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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 2026, 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 2026.
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 $26.50. 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 $615.00 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 $9250.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. This provides affordable access to common prescription medications without any upfront copayments. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance through standard pharmacies and mail order. These coinsurance rates apply to one-month, two-month, and three-month supplies, except for specialty drugs which are limited to a one-month supply.
Additional Benefits
The UPMC for Life Complete Care (HMO D-SNP) plan offers comprehensive medical coverage where most services feature no copays, though a 20% coinsurance often applies. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. For primary care, specialist visits, and outpatient services, you will generally pay no copay but will be responsible for a 20% coinsurance. This plan also includes valuable supplemental benefits like dental, vision, hearing, and transportation to support your daily health needs. Preventive and comprehensive dental services are covered with no copay and no coinsurance up to an annual limit of $8,250, while vision benefits provide an eyewear allowance of up to $575. Additionally, members can utilize up to 60 one-way transportation trips per year and worldwide emergency coverage with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. While standard Medicare-approved stays are covered, additional hospital days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
UPMC for Life Complete Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
UPMC for Life Complete Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services and urgently needed services are covered by UPMC for Life Complete Care (HMO D-SNP) with a 20% coinsurance and no copay, up to a maximum of $115 per emergency visit and $40 per urgent care visit. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance.
Primary Care See details
Primary care services under UPMC for Life Complete Care (HMO D-SNP) are covered with no copay and 20% coinsurance, which also applies to specialists, physical, occupational, and speech therapies, mental health, podiatry, and opioid treatment. Additional telehealth benefits are covered with no copay and 0% to 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance for most additional preventive benefits, though some services like kidney disease education, glaucoma screenings, and diabetes self-management training require a 20% coinsurance and no copay. Sub-services not covered by this plan include annual physical exams, health education, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, enhanced disease management, and telemonitoring.
Hearing Services See details
UPMC for Life Complete Care (HMO D-SNP) covers hearing exams and evaluations with no copay and no deductible, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are not covered.
Vision Services See details
UPMC for Life Complete Care (HMO D-SNP) covers vision services with no copays and no deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. This partially covered benefit includes one routine exam, one contact lens fitting, and up to $575 yearly for eyewear, but individual eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are partially covered by UPMC for Life Complete Care (HMO D-SNP), offering Medicare-covered dental with no copay and 20% coinsurance. Preventive and comprehensive services like exams, cleanings, x-rays, restorative care, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay and no coinsurance up to $8,250 annually, though fluoride, implants, orthodontics, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
UPMC for Life Complete Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain items may be limited to preferred brands or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by UPMC for Life Complete Care (HMO D-SNP), as lab services are not covered. Covered benefits—including diagnostic procedures, therapeutic radiological services, and outpatient X-rays—require prior authorization and have a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
UPMC for Life Complete Care (HMO D-SNP) covers cardiac rehabilitation services with no copay, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UPMC for Life Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no copay and no coinsurance, though prior authorization is required. While this plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UPMC for Life Complete Care (HMO D-SNP), offering Over-the-Counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture and highly integrated services for dual-eligible SNPs are not covered under this benefit.
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