UPMC for Life PPO Premier Rx (PPO)

Pennsylvania Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by UPMC for Life

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 5.0
out of 5 stars

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Plan Name
UPMC for Life PPO Premier Rx (PPO)
Insurance Carrier
UPMC for Life
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

UPMC for Life PPO Premier Rx (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Pennsylvania and offered by the health insurance company UPMC for Life. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,500
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$50-290 copay

UPMC for Life PPO Premier Rx (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $10,000 In and Out-of-network $6,500 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 UPMC for Life PPO Premier Rx (PPO) are defined below.

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

UPMC for Life PPO Premier Rx (PPO) 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. UPMC for Life PPO Premier Rx (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. UPMC for Life PPO Premier Rx (PPO) includes coverage for the following additional benefits:

Other benefits

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

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, UPMC for Life PPO Premier Rx (PPO) received an overall government quality rating of 5.0 stars out of 5 stars.

UPMC for Life PPO Premier Rx (PPO) performed better than Pennsylvania’s State average overall quality score of 4.2 stars.

This Plan’s 5-star Gov’t Quality Score
Pennsylvania State Average Score
Overall Government 5 Star Quality Rating
 5.0
 4.2
Summary rating of health plan quality
 5
 4.1
Staying healthy: screenings, tests, & vaccines
 5
 3.7
Managing chronic (long term) conditions
 4
 3.7
Member experience with health plan
 5
 4.1
Member complaints & changes in the health plan's performance
 5
 4.1
Health plan customer service
 4
 4.2
Summary rating of drug plan quality
 4.5
 4.1
Drug plan customer service
 3
 3.5
Member complaints & changes in the drug plan's performance
 4
 4.3
Member experience with the drug plan
 5
 4.2
Drug safety & accuracy of drug pricing
 4
 3.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

UPMC for Life PPO Premier Rx (PPO) received 5 stars for its health plan quality score which is better than the Pennsylvania State average health plan quality score of 4.1 stars.

UPMC for Life PPO Premier Rx (PPO) received 4.5 stars for its drug plan quality score which is better than the Pennsylvania State average drug plan quality score of 4.1 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$10,000 In and Out-of-network
$6,500 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $35 copay per visit
Out-of-network: $45 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $5 copay
Out-of-network: $20 copay
Lab services
In-network: $5 copay
Out-of-network: $20 copay
Diagnostic radiology services (like MRI)
In-network: $225 copay
Out-of-network: $350 copay
Outpatient x-rays
In-network: $30 copay
Out-of-network: $40 copay
Emergency care
$90 copay per visit (always covered)
Urgent care
$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $165 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $295 copay per visit
Out-of-network: $375 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-network: 30% per stay

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: 30% coinsurance

Ambulance

Ground ambulance
In-network: $50-290 copay
Out-of-network: 30% coinsurance

Therapy services

Occupational therapy visit
In-network: $25 copay
Out-of-network: $45 copay
Physical therapy & speech & language therapy visit
In-network: $25 copay
Out-of-network: $45 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $45 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $45 copay
Outpatient group therapy visit
In-network: $35 copay
Out-of-network: $45 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $45 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$15.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance

Hearing

Hearing exam
In-network: $35 copay
Out-of-network: $45 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $45 copay
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: 30% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 30% coinsurance
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: 30% coinsurance

Comprehensive dental

Non-routine services
In-network: 50% coinsurance
Out-of-network: $0 copay
Diagnostic services
In-network: 50% coinsurance
Out-of-network: $0 copay
Restorative services
In-network: 50% coinsurance
Out-of-network: $0 copay
Endodontics
In-network: 50% coinsurance
Out-of-network: $0 copay
Periodontics
In-network: 50% coinsurance
Out-of-network: $0 copay
Extractions
In-network: 50% coinsurance
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: 50% coinsurance
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 30% 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

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