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UPMC for Life PPO Salute (PPO)

Pennsylvania Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$0
by UPMC for Life

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Overview

Plan Name
UPMC for Life PPO Salute (PPO)
Insurance Carrier
UPMC for Life
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO

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 in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
Coming soon
Max Out-of-Pocket
$6,750
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
ER visit
20% coinsurance per visit (always covered)
Ambulance
0-20% coinsurance

UPMC for Life PPO Salute (PPO) has a monthly premium cost of $0 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $10,100 In and Out-of-network $6,750 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 Salute (PPO) are defined below.

Additional Benefits and Coverage

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

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.

Medicare Advantage health plans can offer even more additional benefits. UPMC for Life PPO Salute (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

Comparing the Quality Score of UPMC for Life PPO Salute (PPO) to Other Plans in Pennsylvania

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 2025, UPMC for Life PPO Salute (PPO) received an overall government quality rating of 4.5 stars out of 5 stars.

UPMC for Life PPO Salute (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
 4.5
 4.2
Summary rating of health plan quality
 4.5
 4.2
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 4
 3.6
Member experience with health plan
 5
 4.1
Member complaints & changes in the health plan's performance
 4
 4.3
Health plan customer service
 4
 4.2

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 Salute (PPO) received 4.5 stars for its health plan quality score which is better than the Pennsylvania State average health plan quality score of 4.2 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$10,100 In and Out-of-network
$6,750 In-network
Nationwide Coverage included
No
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/

Medical Benefits

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: Coming soon
Out-of-network: Coming soon
Outpatient hospital coverage
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: Coming soon
Out-of-network: Coming soon

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 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

Prescription Drug Benefits

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

Part B Drugs

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

Extra Benefits

Hearing

Hearing exam
In-network: 20% coinsurance
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

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

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