UPMC for Life HMO Rx Enhanced 2020 Medicare Advantage HMO Plan for Berks County, PA
UPMC for Life HMO Rx Enhanced is a Medicare Advantage plan, from UPMC Health Plan, that's available to beneficiaries living in Berks County, Pennsylvania.
- It's a Health Maintenance Organization (HMO) health plan.
- It includes a prescription drug plan.
- It has the same health insurance benefits as Original Medicare.
- It offers extras that Original Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $3,400 .
- The monthly premium is $301.00 (plus your Part B premium).
UPMC for Life HMO Rx Enhanced vs. Original Medicare in Berks County, PA
This HMO plan replaces your Part A and Part B Medicare coverage with a managed care health plan in Berks County, Pennsylvania. If you enroll in UPMC for Life HMO Rx Enhanced you agree to let UPMC Health Plan manage your Medicare benefits, including:
- Medicare Part A (hospital insurance).
- Medicare Part B (medical insurance).
- Medicare Part D (prescription drug coverage).
- Additional benefits included in the plan not covered by Medicare.
- Emergency medical coverage when you travel outside of your county (USA and it's territories only).
The benefit of an HMO plan, like UPMC for Life HMO Rx Enhanced, is predictable out-of-pocket expenses. Although more restrictive than Original Medicare, HMOs limit your annual out-of-pocket costs. With traditional Medicare there's no cap, leaving you vulnerable to excessive medical bills.
UPMC for Life HMO Rx Enhanced Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 9 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Medications are expensive, so you'll want to know how this plan covers your prescriptions.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.
CRITICAL: UPMC for Life HMO Rx Enhanced includes a Medicare Drug Plan which has its own deductible and co-pays. If you have regular prescriptions, make sure they are covered at a favorable price before you join this plan. Prescription drug plans vary significantly by plan. Make sure you have the best coverage.
UPMC for Life HMO Rx Enhanced's monthly premium in Berks County is $301.00. That includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H3907-006 Summary of Benefits).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $0.00 per year. That means you have first dollar coverage.
IMPORTANT: When evaluating UPMC for Life HMO Rx Enhanced, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The UPMC for Life HMO Rx Enhanced plan MOOP is $3,400 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
Contact UPMC Health Plan
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the UPMC Health Plan Medicare website.
Additional Medicare Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- BlueJourney Alliance Heart and Diabetes Care (Local HMO), for Chronic or Disabling Condition beneficiaries
- Health Partners Medicare Special (Local HMO), for Dual-Eligible beneficiaries
- Gateway Health Medicare Assured Ruby (Local HMO), for Dual-Eligible beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- Gateway Health Medicare Assured Diamond (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Community Blue Medicare PPO Signature (PPO)
- Geisinger Gold Classic Advantage Rx (HMO)
- Geisinger Gold Preferred Complete Rx (PPO)
- Vibra Health Plan Essential (PPO)
- BlueJourney Classic (PPO)