UPMC for Life Medicare Advantage Reviews

UPMC for Life, recognized as a top choice in J.D. Power's 2023 study, offers highly rated Medicare Advantage plans in Pennsylvania and Ohio.
By . Last update: June 17, 2024

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UPMC for Life Medicare Advantage Reviews
The UPMC for Life logo is a registered trademark of UPMC Health Plan, Inc.

UPMC for Life, the Medicare Advantage arm of the University of Pittsburgh Medical Center (UPMC), offers a range of highly rated plans designed to meet the diverse needs of individuals on Medicare. Known for its comprehensive network and strong emphasis on preventive care, UPMC for Life plans offer additional benefits that promote wellness and disease management.

In this editorial review, we will explore several UPMC for Life plans, highlighting their coverage options, costs, and member feedback. Our goal is to provide a clear understanding of what UPMC for Life offers to help you make an informed decision about your healthcare needs.

Table of Contents

Member Reviews for UPMC for Life

The following UPMC for Life reviews have been left by our members.

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PROS

  • High Ratings: Selected as a top choice in J.D. Power's 2023 study of Medicare Advantage plans.
  • Comprehensive Coverage: Includes additional benefits not covered by Original Medicare, such as dental, vision, and prescription drugs.
  • Preventive Care Focus: Strong emphasis on preventive care and wellness programs.
  • Cost Savings: Many plans offer lower out-of-pocket costs compared to traditional Medicare.
  • Integrated Care: Access to a comprehensive network of UPMC hospitals and providers ensures coordinated care.
  • Additional Perks: Extras often include fitness memberships, wellness programs, and telehealth services.

CONS

  • Network Restrictions: Plans may require beneficiaries to use in-network providers, limiting flexibility.
  • Prior Authorization: Certain treatments and services may need prior authorization, potentially delaying care.
  • Geographic Limitations: Primarily available in Pennsylvania and a few counties in Ohio, limiting options for those outside these areas.
  • Annual Changes: Annual Changes: Benefits, premiums, and provider networks may vary each year.
  • Benefit Limitations: Some additional benefits, such as dental and vision coverage, may have annual limits or restrictions.
FEATURED PARTNER OFFER [i]
Compare Top Medicare Advantage Plans from UPMC for Life
UPMC for Life Medicare Advantage Reviews
  • Compare affordable UPMC for Life plans online
  • Additional benefits may include dental, vision, hearing, lifestyle and transportation
  • Call to speak to a licensed insurance agent. TTY 711, Mon-Fri 8am-9pm, Sat 9pm-8pm EST
On Medicare Enrollment's Website

How Do UPMC for Life Medicare Advantage Plans Work?

UPMC for Life Medicare Advantage plan members receive all of their Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits through their plan. This includes preventive care, screenings, vaccinations, doctor and specialist visits, and inpatient care.

All UPMC for Life Medicare Advantage plans include coverage for:

  • Inpatient hospital admissions.
  • Doctor and specialist care.
  • Preventive care, screenings, and vaccinations.
  • Diagnostic services, lab work, X-rays and other imaging.
  • Outpatient services.
  • Ambulance transportation for emergencies.
  • Durable medical supplies and equipment.

Medicare rules mandate that all Medicare Part C plans offer coverage and benefits that match or exceed those of Original Medicare. However, UPMC for Life sets its own out-of-pocket costs.

Some UPMC for Life plans include extra benefits such as routine dental, vision, hearing, and wellness programs. These services aren't typically covered by Original Medicare.

By signing up for a UPMC for Life Medicare Advantage plan, many beneficiaries find it convenient to have all their healthcare services in one plan, which often includes lower out-of-pocket expenses and additional perks that fit their health and lifestyle needs.

However, it's essential to remember that lower costs are not assured. The costs largely hinge on the chosen plan and your healthcare usage. Additionally, depending on the UPMC for Life plan selected, there may be restrictions like needing referrals and prior authorization, which are not requirements under Original Medicare.

Extra Benefits from UPMC for Life

UPMC Medicare Advantage plans offer several additional benefits to enhance member experience. These benefits include:

  • Flex Spend Card: Provides funds for OTC products and healthcare services.
  • SilverSneakers Fitness Program: Access to fitness centers and online classes to promote physical activity.
  • Vision, Dental, and Hearing Coverage: Services such as routine exams, eyewear, dental cleanings, and hearing aids.
  • Prescription Drug Coverage: Comprehensive coverage for a range of medications, with tools to manage prescriptions online.

What Types of Plans Does UPMC for Life Offer?

Not all UPMC for Life plans are the same. And, UPMC for Life may not offer all plan types where you live, so it pays to explore using our Medicare Advantage Plan Finder tool. Here are the plan types UPMC for Life offers:[6]

Health maintenance organization (HMO) plans require that you use a specific network of doctors and hospitals. Also, with a UPMC for Life HMO plan you may need a referral from your primary care doctor in order to see a specialist. Out-of-network benefits are usually very limited. However, in an emergency you are not limited to care from your local hospital of emergency room.

Medicare preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. With a PPO plan, you generally do not need to choose a primary care doctor, and you don’t need referrals to see specialists. And you can seek out-of-network care, although it may cost more than seeing an in-network doctor.

NOTE: UPMC for Life may also offer Medicare Advantage Special Needs Plans (SNPs). Due to the highly specialized nature of D-SNP (dual eligible), C-SNP (chronic condition), and I-SNP (institutional) insurance plans, we review them separately.

How Much Do UPMC for Life Plans Cost?

The cost of a UPMC for Life plan will vary depending on the specific plan chosen, your location, usage of healthcare services, and the plan's out-of-pocket costs. We detail out-of-pocket costs on all UPMC for Life Medicare Advantage Plans in our plan finder.

Generally, UPMC for Life will charge you a monthly premium, which can vary based on the level of coverage and additional benefits included. You must also continue to pay your Part B premium. If you're a high-income earner, Medicare may add a Income Related Monthly Adjustment Amount (IRMAA) to your premium.[5]

UPMC for Life’s monthly premiums are highly dependent on where you live. For instance, the average cost of a Medicare Advantage plan from UPMC for Life in Pennsylvania is $57.83 per month, but in Ohio the average cost is $86.60 per month. These averages do not include Special Needs Plans.

UPMC for Life's Premiums vs. Competitors

The following list shows UPMC for Life's nationwide average monthly premium (excluding Special Needs Plans) vs. several competitors.

UPMC for Life
$10.11
AARP/UHC
$13.97
Aetna
$7.75
Wellcare
$26.20
UnitedHealthcare
$22.97

You also need to factor in copayments or coinsurance for healthcare services like doctor visits or hospital stays. The costs in each UPMC for Life plan we reviewed varied depending on the level of coverage and the type of services received.

Some plans may offer $0 premiums or low copayments for certain services, while others may have higher premiums but lower out-of-pocket costs. It's important to carefully review the costs and coverage details of each plan option to find the one that best fits your budget and healthcare needs.[7]

We analyzed the following popular UPMC for Life plans to give you an idea of what members pay to use healthcare services. This is just a sample, use our Medicare Advantage Plan Finder to see plans and costs where you live.

Important costs for plan ID H3907-057-1 reviewed in Allegheny County, PA.
  • Monthly premium: $36
  • Out-of-pocket max: $4,500
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $15.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H3907-037-0 reviewed in Allegheny County, PA.
  • Monthly premium: $21
  • Out-of-pocket max: $6,000
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $15.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H5533-015-1 reviewed in Allegheny County, PA.
  • Monthly premium: $19
  • Out-of-pocket max: $5,500
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $15.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None

Is UPMC for Life a Good Medicare Advantage Plan?

UPMC for Life offers a variety of Medicare Advantage plans, and its quality is assessed through several consumer intelligence and review websites. Here’s how UPMC for Life measures up:

J.D. Power Ranking

In J.D. Power’s 2023 U.S. Medicare Advantage Study, UPMC for Life was recognized as a top choice for member satisfaction in Pennsylvania. The study evaluated member satisfaction based on factors such as coverage options, cost, customer service, and provider network. UPMC’s high ranking indicates a strong performance in these areas, reflecting positive member experiences and satisfaction​​​​.

NCQA Health Plan Score

The National Committee for Quality Assurance (NCQA) rates health plans based on quality of care, patient satisfaction, and the health plans' efforts to improve. UPMC for Life has received commendable ratings, with many of its plans scoring between 4.0 and 4.5 stars. These ratings suggest that UPMC for Life provides a high level of care and customer satisfaction, aligning with the best practices in the industry​​.

Better Business Bureau (BBB) Rating

The Better Business Bureau (BBB) assigns ratings to companies based on various factors, including customer complaints and the company's response to them. UPMC for Life holds a high rating (A+) with the BBB, reflecting its commitment to resolving customer issues and maintaining trust​​.

UPMC for Life's Medicare Star Ratings

UPMC for Life's average 5-star rating: 4.90*
*Our calculation is weighted by enrollments in public plans, excluding Special Needs Plans, with CMS star ratings across 4 contracts covering 217,054 members.

If you're interested in the government's unbiased assessment of UPMC for Life's Medicare Advantage plans, you can check the Centers for Medicare and Medicaid Services' star ratings. These ratings evaluate each plan on a scale from 1 (worst) to 5 (best) stars, focusing on the quality of care and customer satisfaction, with updates provided every year.[9]

All Medicare Advantage plans are assessed using CMS's health plan criteria. Plans that come with prescription drug coverage are evaluated on additional drug plan metrics. Based on the latest year of data and adjusted for enrollment numbers, UPMC for Life’s 2024 Medicare Advantage plans have an average rating of 4.90 stars.[9] [11]

As of January 1, 2024, 100% of UPMC for Life members are enrolled in contracts with a Medicare star rating of 4 stars or higher.

You can view all plan ratings in your area with our Medicare Advantage Plan Finder tool.

Plan Availability

UPMC for Life's Medicare Advantage plans are offered in 2 states, including:

OH, and PA.

Overall, UPMC for Life provides coverage in 0 out of 3,140 U.S. counties.[8]

UPMC for Life's Top Plans

Here's a list of UPMC for Life's most popular plans (by enrollments):[9][10]

Medicare Advantage Search and compare Medicare Advantage plans available in your area.

Find Plans in your area with your ZIP Code

Frequently Asked Questions

The following are the most frequently asked questions we found about UPMC for Life's Medicare Advantage plans:

MA Plan Pros

  1. The maximum out-of-pocket cost is $7,550 a year
  2. Many plans cost $0 extra a month
  3. Most plans include drug coverage
  4. Many include basic hearing, dental, and vision benefits
  5. May include gym discounts (Silver Sneakers)

MA Plan Cons
  1. Can only switch during Open Enrollment
  2. Not easy to compare because plans are not standardized
  3. No nationwide coverage (plans don't travel with you)
  4. Most are HMO plans that require referrals to see a specialist
  5. Plans can change health and drug coverage each year

Learn more in this article.

Some Medicare Advantage plans offer a zero-dollar monthly premium because what Medicare pays the plan, plus your Medicare Part B premium, cover the full cost. For healthy people who want to keep their monthly costs low, these plans are an attractive option. But, just be aware that the premium is not the only cost. Plans also have copays or coinsurance you must pay when you use services. To learn more about free Medicare Advantage plans, read Why are Some Medicare Advantage Plans Free?

There is no debate when it comes to which plan offers better coverage. Original Medicare and a supplement plan offer the best coverage, but it costs more up-front. For a complete breakdown of the differences between Medicare Advantage plans and Medigap plans, read: Medicare Advantage vs Medigap: Which is Best for You?

Researching your health plan options is important. Here are some key questions to consider before choosing a Medicare Advantage plan as well as additional companies to read about:

Key Questions

All plans potentially have monthly premiums, deductibles, copayments, and/or coinsurance, including plans from UPMC for Life. Are these costs within your budget?

  • Does the plan cover your prescriptions? Knowing how a plan covers them is important if you have regular prescriptions because costs and coverage vary widely from plan to plan.
  • Are your doctors in the plan’s network? If you have preferred providers, ensure they participate in the plan’s network.
  • Is routine dental, vision, and hearing covered? Traditional Medicare doesn’t cover these services. If you need it, be sure to explore plans that cover it.
  • What extras does the plan include? Plans may include many beneficial extras, like gym memberships (SilverSneakers), medical transportation, meal delivery, telehealth, and more.

If you have additional questions, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

About UPMC for Life

UPMC for Life is the Medicare Advantage branch of UPMC Health Plan, based in Pittsburgh, Pennsylvania. UPMC is an integrated global nonprofit health enterprise and is closely affiliated with the University of Pittsburgh Schools of the Health Sciences. The health plan offers a range of Medicare Advantage options, including HMO, PPO, and Special Needs Plans (SNPs), designed to meet the diverse needs of individuals on Medicare​​​​.

Recent announcements from UPMC for Life include its top ranking in J.D. Power’s 2023 U.S. Medicare Advantage Study, highlighting its strong performance in member satisfaction. Additionally, UPMC has been expanding its Medicare Advantage plan offerings and improving benefits, such as enhanced prescription drug coverage and new wellness programs.

You can enroll in a UPMC for Life plan during your Initial Enrollment Period (IEP) at age 65, the annual Open Enrollment Period (Oct 15 - Dec 7), or during a Special Enrollment Period (SEP) if you meet certain conditions, such as moving or losing other insurance coverage​​​​​​.

Company
UPMC Health Plan, Inc
Phone Number
866-400-5077
Website
https://www.upmchealthplan.com/
Facebook Page
https://www.facebook.com/upmcforlife/
X (Twitter) Page
https://x.com/upmc

Citations

MedicareWire uses trustworthy sources to inform its work, including government websites, government data, actuarial service data, consumer intelligence websites, and peer-reviewed studies. All content is fact-checked for accuracy, timeliness, and relevance. We used the following information sources in this review: