UPMC Medicare Advantage: what Plans are Offered in 2022?

UPMC Medicare Advantage plan options

Several different types of Medicare Advantage plans can replace original Medicare. These plans vary based on their coverage and what options you choose for your coverage. These UPMC Advantage plan options include:

UPMC Health Maintenance Organization (HMO)

HMO plans may offer the most cost savings; however, you must receive care from healthcare providers and hospitals within the network of the plan you choose. Some HMO plans, called HMO Point-of-Service (HMO-POS) plans, may allow you to see out-of-network providers for a higher fee.

UPMC Preferred Provider Organization (PPO)

PPO plans generally offer more flexibility. Depending on the plan you choose, you may go outside your plan’s network for healthcare. However, this expanded choice usually costs more. You’ll likely pay higher premiums for these plans, and higher copays if you choose to see an out-of-network provider.

UPMC Special Needs Plan (SNP)

Medicare SNPs are Medicare Advantage plans designed to help individuals with specific conditions by providing greater coverage and reduced fees.

SNPs are available to individuals meet specific criteria, such as:

  • living in an inpatient facility, such as a nursing home
  • having a chronic condition or disability that Medicare states qualifies you for an SNP
  • being eligible for both Medicare and Medicaid

Medicare requires that all SNPs provide prescription drug coverage.

UPMC Medicare Part D options

At this time, UPMC doesn’t have a stand-alone prescription drug plan, but some of its Medicare Advantage plans include prescription drug coverage.

With original Medicare (parts a and b), you have to choose a separate Part D prescription drug plan. If you don’t sign up for drug coverage when you’re first eligible for Medicare and instead add it later, you’ll pay a penalty.

By choosing a Medicare Advantage plan that includes prescription drug coverage, you’ll get all these “parts” bundled together into one plan. Plus, you won’t face a penalty if you’ve had coverage through Medicare Advantage but choose a separate Part D plan later.

What states offer UMPC plans?

UMPC offers several Medicare Advantage plans to people who live in parts of Pennsylvania and Ohio.

What do UPMC Medicare Advantage plans cover?

All Medicare Advantage plans must offer the basic services covered under original Medicare. Typically, Medicare Advantage plans include additional services as well. These may vary based on the plan you choose.

Each UPMC for Life Medicare Advantage plan includes the following standard services:

  • inpatient hospital stays
  • limited skilled nursing care
  • outpatient doctor’s office visits
  • diagnostic services and lab tests
  • preventive care and vaccines
  • mental health services
  • physical and occupational therapy
  • durable medical equipment
  • emergency and urgent care
  • some transportation services for medical care
  • fitness services
  • telehealth

Each UPMC Medicare Advantage plan also includes extra services beyond basic preventive, inpatient, and outpatient care. These vary by plan but may include:

  • routine hearing screenings and care
  • vision care
  • dental care
  • podiatry services
  • chiropractic care
  • diabetic supplies
  • over-the-counter medical supply allowances

How much do UPMC Medicare Advantage plans cost?

Plan availability and prices vary. Plans are grouped into tiers, and not every plan is offered in every county. Plans typically include a monthly premium, annual deductible, copayments, and coinsurance costs.

The following table shows some of the costs for a few of UPMC’s Medicare Advantage plans in Allegheny County, Pennsylvania.

What is Medicare Advantage (Part C)?

Medicare Advantage (Part C) plans are health plans offered through private insurance providers. Part C combines all the parts of original Medicare — inpatient care through Medicare Part A and outpatient care through Medicare Part B — plus extra products and services like prescription drug coverage.

Plan availability and prices vary based on where you live. You can tailor your Medicare Advantage plan to fit your specific healthcare needs and budget.

Additional coverage and services will cost more, and there may be limitations set by your plan on which providers, services, and products you can use.

You can compare several different Medicare Advantage plans in your area using Medicare’s plan finder tool.

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