UPMC for Life‘s Five Star Rating from Medicare Places Them Among the Highest-Rated Medicare Advantage Plans in the Nation
PITTSBURGH (Oct. 25, 2021) – UPMC Health Plan today announced that UPMC for Life, the insurer’s Medicare Advantage product, was included among U.S. News & World Report‘s “Best Insurance Companies for Medicare Advantage and Part D Prescription Drug Plans” for Pennsylvania.
U.S. News & World Report utilized the Centers for Medicare & Medicaid Services (CMS) Star Ratings data for its rankings, including CMS’s recent five-out-of-five overall Star Ratings of both UPMC for Life’s HMO and PPO plans for 2022.
“We are honored that UPMC for Life made the U.S. News & World Report list,” said Angela Perri, Chief Medicare Officer, UPMC Health Plan. “This rating places us among the highest quality Medicare Advantage plans in the country and confirms what our members already know: Our entire team’s commitment to providing affordable access to outstanding clinical care and award-winning member services is unparalleled.”
For an insurance company to be eligible for the list of U.S. News & World Report‘s Best Insurance Companies for Medicare Advantage, all Medicare Advantage plans offered by the insurance company in that state had to be rated overall with at least three out of five stars by CMS. U.S. News & World Report then averaged the CMS Star Ratings for each of the eligible plans and those companies with an average overall rating of 4.5 or more stars earned recognition as a Best Insurance Company for Medicare Advantage.
CMS rates all Medicare Advantage and prescription drug plans each year to assist Medicare beneficiaries and their families in comparing plans based on quality and performance. The CMS Five-Star Quality Rating System measures the experience Medicare beneficiaries have with their health plan and health care system. Ratings range from a low of “1” star, which is poor, to the highest possible “5” stars, which is excellent.
Enhanced Plan Benefits for 2022
Earlier this month, UPMC for Life announced new plans and improved benefits for its Medicare Advantage plans in 2022. Incorporating feedback from its members has enabled UPMC for Life to offer even more robust benefits and affordable plan options. These include:
- A new $0 monthly plan available in western Pennsylvania, UPMC for Life HMO Salute (HMO), is a great option for those who have U.S. Department of Veterans Affairs (VA) coverage and do not need separate Part D prescription drug coverage. Members get a $50 Part B premium reduction each month along with extra benefits like dental, vision, hearing, an allowance to buy health care products, and transportation.
- A new low-cost plan available in southwestern Pennsylvania that gives members the ability to customize their extra benefits with UPMC for Life HMO Access Rx (HMO). This plan has a $25 monthly premium, includes prescription drug coverage, and provides allowances for dental services, eyewear or contact lenses, hearing aids, and health care products. Members can also customize their plan by choosing enhanced dental, vision, or health care products benefits. This gives the member even more yearly allowance dollars in their chosen enhancement category to use toward their personalized health care needs.
- UPMC for Life also added two new PPO plans to their product portfolio in Central PA with the UPMC for Life PPO Flex (PPO) and UPMC for Life PPO Rx Choice (PPO) plans. The UPMC for Life PPO Flex Rx plan has a $0 monthly premium, prescription drug coverage, and broad provider access. Members get important extra benefits like comprehensive dental services, contact lenses or eyewear, hearing aids, health care products, and a FREE Fitbit with one-year FREE access to the Fitbit Premium app. The UPMC for Life PPO Rx Choice plan has a $29 monthly premium and gives members affordable medical coverage with broad provider access, a low $250 out-of-network deductible, and low costs for out-of-network services. Plus, members get allowances for comprehensive dental services, contact lenses or eyewear, hearing aids, and health care products.
UPMC for Life plans offer a “whole person” approach to health care with additional programs that can help members stay healthy, live independently, keep their health care costs low, and reach their health care goals. Members have access to the following benefits and programs:
- SilverSneakers®, | Fitbit (select plans) | RxWell | Health Coaching | UPMC Prescription for Wellness | Travel Concierge | Assist America | UPMC AnywhereCare | UPMC MyHealth 24/7 Nurse Line | Personal Counseling | Pharmacist Counseling | Caregiver Support | Support for Serious Illness | Bathroom/Home Safety | Resources for Life® | UPMC Health Plan Mobile App | MyHealth OnLine
Ways to Help Members Save Money
In 2022, UPMC for Life will continue its commitment to reducing the financial stress on members when accessing the health care system through the following:
- $0 Monthly Premium Plans – UPMC for Life offers plans with zero-dollar monthly premiums, making access to great benefits and services more affordable.
- Access to UPMC – UPMC for Life members have broad, in-network access to the best doctors and hospitals with UPMC. Members also have access to a large network of high-quality community doctors and hospitals, including 240 hospitals and more than 48,000 doctors.
- $0 Preventive Care Visits – UPMC for Life members will have no copays for recommended preventive care, such as an annual wellness visit, mammograms, colorectal screenings, and diabetic retinal eye exams.
- $0 Telehealth Copays – Most UPMC for Life members will not have copays when seeing their in-network PCP through a video visit. Members also have a reduced copay when seeing in-network specialists through telehealth.
- $0 Preferred Generic Prescriptions – Medications on Tier 1 of the UPMC for Life formulary have a $0 copay when filled at preferred pharmacies or through our mail-order pharmacy.
- Cost-Savings for Diabetic Prescriptions – All brand diabetes medications on Tier 2 of the UPMC for Life formulary continue to have copays as low as $10 for a 30-day supply when they are filled at a preferred pharmacy. Plus, in 2022, UPMC for Life members will be able to save hundreds of dollars when they fill covered diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays ($35 for a 30-day supply when filled at either a preferred or standard pharmacy, and $87.50 for a 90-day supply at a preferred pharmacy, or $105 at a standard pharmacy) in the Part D Initial Coverage and Coverage Gap (donut hole) stages. This applies to covered insulins filled at standard, preferred, or mail-order pharmacies.
- Additional “Donut Hole” Coverage for HMO Rx Members – Members of the UPMC for Life HMO Rx (HMO) plan will have additional coverage for generic Tier 1 and 2 drugs through the Medicare Part D Coverage Gap, otherwise known as the “donut hole.” Members pay the same copays in the Part D Initial Coverage and Coverage Gap (donut hole) stages. When filled at a preferred pharmacy, Tier 1 generic medications will have copays as low as $0 for a 30-day or 90-day supply and Tier 2 generic medications will have copays as low as $10 for a 30-day supply or $20 for a 90-day supply.
- Dental Services &ndasah; Members of UPMC for Life’s most popular plans can receive an increased allowance of up to $3,000 per year for comprehensive dental services like fillings, simple tooth extractions, root canals, bridges, crowns, denture repairs, and periodontal work.
- OTC Allowance – Members of some plans will receive an allowance of up to $50 per quarter to buy approved health care products through our mail-order catalog.
Enrollment Details
The 2022 Annual Election Period is Oct. 15 through Dec. 7, 2021. Medicare beneficiaries can add or drop Part D prescription coverage, switch their current plan, change to a Medicare Advantage plan, or change to Original Medicare. Changes in coverage will be effective Jan. 1, 2022. UPMC for Life’s 5-star rating from Medicare means that Medicare beneficiaries also have the ability to enroll in a UPMC for Life HMO or PPO plan even after the Annual Election Period is over through a Special Election Period. Medicare beneficiaries can use this Special Election Period only once between Dec. 8, 2021, and Nov. 30, 2022.
Medicare beneficiaries interested in UPMC for Life can enroll by phone or online from the comfort and safety of home. For information on the 2022 plans, go to upmchealthplan.com/medicare or call UPMC for Life toll-free at 1-877-381-3765 seven days a week from 7 a.m. to 9 p.m. TTY users should call 711.
Each year, Medicare evaluates plans based on a 5-star rating system. UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal.
Author: Amaury Abreu
