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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 Eastern 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 $8.10. 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) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when using standard pharmacies or standard mail order for one-month, two-month, or three-month supplies. This makes managing common medications highly affordable under this plan. For brand-name and specialty medications, costs are based on a percentage of the drug cost rather than a flat copay. Tier 3 preferred brands and Tier 5 specialty drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 50% coinsurance. These coinsurance rates apply to standard pharmacy and mail-order options, with specialty tier medications limited to a one-month supply.
Additional Benefits
The UPMC for Life Complete Care (HMO D-SNP) plan offers extensive coverage featuring no copays for most medical services, though a 20% coinsurance frequently applies. Inpatient hospital stays, skilled nursing facility care, and home health services are fully covered with no copay and no coinsurance. However, outpatient hospital care, emergency services, specialist visits, and diagnostic tests require a 20% coinsurance in addition to having no copay. For supplemental care, the plan provides preventive and comprehensive dental coverage with no copay and no coinsurance up to a $5,000 annual limit. Vision and hearing services also feature no copays, though routine exams require a 20% coinsurance, and members benefit from a $575 annual eyewear allowance and covered hearing aids. Additionally, members can access up to 20 one-way transportation trips per year, over-the-counter items, and chronic illness meals with no copay and no coinsurance.
Inpatient Hospital See details
UPMC for Life Complete Care (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
UPMC for Life Complete Care (HMO D-SNP) outpatient services are covered with no copay, although outpatient hospital, ambulatory surgical center, and substance abuse services require a 20% coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
UPMC for Life Complete Care (HMO D-SNP) covers partial hospitalization services 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, subject to prior authorization. Transportation services are partially covered, providing up to 20 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
UPMC for Life Complete Care (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay, neither of which apply to the plan-level deductible. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance.
Primary Care See details
UPMC for Life Complete Care (HMO D-SNP) covers primary care, specialist, mental health, therapy, podiatry, and telehealth services with no copay and 20% coinsurance (0% to 20% coinsurance for telehealth). Chiropractic services are not covered in practice, and prior authorization is required for physical, occupational, and speech-language therapies.
Preventive Services See details
UPMC for Life Complete Care (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for additional benefits like personal emergency response systems, while kidney disease education, glaucoma screenings, and diabetes self-management training have no copay and a 20% coinsurance. Uncovered services include annual physical exams, health education, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, chemotherapy wigs, post-discharge medication reconciliation, re-admission prevention, home-based palliative care, in-home support, enhanced disease management, and telemonitoring.
Hearing Services See details
Hearing services are partially covered by UPMC for Life Complete Care (HMO D-SNP), featuring hearing exams with no copay and 20% coinsurance for routine visits. Covered prescription hearing aids are offered with no copay and no coinsurance for up to two aids every three years, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription aids, are not covered.
Vision Services See details
Vision services are partially covered by UPMC for Life Complete Care (HMO D-SNP), offering no copays and a 20% coinsurance for routine exams and contact lenses, with no deductibles. While the plan provides a $575 annual allowance for eyewear packages and contact lenses, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
UPMC for Life Complete Care (HMO D-SNP) provides partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Preventive and comprehensive services—including exams, cleanings, x-rays, and restorative treatments—are covered with no copay and no coinsurance up to a $5,000 annual limit. Fluoride treatments, implants, orthodontics, adjunctive general services, maxillofacial prosthetics, and other diagnostic or preventive 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, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, carry no copay and a coinsurance of no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
UPMC for Life Complete Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these services, and certain benefits may be limited to preferred manufacturers or vendors.
Diagnostic and Radiological Services See details
UPMC for Life Complete Care (HMO D-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. While diagnostic procedures, radiological services, and outpatient x-rays are covered under this benefit, outpatient lab services are not covered.
Home Health Services See details
Home health services are covered under UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
UPMC for Life Complete Care (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, although some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While the plan does not require a three-day inpatient hospital stay prior to admission, 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), which provides over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered under this benefit.
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