UPMC for Life PPO Salute (PPO)

Medicare Plan Details (2023 Plan)

Monthly Premium

by UPMC for Life

Additional Coverage

HearingVisionDental

Overall Government Star Rating

5.0

out of 5 stars

Ready to Enroll Online?

Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

$1,600 per year for inpatient hospital services and $226 for outpatient services with a total plan deductible of $1,826 per year from in-network and out-of-network providers.

Health Plan Max Out-of-Pocket

$8,950 In and Out-of-network
$5,500 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

https://findcare.upmchealthplan.com/browse?caretype=Medical

Plan Link

https://www.upmchealthplan.com/medicare/

Doctor Services

Primary doctor visit

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

Specialist visit

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

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 per visit (always covered)

Urgent care

20% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: In 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90
Out-of-network: In 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90

Outpatient hospital coverage

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

Skilled nursing facility

In-network: In 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100
Out-of-network: In 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100

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

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item

Diabetes supplies

In-network: 0-20% coinsurance per item
Out-of-network: 20% coinsurance per item

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

Part B Drugs

Chemotherapy drugs

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

Other Part B drugs

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

Hearing

Hearing exam

In-network: $0 copay
Out-of-network: 20% coinsurance

Fitting/evaluation

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

Hearing aids - All types

In-network: $690-1,890 copay
Out-of-network: $690-1,890 copay

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

Non-routine services

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

Diagnostic services

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

Restorative services

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

Endodontics

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

Periodontics

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

Extractions

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

Prosthodontics, other oral/maxillofacial surgery, other services

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

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

Other benefits

Fitness benefit

Limited coverage

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

Not covered

Telehealth

Limited coverage

Summary rating of health plan quality

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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Health Plan Radar

In this article we rank Pennsylvania Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

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UPMC for Life PPO Salute (PPO)

Medicare Plan Details (2023 Plan)

Monthly Premium

by UPMC for Life

Additional Coverage

Overall Government Star Rating

Ready to Enroll Online?

Plan Type

Medicare Advantage (Part C)

Plan Details

Medical Benefits

Doctor Services

Tests, labs, & imaging

Hospital Services

Skilled nursing facility

Preventive services

Ambulance

Therapy services

Mental health services

Opioid treatment services

Other services

Prescription Drug Benefits

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

Part B Drugs

Extra Benefits

Hearing

Preventive Dental

Comprehensive dental

Vision

Other benefits

Health Plan Star Ratings

(government star ratings are out of 5 stars)

When Can I Sign Up for Medicare?

Ready to Enroll Online?

Medicare Health Plans

Get Advice & Sign Up Help

Best Pennsylvania Medicare Advantage Health Insurance Companies for 2023

New Pennsylvania Medicare Advantage Health Insurance Companies for 2023