UPMC for Life Offers Affordable Medicare Advantage Plans with Broad In-network Access to UPMC Doctors and Hospitals

Pittsburgh (October 1, 2020) – UPMC Health Plan is pleased to offer UPMC for Life, the largest individual Medicare Advantage plan in Western Pennsylvania. In 2021, UPMC for Life will include enhanced benefits that aim to expand our members’ ability to receive the highest quality health care services in the most affordable way.

UPMC for Life was awarded 4.5 out of a possible 5 Overall Star Rating for its HMO and PPO plans for 2020 according to ratings released by the Centers for Medicare & Medicaid Services (CMS). Every year, Medicare evaluates plans based on a 5-star rating system. This ranking places UPMC for Life among the highest-rated Medicare plans in the nation. Every UPMC for Life plan provides members with a patient-centric model of care that focuses on delivering quality by caring for the “whole person,” attending to both the physical and emotional health of members in all settings, whether in person or through virtual care in the comfort of their homes.

“In 2021, UPMC for Life will continue to place the health and well-being of our members as our top priority, offering them access to the best doctors and hospitals, affordability, quality services, and protections in place, like no cost preventive care and clinical management programs, to help members manage their health and avoid large, unexpected medical costs,“ said April Golenor, Chief Medicare Officer for UPMC Health Plan. “We understand that out-of-pocket costs are as important as monthly premiums, so we want to give our members maximum value in term of benefits and services, like telehealth, low costs for medications, an allowance to buy health care products, and dental and vision care. We know that keeping costs low for these services is important to our members as they try to stay within their monthly budgets.”

Reducing Out-of-pocket Costs

In addition to disease-related stress, UPMC for Life understood the many financial stresses that the pandemic created during 2020, and worked to alleviate those stresses by waiving deductibles, copays, and other cost-sharing for coronavirus testing and treatment. UPMC for Life also increased member access to medications by waiving early refill limits on prescriptions. In 2021, UPMC for Life will continue that commitment to reducing the financial stresses on members when accessing the health care system through the following:

• $0 Monthly Premium Plans—UPMC for Life offers plans with zero-dollar monthly premiums, making access to great benefits and services more affordable.
• Access to UPMC—UPMC for Life members have broad, in-network access to the best doctor’s and hospitals with UPMC’s world renowned network that includes 700 doctors’ offices, and 40 hospitals and outpatient sites. Members also have access to a large network of high-quality community doctors and hospitals.
• $0 Preventive Care Visits—UPMC for Life members will have no copays for recommended preventive care, such as an annual wellness visit, mammograms, colorectal screenings, and diabetic retinal eye exams.
• $0 Telehealth Copays—Most UPMC for Life members will not have copays when seeing their in-network PCP through a video visit. Members also have a reduced copay when seeing in-network specialists through telehealth.
• $0 Preferred Generic Prescriptions—Medications on Tier 1 of the UPMC for Life formulary have a $0 copay when filled at preferred pharmacies or through our mail-order pharmacy.
• Cost-Savings for Diabetic Prescriptions—All brand diabetes medications on Tier 2 of the UPMC for Life formulary continue to have copays as low as $10 for a 30-day supply when they are filled at a preferred pharmacy. Plus, in 2021, UPMC for Life members will now be able to save hundreds of dollars when they fill covered diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays ($35 for a 30-day supply and $87.50 for a 90-day supply) in the Part D Initial Coverage and Coverage Gap donut hole stages. This applies to covered insulins filled at standard, preferred, or mail-order pharmacies.
• Additional Donut Hole Coverage for HMO Rx Members—Members of the UPMC for Life HMO Rx (HMO) plan will have additional donut hole coverage for generic Tier 1 and 2 drugs through the Medicare Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays in the Part D Initial Coverage and Coverage Gap donut hole stages. When filled at a preferred pharmacy, Tier 1 generic medications will have copays as low as $0 for a 30-day or 90-day supply and Tier 2 generic medications will have copays as low as $10 for a 30-day supply or $20 for a 90-day supply.
• Dental Services—Members of UPMC for Life’s most popular plans can receive an increased allowance of up to $3,000 per year for comprehensive dental services like fillings, simple tooth extractions, root canals, bridges, crowns, dentures, and periodontal work.
• OTC Allowance—Members of some plans will receive an allowance of up to $50 per quarter to buy approved health care products through our mail-order catalog.

Additional Benefits

UPMC Health Plan’s “whole person” approach to health care is a core part of our founding mission, so UPMC for Life offers numerous benefits that support each member’s physical and emotional health.

Virtual Enrollment Help and Support

UPMC for Life has expanded their weekly Staying in Touch events to help members understand their benefits changes for 2021. Members will have the opportunity to participate by phone or online from the comfort and safety of home to get all the details on their new and improved benefits. Members can go to upmchp.us/medicare-intouch to see a complete list of event details. For members who want personal help, the award-winning Health Care Concierge is on-hand to answer questions and provide exceptional customer service. The UPMC Health Plan Health Care Concierge team earned 11 awards at the 2020 Stevie® Awards, including three Gold Stevie Awards. The Stevie awards are the world’s premier business awards.

Enrollment Details

The 2021 Annual Election Period is Oct. 15 through Dec. 7, 2020. Medicare beneficiaries can add or drop Part D prescription drug coverage, switch their current plan, or change to a Medicare Advantage plan, or change to Original Medicare. Changes in coverage will be effective Jan. 1.

Medicare beneficiaries who are interested in UPMC for Life can get information on the 2021 plans online at www.upmchealthplan.com/medicare or by calling UPMC for Life toll-free at 1-877-381-3765 seven days a week from 8 a.m. to 8 p.m. TTY users should call 711.

For more information about UPMC’s best doctors and hospitals, go to www.upmchealthplan.com/best.

UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal.

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About UPMC Insurance Services

Serving more than 3.9 million members, UPMC Insurance Services is owned and operated by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. UPMC Insurance Services includes commercial products from UPMC Health Plan for groups as well as individuals. Commercial products also include workers' compensation and employee assistance from nationally known Workpartners. Government products include Medicare Advantage (UPMC for Life); special needs plans for those eligible for Medicare and Medical Assistance (UPMC for Life CompleteCare and UPMC Community HealthChoices); Medical Assistance (UPMC for You); and Children's Health Insurance Program (UPMC for Kids). Community Care Behavioral Health, one of the nation's largest managed care behavioral health organizations, offers a full range of services to Commercial and Medical Assistance members. For more information, visit www.upmchealthplan.com.