary health care coverage. You will get additional benefits, including an over-the-counter (OTC) allowance to buy health care products, vision care, dental care, hearing care, transportation services, a free gym membership, and home-delivered meals. Members with diabetes also have an allowance to buy healthy foods.
- 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 medical coverage.
If your UPMC for Life Complete Care plan does not fully cover something you need, UPMC Community HealthChoices may help cover the cost.* When you have both plans, you can have peace of mind that most of your health care services are covered. Plus, you’ll have only one member ID card for all your health care information. 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 Complete Care:
- $0 copay for two oral cleanings and exams every year
- $3,000 or $5,000 yearly allowance (depending on your plan) for additional dental services
UPMC Community HealthChoices:
- $0 copay for two oral cleanings and exams every year
- Restorations (fillings) and tooth removal.
- Up to a $500 yearly allowance for certain dental services
UPMC for Life Complete Care:
- $0 copay for one routine vision exam each year
- $575 yearly allowance (depending on your plan) for eyewear or contact lenses
UPMC Community HealthChoices:
- $0 copay for two routine vision exams each year
- Specialist eye exam with PCP prescription
- Up to a $100 yearly allowance for eyewear or contacts
UPMC for Life Complete Care: Unlimited free gym memberships through SilverSneakers® to participating fitness facilities plus one free personal training session each year. The option to work out from the safety of home with in-home fitness kits.
UPMC for Life Complete Care: A $900 or $1,400 yearly allowance (depending on your plan) to buy health and wellness items you use every day.**
UPMC for Life Complete Care: A $25 allowance per month—$300 a year—to buy healthy foods at participating stores for members with diabetes. We’ll mail your healthy food card, a list of participating stores, and information about the kinds of healthy foods you can buy at the end of the year. Not all plans offer this benefit.
UPMC for Life Complete Care: Depending on your plan, 12 or 60 one-way trips (6 or 25 round trips) to and from plan-approved locations, including doctor’s offices, health care facilities, and pharmacies.
UPMC Community HealthChoices: Nonmedical trips may be covered for those with Medicaid long-term services and supports based on your service plan.
UPMC for Life Complete Care: Select up to six home 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 Complete Care:
- $0 copay for one hearing exam and hearing aid fitting each year
- $1,500 or $2,000 allowance (depending on plan) for 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 Complete Care:
- $0 copay for inpatient medical services
- $0 copay for outpatient medical services
UPMC Community HealthChoices:
- $0 copay for inpatient medical services
- $0 copay for outpatient medical services
UPMC for Life Complete Care:
- $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 Complete Care:
- $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 via UPMC AnywhereCare
*UPMC for Life Complete Care benefits must be used before UPMC Community HealthChoices benefits can be used.
**All allowance amounts are based on the 2022 benefit year. Some benefit allowances are quarterly based. For more information about benefit allowances, call us toll-free at 1-844-575-8241 (TTY: 711).
View our Caring for Life eNewsletter to learn more:
Learn more about the UPMC for Life Complete Care plan available in your area
Learn more about UPMC Community HealthChoices