UPMC for Life PPO Premier Rx (PPO)

UPMC for Life PPO Premier Rx (PPO) is a PPO plan offered by UPMC Health System available for enrollment in 2025 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 PPO Premier Rx (PPO) 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 PPO Premier Rx (PPO).

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 PPO Premier Rx (PPO) plan has a $500 annual drug deductible. You can avoid copays entirely for Tier 1 preferred generic and Tier 2 generic medications by using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, Tier 1 drugs have a copay starting at $15 and Tier 2 drugs start at $20. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brands require 23% coinsurance, Tier 4 non-preferred drugs require 28% coinsurance, and Tier 5 specialty drugs require 27% coinsurance for a one-month supply. These coinsurance rates apply equally across preferred and standard pharmacies as well as mail-order services.

Additional Benefits

The UPMC for Life PPO Premier Rx (PPO) plan offers robust coverage with predictable out-of-pocket costs for essential medical services. Members benefit from no copay for primary care visits, home health services, and preventive care, while specialist visits require a $30 copay and outpatient hospital services carry a $325 copay. For inpatient hospital stays, there is no coinsurance and a daily copay of $165 for days 1 through 7, followed by no copay for days 8 through 90. This plan also features valuable supplemental coverage, including preventive dental care, over-the-counter items, and meal benefits with no copay. Routine vision and hearing exams are available with a $35 copay, while comprehensive dental services are covered with no copay and a 50% coinsurance up to a $4,700 annual limit. Most medical equipment, dialysis, and Part B drugs generally carry a 20% coinsurance with no copay, providing clear and manageable cost structures for members.