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Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP)

Michigan Medicare-Medicaid Dual Eligible D-SNP Plan (2026 Plan)

Monthly Premium

Your Cost
$0
by Upper Peninsula Health Plan (UPHP) MI Coordinated Health

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Overview

Plan Name
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP)
Insurance Carrier
Upper Peninsula Health Plan (UPHP) MI Coordinated Health
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Michigan and offered by the health insurance company Upper Peninsula Health Plan (UPHP) MI Coordinated Health. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$9,250
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,250 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$9,250 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
https://www.uphp.com/providers/
Plan Link
https://www.uphp.com/medicare/

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0 copay
Out-of-network: $0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
Tier 1
$0 per day for days 1-60
$0 per day for days 61-90
$0 per day for days 91-150
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: $0 copay

Skilled nursing facility

Skilled nursing facility

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: $0 copay

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: $0 copay
Out-of-network: $0 copay
Other Part B drugs
In-network: $0 copay
Out-of-network: $0 copay

Extra Benefits

Hearing

Hearing exam
Not covered
Fitting/evaluation
Not covered
Hearing aids - prescription
Not covered
Hearing aids - over the counter
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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