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 have $0 premium, $0 medical copays, and $0 prescription copays. You also get additional benefits including additional dollars to buy OTC products, healthy foods, pet care supplies, pest control, and household utilities. You’ll also get vision, dental, and hearing care, transportation services, unlimited gym memberships, and home-delivered meals.
- 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.* You’ll have only one member ID card and one point of contact 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
- $4,000, $5,000 or $8,250 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 simple 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 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 allowance every 12 months 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.
Members get additional dollars every quarter to pay for OTC products, healthy foods, pet care supplies, pest control, and household utilities.
UPMC for Life Complete Care: Transportation to and from plan-approved locations, including doctor’s offices, health care facilities, pharmacies, fitness centers, grocery stores, and adult day/community centers. Depending on your plan, you get:
- 20 one-way trips or nine roundtrips. Eight one-way trips may be to non-medical locations.
- 60 one-way trips or 30 roundtrips. 28 one-way trips may be to non-medical locations.
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 home 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 for one hearing exam and hearing aid fitting each year
- $0 copay per ear every three years for hearing aids.
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 Prescription Perks:
- $0 copay for covered Part D prescription drugs
- All members have a $0 copay no matter the level of Extra Help (Low Income Subsidy) they receive.
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 UPMC for Life Complete Care allowance amounts are based on the 2024 benefit year. Some benefit allowances are monthly or quarterly based. For more information about benefit allowances, call us toll-free at 1-844-575-8241 (TTY: 711).
***UPMC for Life members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Providers are not available to treat members who are in Puerto Rico.
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