UPMC Medicare Advantage: What Plans Are Offered in 2020?

What areas offer UPMC Medicare Advantage plans?

UPMC Health Plan offers its Medicare Advantage program, UPMC for Life, to residents throughout most of Pennsylvania and in some parts of Ohio.

In Pennsylvania, UPMC serves all counties except:

• Columbia
• Franklin
• Northumberland
• Pike
• Schuylkill

In Ohio, plans are available only in Harrison and Jefferson counties.

What are the UPMC Medicare Advantage plans?

Several different types of Medicare Advantage plans can replace original Medicare. These plans vary based on their coverage and what options you choose for your coverage.

UPMC offers the following types of plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Special Needs Plan (SNP)

The specific Medicare Advantage plans from UPMC in 2020 include:

• HMO Premier Rx
• HMO Deductible with Rx
• HMO Rx Choice
• HMO Rx
• HMO No Rx
• HMO Rx Enhanced
• PPO High Deductible with Rx
• PPO Rx Enhanced
• Dual HMO SNP

Does UPMC have Medicare Part D plans?

At this time, UPMC doesn’t have a stand-alone prescription drug plan, but some of its Medicare Advantage plans include prescription drug coverage.

With original Medicare (Part A and Part B), you have to choose a separate Part D prescription drug plan. If you don’t sign up for drug coverage when you’re first eligible for Medicare and instead add it later, you’ll pay a penalty.

By choosing a Medicare Advantage plan that includes prescription drug coverage, you’ll get all these “parts” bundled together into one plan. Plus, you won’t face a penalty if you’ve had coverage through Medicare Advantage but choose a separate Part D plan later.

What services do UPMC Medicare Advantage plans cover?

All Medicare Advantage plans must offer the basic services covered under original Medicare. Typically, Medicare Advantage plans include additional services as well. These may vary based on the plan you choose.

Each UPMC for Life Medicare Advantage plan includes the following standard services:

• inpatient hospital stays
• limited skilled nursing care
• outpatient doctor’s office visits
• diagnostic services and lab tests
• preventive care and vaccines
• mental health services
• physical and occupational therapy
• durable medical equipment
• emergency and urgent care
• some transportation services for medical care
• fitness services
• telehealth

Each UPMC Medicare Advantage plan also includes extra services beyond basic preventive, inpatient, and outpatient care. These vary by plan but may include:

• routine hearing screenings and care
• vision care
• dental care
• podiatry services
• chiropractic care
• diabetic supplies
• over-the-counter medical supply allowances

How much do UPMC Medicare Advantage plans cost?

Plan availability and prices vary. Plans are grouped into tiers, and not every plan is offered in every county. Plans typically include a monthly premium, annual deductible, copayments, and coinsurance costs.

The following table shows some of the costs for a few of UPMC’s Medicare Advantage plans in Allegheny County, Pennsylvania.

What is Medicare Advantage (Medicare Part C)?

Medicare Part C, or Medicare Advantage, plans are health plans offered through private insurance providers. Part C combines all the parts of original Medicare — inpatient care through Medicare Part A and outpatient care through Medicare Part B — plus extra products and services like prescription drug coverage.

Plan availability and prices vary based on where you live. You can tailor your Medicare Advantage plan to fit your specific healthcare needs and budget.

Additional coverage and services will cost more, and there may be limitations set by your plan on which providers, services, and products you can use.

You can compare several different Medicare Advantage plans in your area using Medicare’s plan finder tool.

When should I enroll?

You can sign up for a Medicare Advantage plan during specific enrollment periods. You first need to enroll in Medicare parts A and B, then you can enroll in Medicare Advantage during open enrollment periods.

Medicare’s open enrollment period is from October 15 through December 7. Medicare Advantage open enrollment is from January 1 through March 31.

What is Medicare Part D?

Medicare Part D is Medicare’s prescription drug program. This program is optional and is only offered by private insurance companies.

Coverage is based on a formulary. This is a list of prescription drugs that each plan covers. The formulary usually includes two medications for each class. For example, it might have two medications to treat blood pressure or diabetes. It may also include generic, preferred, and brand name medications.

If your prescription isn’t on a plan’s formulary, you could ask the insurance company for an exception or talk with your doctor about an alternative medication. Formulary lists are updated by Medicare every year.

You’ll save the most money on your prescription drugs by using medications from your plan’s formulary and going to in-network doctors and pharmacies.

The takeaway

• UPMC is a private health insurance company that offers Medicare Advantage plans to residents of most counties in Pennsylvania plus some parts of Ohio.
• Costs and services vary based on how much you want to pay and what services you want included.
• Consider your present and future healthcare needs, plus potential penalties for late Part D enrollment, when considering a Medicare Advantage plan.

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