A non-government entity
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) in 2026, please refer to our full plan details page.
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) is a HMO D-SNP plan offered by DLP Marquette Health Plan, LLC available for enrollment in 2026 to people living in Upper Peninsula of Michigan. The overall rating for this plan is not yet available for 2026.
It's important to know that Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) features an annual prescription drug deductible of $615. You will need to pay this deductible amount out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including copayments and coinsurance for individual formulary tiers, are not currently available for this plan. For detailed information on how your specific medications are covered, it is recommended to contact the plan directly.
Additional Benefits
The Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) provides comprehensive coverage for core medical needs, with many essential services requiring no copay. You will pay no copay and no coinsurance for inpatient hospital stays, home health services, skilled nursing facility care, and preventive screenings. For outpatient hospital visits, primary and specialist care, emergency services, and diagnostic tests, the plan typically charges no copay but requires a twenty percent coinsurance. While Medicare-covered dental care and diagnostic hearing exams are available, this plan does not cover routine dental, vision, or hearing services, including eyeglasses and hearing aids. Essential medical equipment, diabetes supplies, and dialysis are covered with no copay and a twenty percent coinsurance. Additionally, members benefit from a forty-two dollar monthly allowance with no copay for over-the-counter items to help manage daily health needs.
Inpatient Hospital See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though Medicare-defined cost-sharing and prior authorization are required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and observation services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) with a 20% coinsurance (up to $115 per visit, waived if admitted within 24 hours) and no copay, both counting toward the plan deductible. Urgently needed services also require a 20% coinsurance (up to $40 per visit) and no copay, and while some worldwide emergency services are covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and mental health services with no copay and a 20% coinsurance, as well as telehealth benefits. Chiropractic and podiatry services are not covered.
Preventive Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers Medicare-covered preventive services, kidney disease education, and select screenings with no copay and no coinsurance. This benefit is only partially covered, as annual physical exams and additional services like health education, fitness benefits, and weight management programs are not covered.
Hearing Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible, although a referral is required. Routine hearing exams, fitting evaluations, OTC hearing aids, and all prescription hearing aid types are not covered.
Vision Services See details
Vision services are not covered under the Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) because all sub-services, including routine eye exams, contact lenses, and eyeglasses, are not covered.
Dental Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride treatments, and restorative or orthodontic services, are not covered.
Home Infusion bundled Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Medicare Part B chemotherapy, insulin, and other drugs under this benefit carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) with no copay and a 20% coinsurance. A referral is required to receive these covered services.
Medical Equipment See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these covered items, which are not restricted to specific manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Covered services include lab work, diagnostic procedures, X-rays, and therapeutic radiology, with diagnostic services requiring prior authorization and a referral.
Home Health Services See details
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although a referral is required to receive this care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP), as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage. These services require a referral and carry a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) with no copay and no coinsurance, but prior authorization and referrals are required. The plan allows for admission with less than a three-day prior inpatient hospital stay, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP), featuring over-the-counter item coverage with no copay and no coinsurance up to $42 monthly. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved