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Medicare Advantage · Local PPO · 2027

UPMC for Life PPO Rx Enhanced (PPO)

UPMC for Life H5533-0054.5 CMS rating for 2027
Is it offered where you live?

No referral needed to see a specialist

At a glance: $155 monthly premium and $0 primary care visits.

Monthly premium
$155
Part B premium separate
Yearly limit
$7,550
Most you’d pay for in-network care
Dental
$1,000/yr
Comprehensive dental allowance
Doctor visits
$0
Primary care · specialists $40

Check this plan for you

Add your doctors and prescriptions to see how they work with this plan.

Your doctors
Not checked yetSee if they’re in this plan’s network
Your prescriptions
Not checked yetSee your drug tier and monthly cost
Extra benefits
4 includedDental · Hearing · Vision · Fitness

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TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

Costs and copays

Deductibles, yearly limit, visits, hospital stays and drug tiers
DeductiblesMedical · $0 for drugs
$500
Yearly limitIn-network care, not counting drugs
$7,550
Yearly limit, in and out of networkCombined, not counting drugs
$11,300
Primary doctorPer visit
$0
SpecialistPer visit · no referral needed
$40
Hospital stayNo limit on covered hospital days
$250 per stay
Inpatient mental healthHospital stay
$250 per stay
Outpatient surgeryPer procedure
$150
Emergency roomPer visit
$115
Urgent carePer visit
$40
Tier 1 · Preferred Generic30-day supply at a retail pharmacy
$0
Tier 2 · Generic30-day supply at a retail pharmacy
$0
Tier 3 · Preferred Brand30-day supply at a retail pharmacy
25%
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
40%
Tier 5 · Specialty30-day supply at a retail pharmacy
33%

Our take

Where this plan shines, and what to know

Where this plan shines

  • See your primary doctor for $0.
  • No separate drug deductible.
  • Highly rated by CMS (4.5 stars).

Things to know before you enroll

  • This plan’s out-of-pocket maximum is above the national median.
  • Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in Pennsylvania

Common questions

6 answers about this plan

What does UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) cover?

UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental ($1,000/yr comprehensive dental allowance), vision ($250/yr eyewear allowance), hearing ($690–$1,890 copay per hearing aid), and fitness ($0 fitness benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) cost in 2027?

The published 2027 monthly plan premium for UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) is $155. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $500. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $7,550; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $40. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with UPMC for Life PPO Rx Enhanced (PPO) (Local PPO)?

CMS lists UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) as a Local PPO plan. The plan record says specialist referrals are not required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) cover my prescriptions?

UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) has 5 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $0, Tier 2 at $0, Tier 3 at 25%, Tier 4 at 40%, and Tier 5 at 33%. The listed Part D deductible is $0. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

Check your prescriptions

What dental, vision, and hearing benefits does UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) include?

The current plan record for UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) lists dental ($1,000/yr comprehensive dental allowance), vision ($250/yr eyewear allowance), and hearing ($690–$1,890 copay per hearing aid). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in UPMC for Life PPO Rx Enhanced (PPO) (Local PPO)?

UPMC for Life PPO Rx Enhanced (PPO) (Local PPO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

Evidence of Coverage

Talk to a licensed agent

Talk with a licensed advisor

A licensed agent can review this plan and other plans in your area that fit your needs.

TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

UPMC for Life PPO Rx Enhanced H5533-005 (PPO) — 2027 Costs & Benefits