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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 Eastern 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 $33.20. 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. If you qualify for the low-income subsidy, you will pay $33.20 per month for Part D. During the initial coverage phase, you pay the costs for your drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered Part D drugs.
Additional Benefits
The UPMC for Life Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient, partial hospitalization, ambulance, emergency, primary care, hearing, vision, dental, home infusion, dialysis, medical equipment, and diagnostic services, typically involve a 20% coinsurance. Preventive services include in-home safety assessments and medical nutrition therapy, with some services like kidney disease education having a 20% coinsurance. This plan also covers home health services with no copay, and provides up to $133 per month for over-the-counter items. The plan offers coverage for hearing aids and eyewear, and covers transportation to plan-approved health-related locations, up to 20 one-way trips per year. However, certain services like cardiac rehabilitation and additional home care hours are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the UPMC for Life Complete Care (HMO D-SNP) plan, but the specific cost-sharing details are not provided. Additional days for Inpatient Hospital-Acute and Psychiatric, Non-Medicare-covered stays for Inpatient Hospital-Acute and Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a 20% coinsurance, while Ambulatory Surgical Center Services and Outpatient Substance Abuse Services are covered with a coinsurance between 20% and 20%. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the UPMC for Life Complete Care (HMO D-SNP) plan with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UPMC for Life Complete Care (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has no coinsurance.
Primary Care See details
Under the UPMC for Life Complete Care (HMO D-SNP) plan, 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 are covered. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, have a 20% coinsurance, while Chiropractic Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Additional Telehealth Benefits, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The UPMC for Life Complete Care (HMO D-SNP) plan covers preventive services, including Medicare-covered zero dollar services and additional preventive services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy. Other services like annual physical exams, health education, and post-discharge in-home medication reconciliation are not covered. Kidney disease education services, glaucoma screenings, and diabetes self-management training have a 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered up to two every three years, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The UPMC for Life Complete Care (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance. Eyewear is also covered, with a 20% coinsurance on contact lenses, and a combined maximum plan benefit coverage amount of $575.00 every year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with 20% coinsurance, Other Dental Services, Oral Exams (2 visits per year), Dental X-Rays, Prophylaxis (Cleaning) (2 visits per year), Orthodontic Services with a $5,000 annual maximum, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. 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%.
Dialysis Services See details
Dialysis Services are covered under the UPMC for Life Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by UPMC for Life Complete Care (HMO D-SNP). For Durable Medical Equipment and Diabetic Supplies, you will pay 20% coinsurance, while Medical Supplies and Prosthetic Devices 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 are covered under the UPMC for Life Complete Care (HMO D-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Medicare-covered Lab Services are not covered.
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, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UPMC for Life Complete Care (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the copay is determined by Medicare cost sharing rules.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits, with acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services not covered. The plan provides up to $133 per month for OTC items.
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