UPMC for Life HMO Premier Rx (HMO)

UPMC for Life HMO Premier Rx (HMO) is a HMO plan offered by Upmc Health Plan, Inc. available for the 2026 plan year to people living in Western 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 Premier Rx (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 Premier 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.

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 Premier Rx (HMO) plan features an annual drug deductible of $350. You will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services require copays ranging from $15 to $30 for Tier 1 and $20 to $40 for Tier 2, depending on the supply length. For brand-name and specialty drugs, costs are determined by a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance across all pharmacy options. Specialty medications in Tier 5 are subject to a 29% coinsurance for a one-month supply.

Additional Benefits

The UPMC for Life HMO Premier Rx (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits and preventive care. Specialist visits, mental health therapies, and urgent care require a copay of $35 to $50, while emergency room care is covered with a $130 copay and no coinsurance. For hospital care, inpatient acute stays require a $100 daily copay for days one through five with no copay for subsequent days, and outpatient hospital services carry a $300 copay. Additional benefits include preventive dental exams with no copay and comprehensive dental covered up to $4,500 annually with a 50% coinsurance. Routine vision and hearing exams require a $35 copay, which includes up to a $270 annual eyewear allowance and coverage for up to two hearing aids per year. Members also receive home health care, over-the-counter items, and meal benefits with no copay, while durable medical equipment and dialysis require a 20% coinsurance.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.