What to know about UPMC's Medicare Advatange plans and vision coverage
The University of Pittsburgh Medical Center (UPMC) offers Medicare Advantage plans that include vision benefits. Its UPMC for Life plans are available across most of Pennsylvania and parts of Ohio.
Original Medicare plans do not generally include vision and eye care benefits.
Medicare Advantage plans provide all the benefits of Original Medicare parts A and B and often include additional coverage for vision, dental, and hearing services. Some UPMC Medicare Advantage plans provide these extra benefits.
Read on to learn more about UPMC Medicare Advantage plans, what vision coverage they offer, and more.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
UPMC Medicare Advantage vision coverage
Many Medicare Advantage plans offer vision care, including UPMC for Life.
These plans include a routine vision allowance that pays for one annual routine eye exam as well as glasses and contact lenses.
People do not need to visit an in-network healthcare provider. If the provider is in-network, they will send the bill directly to UPMC for payment up to the plan limits.
If an individual visits an out-of-network healthcare provider, they will typically pay out of pocket at the time of the appointment. They can then send a claim to UPMC for reimbursement within the vision allowance.
It is important to note that the plans do not cover glasses that someone needs after cataract surgery.
Learn more about Medicare coverage for eye exams.
About UPMC Medicare Advantage plans
UPMC is one of the Medicare-approved private insurance companies able to administer Medicare Advantage (Medicare Part C) plans across Pennsylvania and in parts of Ohio.
All private companies that administer these plans must follow Medicare’s coverage rules. However, they may also include additional benefits and provider network rules.
There are four common types of Medicare Advantage plans that UPMC offers, which are as follows:
HMO Dual Eligible Special Needs Plans (HMO D-SNP)
If a person requires vision care with their insurance, it is important to ensure that the specific plan they select includes vision coverage.
HMO plans
HMO plans have a healthcare provider network that a person must use for their care.
In some cases, such as emergencies, individuals can visit a provider out of the network, but the costs will be higher.
HMO D-SNP plans
HMO D-SNP plans combine HMO with D-SNPs. D-SNPs are suitable for people who are eligible for both Medicare and Medicaid.
The UPMC for Life Complete Care (HMO D-SNP) plan offers vision coverage and additional benefits such as:
a $0 copay for prescription drugs
hearing care
dental care
transportation services
access to SilverSneakers
home-delivered meals in some circumstances
PPO plans
The UPMC PPO plan has a provider network, but a person can also use services outside of the network.
Generally, it will cost less to go to an in-network provider.
UPMC Medicare Advantage costs
The cost for a Medicare Advantage plan with vision cover depends on where a person lives and can include:
in-network and out-of-network deductibles
coinsurance
The information below provides examples of some of the costs in 2025.
UPMC for Life HMO No Rx (HMO)
Costs associated with the UPMC for Life HMO No Rx (HMO) plan for people in Allegheny, PA, with the ZIP code 15108, include:
a monthly premium of $0
a health deductible of $0
a primary doctor copay of $0
a specialist copay of $25 per visit
an in-network maximum of $5,000
UPMC for Life PPO Essential Care Rx (PPO)
Costs associated with the UPMC for Life PPO Essential Care Rx (PPO) plan for people in Northampton, PA, with the ZIP code 18042, include:
a monthly premium of $0
a health deductible of $500
a primary doctor copay of $0
a specialist copay of $45 per visit
an in-network maximum of $8,000
an in- and out-of-network maximum of $11,500
Enrolling in Medicare Advantage
A person can enroll in a UPMC Medicare Advantage when they first become eligible for Medicare during the initial enrollment period (IEP).
The IEP runs for 7 months. It begins 3 months before a person turns 65 years, continues through their birth month, and ends 3 months after.
Individuals can also enroll during two other periods throughout the year.
The first is during the open enrollment period, which runs from October 15 to December 7 each year. During this time, a person can add or drop a Medicare Advantage plan.
The second time is during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 every year. During these months, a person can make only one change to their coverage, such as moving from one Medicare Advantage plan to another.
Learn more about Medicare enrollment periods.
Finding a UPMC Medicare Advantage plan
A person can look for a UPMC Medicare Advantage plan on the UPMC website by entering their ZIP code.
Alternatively, they can use the Medicare plan finder tool to search all available Medicare Advantage plans in their area.
Learn about choosing a Medicare Advantage plan.
Summary
The University of Pittsburgh Medical Center (UPMC) offers Medicare Advantage plans in many areas of Pennsylvania and some parts of Ohio. It has Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans available, which typically include vision care such as eye exams and help with the costs of glasses.
Each Medicare Advantage plan has costs that include a monthly premium, deductibles, and copayments. The costs will depend on a person’s location.
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