UPMC for Life Complete Care D-SNP: H4279-001-0
What is Plan H4279-001-0 from UPMC for Life Complete Care?
UPMC for Life Complete Care, is a 2024 D-SNP Special Needs Plan, with a HMO provider network. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
You must meet all qualification requirements to join this D-SNP plan.
This plan is rated 4.5 (Good+) stars by CMS making it a top-rated plan.
| Plan Basics | |
|---|---|
| Plan ID: | H4279-001-0 |
| Plan Type: | HMO |
| Plan Year: | 2024 |
| Premium: | $40.20/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced $545.00 deductible |
| Rx Gap Coverage: | {gap} |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Montour County, PA |
| Insured By: | UPMC for Life Complete Care |
| Summary of Benefits |
|---|
Health Plan Costs & Benefits
UPMC for Life Complete Care is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, UPMC for Life Complete Care does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this UPMC for Life Complete Care plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | 0% Coinsurance |
| Specialist: | 0% Coinsurance |
| Wellness programs (e.g., fitness, nursing hotline): | |
| Preventive care: | 0% Coinsurance |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | 0% Coinsurance |
| Routine foot care: | 0% Coinsurance |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | 0% Coinsurance Authorization Required |
| Routine chiropractic care: | 0% Coinsurance Authorization Required |
| Emergency Care / Urgent Care | |
| Emergency room care: | 0% Coinsurance |
| Urgent care: | 0% Coinsurance |
| Ground ambulance: | 0% Coinsurance |
| Inpatient hospital coverage: | |
| Outpatient hospital coverage: | 0% Coinsurance Authorization Required |
| Skilled Nursing Facility: | |
| Optional supplemental benefits: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | 0% Coinsurance |
| Outpatient group therapy visit with a psychiatrist: | 0% Coinsurance |
| Inpatient hospital - psychiatric: | |
| Outpatient group therapy visit: | 0% Coinsurance |
| Outpatient individual therapy visit: | 0% Coinsurance |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | 0% Coinsurance Authorization Required |
| Occupational therapy visit: | 0% Coinsurance Authorization Required |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | 0% Coinsurance Authorization Required |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 0% Coinsurance Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 0% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | 0% Coinsurance Authorization Required |
| Lab services: | 0% Coinsurance Authorization Required |
| Outpatient x-rays: | 0% Coinsurance Authorization Required |
| Diagnostic tests and procedures: | 0% Coinsurance Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 0% Coinsurance |
| Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Feel free to download our UPMC for Life Complete Care Summary of Benefits information.
Supplemental Health Plan Benefits (H4279-001-0)
The following is a summary of the supplemental benefits UPMC for Life Complete Care includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| Preventive Dental | |
| Oral exam (In-Network) | Not Covered |
| Fluoride treatment (In-Network) | Not Covered |
| Dental x-ray(s) (In-Network) | Not Covered |
| Cleaning (In-Network) | Not Covered |
| Comprehensive Dental | |
| Periodontics (In-Network) | Not Covered |
| Non-routine services (In-Network) | Not Covered |
| Diagnostic services (In-Network) | Not Covered |
| Extractions (In-Network) | Not Covered |
| Endodontics (In-Network) | Not Covered |
| Restorative services (In-Network) | Not Covered |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
| Hearing | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | Covered Limits may apply |
| Vision | Maximum vision benefit: | $575.00 Every year |
| Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
| Routine eye exam (In-Network) | Covered Limits may apply |
| Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
UPMC for Life Complete Care includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $40.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $40.20 |
| Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay at the pharmacy before UPMC for Life Complete Care begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, UPMC for Life Complete Care has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $5.00 copay | $15.00 copay |
| 2 (Generic) | $15.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $35.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 49% | 49% |
| 5 (Specialty Tier) | 25% | 25% |
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this UPMC for Life Complete Care plan.
| CMS Measure | Star Rating |
|---|---|
| 2024 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
UPMC for Life Complete Care
To qualify for enrollment in UPMC for Life Complete Care in Montour County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Pennsylvania's state thresholds.
Before enrolling in UPMC for Life Complete Care, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Highmark Wholecare Medicare Assured Ruby
- Aetna Medicare Advantra Cares
- HumanaChoice SNP-DE H5216-227
- Highmark Wholecare Medicare Assured Diamond
- AmeriHealth Caritas VIP Care
Contact UPMC for Life Complete Care
| Plan Website: | https://www.upmchealthplan.com/snp/ |
|---|---|
| Formulay Information: | https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/ |
| Pharmacy Information: | UPMC for Life Complete Care Pharmacy Page |
| Prospective Members: | (866)405-8762 |
| TTY Users: | 711 |
If you qualify for Medicare benefits 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.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- UPMC for Life Complete Care, https://www.upmchealthplan.com/snp/, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Pennsylvania", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023