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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 Southeastern Pennsylvania. This plan received an overall rating of 3.5 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 $32.70. 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 prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. This budget-friendly benefit helps lower the out-of-pocket costs for essential daily medications. For higher-tier prescriptions, coverage transitions to a coinsurance model at standard pharmacies and mail order services. Members pay a 25% coinsurance for Tier 3 preferred brand drugs and Tier 5 specialty drugs, with specialty medications limited to a one-month supply. Tier 4 non-preferred drugs are covered with a 50% coinsurance for all supply durations.
Additional Benefits
The UPMC for Life Complete Care (HMO D-SNP) plan offers robust healthcare coverage with no copays for a wide range of essential services, including inpatient hospital stays, primary care visits, and skilled nursing facility care. While copayments are largely eliminated across the plan, many outpatient, emergency, specialist, and diagnostic services carry a 20% coinsurance. Prior authorization is required for certain benefits, but members can expect no copay or coinsurance for home health services and worldwide emergency care. This plan also features strong supplemental benefits, offering dental coverage up to a $3,995 annual limit and a $575 yearly eyewear allowance with no copays. Additionally, members receive no-copay coverage for routine hearing exams, over-the-counter items, and up to 20 one-way transportation trips per year to approved locations. While most preventive services are fully covered, select medical equipment and diagnostic procedures require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UPMC for Life Complete Care (HMO D-SNP) covers outpatient services with no copay, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, with the deductible waived for the first three pints.
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. Transportation services are partially covered with no copay or coinsurance for up to 20 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
UPMC for Life Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which do not count toward the plan-level deductible. Worldwide emergency, urgent care, and emergency 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 visits, therapy, mental health, and podiatry services with no copay and 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also covered with no copay and coinsurance ranging from no coinsurance to 20%.
Preventive Services See details
UPMC for Life Complete Care (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services and select additional benefits, though annual physical exams, health education, and weight management programs are not covered. Certain other services, including kidney disease education and glaucoma screenings, are covered with no copay but require a 20% coinsurance.
Hearing Services See details
Hearing services are covered by UPMC for Life Complete Care (HMO D-SNP) with no copay for exams and prescription hearing aids, featuring a 20% coinsurance for routine exams and no coinsurance for prescription aids. This benefit is partially covered, as OTC hearing aids along with inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
UPMC for Life Complete Care (HMO D-SNP) covers vision services with no deductibles and no copays, though a 20% coinsurance applies to routine eye exams and contact lenses. This partially covered benefit provides one annual routine exam, one contact lens fitting, and a $575 yearly eyewear allowance, but individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
UPMC for Life Complete Care (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $3,995 annual limit, while Medicare-covered dental has no copay and 20% coinsurance. Some dental services are not covered, including other diagnostic services, fluoride treatment, other preventive services, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
UPMC for Life Complete Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs, including chemotherapy, radiation, and insulin, are covered with a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also carrying a $35 copay.
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 benefits, and coverage may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
UPMC for Life Complete Care (HMO D-SNP) partially covers diagnostic and radiological services, with prior authorization required for all services. Covered diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays have no copay and a 20% coinsurance, 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
UPMC for Life Complete Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, although some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation 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) services with no copayment and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, though a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
UPMC for Life Complete Care (HMO D-SNP) offers partial coverage for other services, featuring over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. However, acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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