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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 2026, 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 2026.
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 $125.00. 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 $6000.00 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 offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and mental health services require a low $25 copay, while inpatient hospital stays have a $495 annual copay per stay with no coinsurance. Emergency care is accessible with a $130 copay, and outpatient hospital services carry a $250 copay, both with no coinsurance required. This plan also includes valuable supplemental benefits, such as routine dental care with no copay and annual vision exams for a $25 copay, alongside a $200 annual allowance for eyewear. Routine hearing exams are also available for a $25 copay, while comprehensive dental services are covered with no copay and a 50% coinsurance up to a $3,000 yearly limit. Additionally, members benefit from no copays on over-the-counter items, meal benefits, and partial hospitalization services.
Inpatient Hospital See details
UPMC for Life HMO No Rx (HMO) partially covers inpatient hospital services with a $495 annual copayment per Medicare-covered stay and no coinsurance for both acute and psychiatric care. Prior authorization is required, and while unlimited additional acute days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by UPMC for Life HMO No Rx (HMO), featuring a $250 copay and no coinsurance for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are fully covered under the UPMC for Life HMO No Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
UPMC for Life HMO No Rx (HMO) covers prior-authorized ground ambulance services with a $50 to $290 copay and air ambulance services with a $290 copay, with no coinsurance required for either service. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
UPMC for Life HMO No Rx (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $50 to $290 and no coinsurance.
Primary Care See details
UPMC for Life HMO No Rx (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, mental health, and podiatry services require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered, and telehealth benefits are available with a $0 to $25 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by UPMC for Life HMO No Rx (HMO) with no copay and no coinsurance for covered benefits, including Medicare-covered preventive care, glaucoma screenings, and diabetes training. While benefits like counseling and home safety assessments are included, other services such as the annual physical exam, health education, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
UPMC for Life HMO No Rx (HMO) covers annual routine hearing exams and fitting evaluations with a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $690 to $1,890 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by UPMC for Life HMO No Rx (HMO) with no deductibles, offering annual routine eye exams and contact lens fittings for a $25 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $200 yearly limit, though individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by UPMC for Life HMO No Rx (HMO), featuring preventive care with no copay or coinsurance and comprehensive services with no copay and 50% coinsurance up to a $3,000 annual limit. Medicare-covered dental has a $25 copay and no coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, adjunctive general, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
UPMC for Life HMO No Rx (HMO) covers home infusion bundled services with no copay, requiring prior authorization and potential step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs incur a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
UPMC for Life HMO No Rx (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
UPMC for Life HMO No Rx (HMO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and generally a 20% coinsurance (0% to 20% coinsurance for diabetic supplies). Prior authorization is required for these covered benefits, and certain items may be limited to specified manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by UPMC for Life HMO No Rx (HMO) with no coinsurance and prior authorization required for all covered services. Diagnostic services feature no copay, whereas radiological services require a $110.00 copay for diagnostic radiological services and an $80.00 copay for therapeutic radiological services; however, diagnostic procedures, tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
UPMC for Life HMO No Rx (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UPMC for Life HMO No Rx (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
UPMC for Life HMO No Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20 and an $80 copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UPMC for Life HMO No Rx (HMO) partially covers other services, which include over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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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.
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