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UPMC for Life HMO No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UPMC for Life HMO No Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UPMC for Life HMO No Rx (HMO) in 2025, please refer to our full plan details page.
UPMC for Life HMO No Rx (HMO) is a HMO plan offered by UPMC Health System available for enrollment in 2025 to people living in Western, Central, and Northeastern Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UPMC for Life HMO No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UPMC for Life HMO No Rx (HMO).
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 UPMC for Life HMO No Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $110.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5000.00 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 UPMC for Life HMO No Rx (HMO)
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Drug Coverage
Prescription drugs are not covered by UPMC for Life HMO No Rx (HMO).
Additional Benefits
The UPMC for Life HMO No Rx (HMO) plan provides a range of benefits with varying costs. Inpatient hospital stays have a $300 copay per stay, while outpatient services, including doctor visits and some therapies, have copays ranging from $18 to $225. Emergency services, including worldwide coverage, come with copays between $55 and $290 depending on the service. Preventive services are covered with no copay, and dental services include a $25 copay for Medicare-covered services. The plan also includes coverage for hearing and vision services, with copays for exams and coverage for eyewear. The plan also offers some coverage for medical equipment and home health services, and some other specialized services with a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $300 copay per stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services, have a $225 copay. Outpatient Substance Abuse Services have a $25 copay for both Individual and Group Sessions, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the UPMC for Life HMO No Rx (HMO) plan. There is no information about the cost of this benefit, so the copay and coinsurance are unknown.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UPMC for Life HMO No Rx (HMO). Ground ambulance services have a copay of $50-$290, and air ambulance services have a copay of $290, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UPMC for Life HMO No Rx (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have an $18 copay, while other services have copays ranging from $25. Additional Telehealth benefits have copays between $0 and $25.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional services such as In-Home Safety Assessment, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Counseling Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, Health Education, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, as well as Routine Hearing Exams and Fitting/Evaluation for Hearing Aids, both covered once per year. Prescription hearing aids are covered with a copay between $690 and $1890, while OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include routine eye exams with a $25 copay, and the plan covers one routine eye exam and one contact lens fitting per year. Eyeglasses (lenses and frames) and contact lenses are covered, with a combined maximum of $200 per year for eyewear, but eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $25 copay, oral exams (2 visits per year), dental x-rays, prophylaxis (cleaning) (2 visits per year), restorative services with 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics (removable) with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with 50% coinsurance. Fluoride treatment, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UPMC for Life HMO No Rx (HMO) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic procedures/tests, lab services, and outpatient X-Ray services are not covered. Diagnostic Radiological Services have a copay of at most $110, and Therapeutic Radiological Services have a copay of at most $80.
Home Health Services See details
Home Health Services are covered by UPMC for Life HMO No Rx (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UPMC for Life HMO No Rx (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $80.
Other Services See details
Under "Other Services," UPMC for Life HMO No Rx (HMO) covers Over-the-Counter (OTC) Items and a Meal Benefit, but does not cover Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. The plan offers OTC items as a supplemental benefit under Part C, including Nicotine Replacement Therapy (NRT).
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