UPMC for Life HMO Rx Choice (HMO)

UPMC for Life HMO Rx Choice (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 Rx Choice (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about UPMC for Life HMO Rx Choice (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.

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:

Drug Coverage

The UPMC for Life HMO Rx Choice (HMO) medicare plan features an annual drug deductible of $175. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for any supply duration when using preferred pharmacies or preferred mail order. Standard pharmacies and standard mail order services require copays ranging from $15 to $40 depending on the tier and supply length. For brand-name and specialty medications, costs are based on a percentage coinsurance. Tier 3 preferred brands have a 25% coinsurance, while Tier 4 non-preferred drugs carry a 49% coinsurance across all pharmacy options. Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply.

Additional Benefits

The UPMC for Life HMO Rx Choice (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, physical therapy, and routine eye exams, members pay a predictable $35 copay with no coinsurance. Inpatient hospital stays feature no coinsurance and a $250 annual copay for acute care, while emergency room visits require a $130 copay that is waived if admitted. This plan also includes valuable supplemental benefits, such as preventive dental care with no copay and comprehensive dental services covered at 50% coinsurance up to a $5,000 annual limit. Vision eyewear is covered with no copay up to $200 annually, and diagnostic lab services require a low $5 copay with no coinsurance. Durable medical equipment and dialysis services are available with no copay and a 20% coinsurance.