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UPMC for Life Complete Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UPMC for Life Complete Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UPMC for Life Complete Care (HMO D-SNP) in 2025, please refer to our full plan details page.
UPMC for Life Complete Care (HMO D-SNP) is a HMO D-SNP 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 out of 5 stars in 2025.
It's important to know that UPMC for Life Complete Care (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:
UPMC for Life Complete Care (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 UPMC for Life Complete Care (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 UPMC for Life Complete Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.70. 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 $590.00 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 $8850.00 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:
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Drug Coverage
The UPMC for Life Complete Care (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly premium of $44.70.
Additional Benefits
The UPMC for Life Complete Care (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, like emergency services, home health services, and diagnostic and radiological services, have no copay. This plan includes coverage for primary care, outpatient, and hearing, vision, and dental services, most of which have a 20% coinsurance. Additional benefits include transportation, medical equipment, and home infusion services, each with specific cost-sharing details. Preventive services are covered with varying cost-sharing, and there is an allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered under the UPMC for Life Complete Care (HMO D-SNP) plan, but the copay details are not provided. Additional days, non-Medicare-covered stays, and upgrades for both Acute and Psychiatric services are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a three-pint deductible waived. Individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by UPMC for Life Complete Care (HMO D-SNP) with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered for up to 60 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UPMC for Life Complete Care (HMO D-SNP) plan. For Emergency and Urgently Needed Services, there is a 20% coinsurance, and no copay. Worldwide Emergency Services are covered, but have no cost sharing details.
Primary Care See details
The UPMC for Life Complete Care (HMO D-SNP) plan covers 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. Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a 20% coinsurance, while Chiropractic Services, Individual/Group Mental Health and Psychiatric Sessions, and Opioid Treatment Program Services have a 20% coinsurance. Additional Telehealth Benefits have a coinsurance between 0% and 20%.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, along with additional preventive services like in-home safety assessments, personal emergency response systems, and counseling services, with some services like kidney disease education services, glaucoma screening, and diabetes self-management training incurring a 20% coinsurance. This plan does not cover annual physical exams, health education, 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 benefits, home-based palliative care, in-home support services, enhanced disease management, telemonitoring services, or telemonitoring services.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, and routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered twice per year, however, inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and also covers routine eye exams and other eye exam services, each limited to one visit per year. Eyewear benefits are covered with a 20% coinsurance, and include one pair of contact lenses or eyeglasses (lenses and frames) per year, with a combined maximum benefit of $575 per year; however, eyeglass lenses and frames are not covered.
Dental Services See details
The UPMC for Life Complete Care (HMO D-SNP) plan covers dental services with a 20% coinsurance for Medicare Dental Services. Oral exams and teeth cleanings (prophylaxis) are covered, with limitations on the number of visits per year. Orthodontic Services are covered up to a maximum of $8250 per year. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are also covered, but 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. 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 by UPMC for Life Complete Care (HMO D-SNP). The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment (DME) has a 20% coinsurance, and a prior authorization is required. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the UPMC for Life Complete Care (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UPMC for Life Complete Care (HMO D-SNP), but the plan does not cover the listed services. There is a coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays.
Other Services See details
Other Services include a $133 monthly allowance for over-the-counter items, and a meal benefit for chronic illnesses, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered. The plan also offers nicotine replacement therapy as a Part C OTC benefit.
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