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UPMC for Life Medicare Advantage 2024 Review
UPMC for Life Medicare Advantage plans are available in only two states but get above-average star ratings from CMS.
Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 18 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
UPMC for Life sells Medicare Advantage in Pennsylvania and a small part of Ohio. Its plans get above-average ratings from CMS, and member experience scores are high.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
4.55 (Above average)
Pros
Weighted by enrollment, average star ratings are above the industry average.
Member experience ratings are above the average for major providers.
Landed the top spot for customer satisfaction in Pennsylvania, according to latest J.D. Power study.
Cons
Plans offered only in Pennsylvania and a couple of counties in Ohio.
Fewer $0-premium plans than many other providers.
States available
2 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
4.55 (Above average)
Pros
Weighted by enrollment, average star ratings are above the industry average.
Member experience ratings are above the average for major providers.
Landed the top spot for customer satisfaction in Pennsylvania, according to latest J.D. Power study.
Cons
Plans offered only in Pennsylvania and a couple of counties in Ohio.
Fewer $0-premium plans than many other providers.
UPMC for Life Medicare Advantage plans are available in two states — Ohio and Pennsylvania — and the provider’s star ratings from the Centers for Medicare & Medicaid Services (CMS) are well above average. Member experience ratings are also above the average for major providers. UPMC didn’t increase monthly premiums in 2024, but it offers fewer $0-premium plans than many other providers.
Here’s what you should know about UPMC for Life Medicare Advantage.
UPMC for Life Medicare Advantage pros and cons
UPMC for Life’s offerings have advantages and disadvantages.
Pros
High star ratings: UPMC for Life Medicare Advantage plans score a higher-than-average star rating from CMS — 4.9 for 2024 plans versus 4.04 for the industry as a whole.
High marks from members: Member experience ratings on metrics like customer service and getting appointments and care quickly are above the average for major providers.
Affordable prescription drugs: Plans offer $0 copays for Tier 1 and Tier 2 prescription drugs when members fill them at their plan’s preferred pharmacies.
Cons
Limited availability: UPMC for Life offers Medicare Advantage plans mostly in Pennsylvania, along with two counties in Ohio.
Fewer $0 plans: UPMC for Life offers fewer $0-premium plans than many other providers.
The Centers for Medicare & Medicaid Services maintains star ratings for Medicare Advantage plans on a 5-point scale, ranking plans from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.
Based on the most recent year of data and weighted by enrollment, UPMC for Life’s 2024 Medicare Advantage plans get an average rating of 4.9 stars
Costs for Medicare Advantage plans depend on your plan, your geographic location and your health needs.
Premiums
One of the costs to consider is the plan’s premium. In 2024, about a third of UPMC for Life Medicare Advantage plans (35%) that aren’t special needs plans (SNPs) have a $0 premium
, although some plans cover part or all of this cost. (Most people pay this standard amount, but if your income is above a certain threshold, you'll pay more.)
Copays, coinsurance and deductibles
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:
Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and any other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.
Whether you require extra benefits, and if the plan charges for them.
To get a sense of costs, use Medicare’s plan-finding tool to compare information among available plans in your area. You can select by insurance carrier to see only UPMC for Life plans or compare across carriers. You can also shop directly from UPMC for Life’s website by entering your ZIP code.
Available Medicare Advantage plans
There are a few kinds of UPMC for Life Medicare Advantage plans, and they vary in terms of structure, costs and benefits. UPMC for Life offers Medicare Advantage prescription drug plans (MAPDs) as well as Medicare Advantage plans without drug coverage.
Plan offerings include the following types:
HMO plans
A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.
PPO plans
Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.
SNPs
Special needs plans (SNPs) restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. UPMC for Life offers one type of SNP:
Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.
UPMC for Life Medicare Advantage service area
UPMC for Life offers Medicare Advantage plans in only two states — Pennsylvania and Ohio — and the provider is available in only two counties in Ohio. UPMC for Life covers more than 210,000 Medicare Advantage beneficiaries
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
