UPMC for Life PPO Salute (PPO) H5533-012 is a 2023 Medicare Advantage Plan or Part-C by UPMC for Life available to residents in Pennsylvania. This plan does not provide extra prescription drug (Part-D) coverage. UPMC for Life UPMC for Life PPO Salute (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be an extremely nice safety net.

UPMC for Life works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UPMC for Life PPO Salute (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UPMC for Life and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from UPMC for Life except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Pennsylvania.

2023 UPMC for Life Medicare Advantage Plan Overview

What type of plan is UPMC for Life PPO Salute (PPO)

UPMC for Life PPO Salute (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does UPMC for Life PPO Salute (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. UPMC for Life charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. UPMC for Life PPO Salute (PPO) by UPMC for Life MOOP is $5,500. Once you spend $5,500 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what UPMC for Life PPO Salute (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from UPMC for Life helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

In-Network Vision	$0 copay
Out-of-Network Vision	$0 copay

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Other

In-Network Vision	$0 copay
Out-of-Network Vision	50% coinsurance

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Routine eye exam

In-Network Vision	$0 copay
Out-of-Network Vision	50% coinsurance

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Upgrades

In-Network Vision	$0 copay
Out-of-Network Vision	$0 copay

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Transportation	Not covered
Out-of-Network Skilled Nursing Facility	In 2023 the amounts for each benefit period are: $0 copay for days 1 through 20 $200 copay per day for days 21 through 100
In-Network Skilled Nursing Facility	In 2023 the amounts for each benefit period are: $0 copay for days 1 through 20 $200 copay per day for days 21 through 100

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Occupational therapy visit

In-Network Rehabilitation services	20% coinsurance
Out-of-Network Rehabilitation services	20% coinsurance

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	20% coinsurance
In-Network Rehabilitation services	20% coinsurance

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Cleaning

Out-of-Network Preventive dental	50% coinsurance
In-Network Preventive dental	$0 copay

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Dental x-ray(s)

Out-of-Network Preventive dental	50% coinsurance
In-Network Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

Out-of-Network Preventive dental	50% coinsurance
In-Network Preventive dental	$0 copay

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	20% coinsurance per visit
Out-of-Network Outpatient hospital coverage	20% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
Out-of-Network Mental health services	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90

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Outpatient group therapy visit

Out-of-Network Mental health services	20% coinsurance
In-Network Mental health services	20% coinsurance

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	20% coinsurance
Out-of-Network Mental health services	20% coinsurance

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Outpatient individual therapy visit

In-Network Mental health services	20% coinsurance
Out-of-Network Mental health services	20% coinsurance

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Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	20% coinsurance
In-Network Mental health services	20% coinsurance

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Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20% coinsurance

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Diabetes supplies

In-Network Medical equipment/supplies	0-20% coinsurance per item
Out-of-Network Medical equipment/supplies	20% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $5,500 In-network
In-Network Inpatient hospital coverage	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
Out-of-Network Inpatient hospital coverage	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90

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Fitting/evaluation

Out-of-Network Hearing	50% coinsurance
In-Network Hearing	$0 copay

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Hearing aids

In-Network Hearing	$690-1,890 copay
Out-of-Network Hearing	$690-1,890 copay

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Hearing exam

In-Network Hearing	$0 copay
Out-of-Network Hearing	20% coinsurance

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Health plan deductible	$1,600 per year for inpatient hospital services and $226 for outpatient services with a total plan deductible of $1,826 per year from in-network and out-of-network providers.
In-Network Ground ambulance	0-20% coinsurance
Out-of-Network Ground ambulance	20% coinsurance

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	20% coinsurance
In-Network Foot care (podiatry services)	20% coinsurance

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	20% coinsurance per visit (always covered)

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Urgent care

Emergency care/Urgent care	20% coinsurance per visit (always covered)

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Primary

Out-of-Network Doctor visits	20% coinsurance per visit
In-Network Doctor visits	20% coinsurance per visit

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Specialist

Out-of-Network Doctor visits	20% coinsurance per visit
In-Network Doctor visits	20% coinsurance per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	20% coinsurance

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Diagnostic tests and procedures

Out-of-Network Diagnostic procedures/lab services/imaging	20% coinsurance
In-Network Diagnostic procedures/lab services/imaging	20% coinsurance

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	20% coinsurance

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Diagnostic services

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Endodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Extractions

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Non-routine services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Periodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Restorative services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	Yes, contact plan for further details

UPMC for Life PPO Salute (PPO) Reviews

Is UPMC for Life PPO Salute (PPO) a good plan? UPMC for Life PPO Salute (PPO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare UPMC For Life PPO Salute Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H5533-012 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for UPMC for Life

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for UPMC for Life PPO Salute (PPO) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.