UPMC for Life PPO Salute (PPO)

by UPMC for Life

2026 Medicare Advantage plan available in Pennsylvania

Plan ID H5533-016-2

Additional coverage:

HearingVisionDental

Medicare Advantage PPO $0 premium 4.5 Overall

Monthly plan premium $0 / mo

Annual deductible $1,736 / yr

Max out-of-pocket · in-network $9,250 / yr

4.5 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

UPMC for Life PPO Salute (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Pennsylvania and offered by the health insurance company UPMC for Life. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name UPMC for Life PPO Salute (PPO)

Insurance Carrier UPMC for Life

Plan Type Medicare Advantage Plan Without Prescription Drugs

Network Type PPO

Cost Summary

UPMC for Life PPO Salute (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $1,736 per year for inpatient hospital services and $283 for outpatient services with a total plan deductible of $2,019 per year from in-network and out-of-network providers. and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Annual Deductible $1,736 per year for inpatient hospital services and $283 for outpatient services with a total plan deductible of $2,019 per year from in-network and out-of-network providers. / yr

Max Out-of-Pocket · in-network $9,250 / yr

Primary doctor visit 20% coinsurance

Specialist visit 20% coinsurance

ER visit 20% coinsurance

Ambulance 0%-20% coinsurance

Additional Benefits and Coverage

UPMC for Life PPO Salute (PPO) is a Medicare Advantage plan which does not include Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. UPMC for Life PPO Salute (PPO) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage No

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Not covered

Home & bathroom safety devices Limited coverage

Meals for short duration Limited coverage

Annual physical exams Not covered

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Specialist visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: 20% coinsurance
Out-of-network: 20% coinsurance

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

Diagnostic radiology services (like MRI) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient x-rays In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Emergency care 20% coinsurance

Urgent care 20% coinsurance

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $0 per day for days 1-60
  $434 per day for days 61-90
  $868 per day for days 91-150
Out-of-network:
  $0 per day for days 1-60
  $434 per day for days 61-90
  $868 per day for days 91-150

Outpatient hospital coverage In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $217 per day for days 21-100
Out-of-network:
  $0 per day for days 1-20
  $217 per day for days 21-100

Preventive services

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

Ambulance

Ground ambulance In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Physical therapy & speech & language therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient individual therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient group therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient individual therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, UPMC for Life PPO Salute (PPO) earned an overall rating of 4.5 stars — better than Pennsylvania's state average of 4.1 stars.

Rating category This plan State average

Overall star rating ★ 4.5 4.1

Health plan quality

Summary rating of health plan quality ★ 4.5 4.0

Staying healthy: screenings, tests & vaccines ★ 4.0 3.6

Managing chronic (long-term) conditions ★ 4.0 3.7

Member experience with health plan ★ 5.0 4.1

Member complaints & changes in performance ★ 5.0 3.9

Health plan customer service ★ 4.0 4.0

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 50% coinsurance

Fitting/evaluation In-network: $0 copay
Out-of-network: 50% coinsurance

Hearing aids - prescription In-network: $690-$1890 copay
Out-of-network: $690-$1890 copay

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance

Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance

Fluoride treatment Not covered

Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Periodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Prosthodontics, removable In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Prosthodontics, fixed In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 50% coinsurance

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades In-network: $0 copay
Out-of-network: $0 copay

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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