UPMC for Life PPO Salute (PPO)
Medicare Plan Details (2023 Plan)
Monthly Premium

by UPMC for Life
Additional Coverage
Overall Government Star Rating
5.0Ready to Enroll Online?
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
$5,500 In-network
Medical Benefits
Doctor Services
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 20% coinsurance
Out-of-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hospital Services
$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
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
$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
Out-of-network: $0 copay
Ambulance
Out-of-network: 20% coinsurance
Therapy services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Extra Benefits
Hearing
Out-of-network: 20% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: $690-1,890 copay
Preventive Dental
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: 50% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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