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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 Southeastern Pennsylvania. This plan received an overall rating of 3.5 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 $34.40. 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 deductible of $590.00. After the deductible, you will pay the costs for your drugs as outlined in the plan's formulary. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $34.40. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
UPMC for Life Complete Care (HMO D-SNP) offers a range of benefits with varying cost-sharing options. The plan covers outpatient services, preventive services, and dental services with a 20% coinsurance, while emergency services and home health services have no copay. Additionally, the plan provides coverage for hearing, vision, and medical equipment. This plan includes specific coverage for hearing aids, eyewear, and dental care, with copays and coinsurance applying to many services. It's important to note that certain services like Cardiac Rehabilitation Services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but the specific cost-sharing details, such as copays, are not provided. Additional days, non-Medicare covered stays, and upgrades for both Acute and Psychiatric inpatient hospital stays 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, and individual and group sessions for outpatient substance abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UPMC for Life Complete Care (HMO D-SNP). Ground and Air Ambulance Services have a 20% coinsurance, with no copay. Transportation Services to a plan-approved health-related location are covered for up to 20 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 UPMC for Life Complete Care (HMO D-SNP), with a 20% coinsurance for Emergency Services and Urgently Needed Services, and no copay for any of the services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered.
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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with varying coinsurance amounts. Chiropractic services require prior authorization, and routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and additional preventive services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Counseling Services, Kidney Disease Education Services, and Other Preventive Services, with some services subject to a 20% coinsurance. 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 Benefit, Home-Based Palliative Care, Enhanced Disease Management, Telemonitoring Services, and In-Home Support Services are not covered.
Hearing Services See details
Hearing Services are covered, including routine hearing exams and fitting/evaluation for hearing aids. Routine hearing exams are covered with a 20% coinsurance, and you are allowed one exam per year, while fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are partially covered, and prescription hearing aids (all types) are covered with 2 per every three years, however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year, including contact lens fittings. Eyewear, including contact lenses, and eyeglasses (lenses and frames) have a 20% coinsurance and are limited to a combined maximum of $575 per year, and contact lenses and eyeglasses are limited to one per year, while eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services including oral exams (2 per year), dental x-rays (bitewing x-rays every six months, and panoramic x-ray every 60 months), and prophylaxis (cleaning) (2 per year), but does not cover fluoride treatments. Orthodontic services are covered up to $4,000 per year, while restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. 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 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. Prior authorization is required for this benefit.
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 require prior authorization. The plan follows Original Medicare for SNF cost sharing, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and a Meal Benefit, with OTC items offering a monthly benefit of $133. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and multiple additional services are not covered.
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