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UPMC

UPMC for Life HMO Rx Enhanced (HMO)

HMO
UPMC
Last Updated: 
May 23, 2026
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Basic Costs and Coverage

Monthly premiums, deductibles, and core cost-sharing amounts.

CoverageCost
Monthly plan premium $295.00
Vision coverage true
Dental coverage true
Hearing coverage true
Prescription drug coverage true
Medical deductible $0.00
Out-of-pocket maximum
In$7,550.00
Combined$7,550.00
Initial drug coverage limit $0.00
Catastrophic drug coverage limit $2,100.00
Primary care doctor visit $0.00
Specialty doctor visit $10
Inpatient hospital care $125.00
Urgent care $40.00
Emergency room visit $115
Ambulance transportation $50.00

Health Care Services and Medical Supplies

Specialist services, therapies, and equipment.

ServiceCost
Chiropractic services Included
Diabetes supplies, training, nutrition therapy Included
Durable medical equipment (DME) 20%
Diagnostic tests, lab, radiology, X-rays $75.00
Home health care BIncluded
Mental health inpatient care Included
Mental health outpatient care Included
Outpatient services / surgery Included
Outpatient substance abuse care Included
Over-the-counter items Not covered Not specified
Podiatry services Included
Skilled Nursing Facility (SNF) care $0.00

Dental Benefits

Preventive and comprehensive dental coverage.

CoverageCost & limits
Preventive dental Included
Comprehensive dental — covered? No
Annual dental maximum Included
Comprehensive dental — annual max Not covered

Vision Benefits

Routine Eye Exams and Eyewear.

CoverageCost & limits
Routine eye exam
In$10.00 $0.00
Out$75 copay · 1 per year
Eyeglass frames & lenses $450.00
Eyewear allowance $450.00
Eye exam — covered? No
Eye exam supplement — max coverage Not covered

Hearing Benefits

Hearing exams, fittings, and aids.

CoverageCost & limits
Hearing exam
In$0.00
Out$10.00
Hearing exam — covered? No
Hearing aid fitting — covered? No
Hearing aid fitting cost Not covered
Hearing aids — covered? No
Hearing aids — max coverage $690.00

Preventive Services

All Medicare-covered preventive services at $0 in-network.

In-Network: $0.00 copay for all Medicare-covered preventive services.
  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis B (HBV) infection screening
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time Welcome to Medicare preventive visit
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening & counseling
  • Shots: COVID-19 · Flu · Hepatitis B · Pneumococcal
  • Tobacco use cessation
  • Yearly "Wellness" visit
Fitness / Wellness program: Not specified

Prescription Drug Costs and Coverage

Part D formulary tiers and supply length pricing.

Annual drug deductible: $0.00
Tier Drug type 30-day retail 30-day mail 90-day mail
1 Preferred generic Lowest-cost generic drugs $0.00 $0.00 $0.00
2 Generic Standard generic drugs $0.00 $0.00 $0.00
3 Preferred brand Preferred brand-name drugs 25% 25% 25%
4 Non-preferred brand Non-preferred brand drugs 50% 50% 50%
5 Specialty tier Specialty medications 33% 33% 33%

Not sure if this plan is right for you?

Peter Abilla is a licensed Medicare agent. He can walk you through this plan's costs, coverage, and whether your doctors are in-network.

Book a Free Plan Review
Independent agent. Not affiliated with any insurance carrier.
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Smiling elderly man sees urologist paid for by medicare and young boy in a garden surrounded by blooming yellow and pink roses, the boy holding a gardening tool.Older couple have no medicare benefits because they were late to enroll, standing outdoors hugging near snow-covered evergreen trees in winter.Smiling elderly couple both under 65 and wish they had medicare sitting outdoors wrapped in warm clothing with a child standing behind them, hugging and laughing.
Overall Rating
Part C Rating
Part D Rating

Where Is This Plan Available?

Riverside

Meyersdale

McDonald

New Eagle

Moscow

Mount Holly Springs

Cleona

Port Allegany

Topton

Pine Grove

Leechburg

New Wilmington

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See Interactive Medicare Tools

Decision area Tool What it answers
Enrollment Initial Enrollment Period Calculator When your 7-month Medicare eligibility window begins and ends based on your 65th birthday
Enrollment When Should I Sign Up for Medicare? The best time to enroll based on your work status, other coverage, and age
Enrollment Special Enrollment Period Checker Whether a life event qualifies you for enrollment outside the standard windows
Enrollment Late Enrollment Penalty Checker How much extra you'll pay monthly if you missed your enrollment window
Enrollment Part B Penalty Calculator The exact 10%-per-year premium increase for delayed Part B enrollment
Enrollment Part D Penalty Calculator The 1%-per-month premium increase for gaps in creditable drug coverage
Costs Cost Scenario Planner Estimated annual spending across plan types at different health utilization levels
Costs Advantage vs. Medigap Cost Comparison True cost difference between Medicare Advantage and Original Medicare with Medigap
Costs IRMAA Calculator Whether your income triggers higher Part B and Part D premiums
Costs Part A Premium Estimator Your monthly Part A premium based on work history and quarters of coverage
Costs M3P Calculator How the Medicare Prescription Payment Plan smooths your drug costs into monthly payments
Coverage Doctor & Drug Assessment Whether your providers and prescriptions are covered by a specific plan
Coverage Part D Shopping Tool Which Part D plan has the lowest total annual cost for your specific medications
Coverage Travel & Network Risk Assessment How your coverage works outside your home area and which plan types travel best
Employer/COBRA COBRA vs. Medicare Why COBRA can trigger permanent Medicare penalties and how costs compare
Employer/COBRA Employer Coverage vs. Medicare Whether your employer plan or Medicare is primary and when to transition
Employer/COBRA HSA & Medicare Compatibility How Medicare enrollment affects HSA eligibility and what to do before enrolling
Planning Caregiver Readiness Checklist Whether you have everything in place to help a loved one with Medicare decisions
Planning Document Gatherer Which documents you need to have ready before enrolling or changing plans
Planning Medigap Fit Assessment Whether Medigap or Medicare Advantage is the better fit for how you use healthcare
Planning Medigap Open Enrollment Window Whether you're inside your one-time guaranteed issue window for Medigap
Planning Medicare Savings Program Eligibility Whether your income qualifies you for help paying Medicare premiums and cost-sharing
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Medicare Questions About 

Medicare Advantage Prescription Drug HMO Plans

 Plans

Do I need a new Medicare Advantage plan if I move to Utah?

What is MOOP and why does it matter for Medicare?

Which Utah Medicare Advantage plans have the fewest prior authorization headaches?

Which Utah D-SNP plans are available in my area?

What is the maximum out-of-pocket on Medicare Advantage plans?

Which Utah Medicare Advantage plans are too narrow for someone who wants flexibility?

Understanding 

Medicare Advantage Prescription Drug HMO Plans

A Medicare Advantage HMO gives you all your Medicare benefits through one plan, usually with a $0 or low monthly premium. You pick a primary care doctor who coordinates your care. Referrals are required to see specialists. You must use doctors in the plan's network except in emergencies. These plans tend to have the lowest premiums and copays of any Medicare Advantage option.

An HMO is a good fit if you live near network providers and don't need a lot of flexibility in who you see. Because the plan routes care through your primary doctor, it works well for people who want coordinated care and are okay trading some choice for lower costs. If you're willing to call your primary care doctor before seeing a specialist, an HMO typically rewards you with lower out-of-pocket costs throughout the year.

Before enrolling, check whether your current doctors and preferred hospitals are in the plan's network. In Utah, many HMO plans are anchored to either Intermountain Health or University of Utah Health — but not both. That matters if you've been seeing doctors at both systems. In Ohio and Pennsylvania, network boundaries vary significantly by carrier and county.

Compare the plan's maximum out-of-pocket limit alongside the premium. A $0 monthly premium with a $7,550 annual out-of-pocket cap is a different financial risk than a $45/month plan with a $3,400 cap. Think about how much care you typically use each year before deciding which structure makes more sense for you.

Go to Plan Type
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HMO vs PPO — Which Is Right for You?

Summary of Benefits

Evidence of Coverage

Star Ratings Report

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Not sure if this plan is right for you?

Peter Abilla is a licensed Medicare agent. He can walk you through this plan's costs, coverage, and whether your doctors are in-network.

Book a Free Plan Review
Independent agent. Not affiliated with any insurance carrier.
Elderly man smiling and showing yellow roses to a young boy in a sunlit garden.

‍CMS TPMO Compliance Disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

Not Government Affiliated: Resting Sycamore Advisors is a licensed Medicare insurance agency. We are not affiliated with or endorsed by the U.S. government or the federal Medicare program.

‍Data & Methodology for Research Articles: All provider, facility, quality star ratings, and enrollment data is sourced from primary CMS records (cms.gov), including the December 2025 CPSC Enrollment files and the January 2026 Provider Data Catalog. Calculations for patient-to-provider ratios are performed using indexed clinician and facility data. Everything on restingsycamore.com is for educational purposes and does not constitute an endorsement of any specific plan or provider.

Non-CMS Data Sources: Some  specific data was obtained from https://opendata.gov