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UPMC for Life HMO No Rx (HMO) Medicare Advantage Plan H3907-002 • 2027 • Harrison County, OH

CMS Rating: ☆☆☆☆☆ (4.5 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6500.00In-network
Part B Giveback
−$140.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Harrison County, OH
Local Enrollment
0 beneficiaries in Harrison County
Last update:

UPMC for Life HMO No Rx (HMO) Introduction

CMS Plan ID H3907-002 identifies UPMC for Life HMO No Rx, a Medicare Advantage HMO plan offered by UPMC for Life. The plan uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $6500.00 in-network maximum out-of-pocket.

Eligible Medicare beneficiaries residing in Harrison County, Ohio can enroll in this plan. CMS reports local enrollment of 0 beneficiaries for this plan in Harrison County. New members can contact the plan at (877)381-3765 (TTY 711) for help and additional plan information.

Compare Similar Plans in Harrison County

Compare this plan with the two most-enrolled HMO plans available in Harrison County, Ohio. Enrollment is based on CMS local enrollment data.

HMO plan comparison for Harrison County, Ohio
Plan Detail UPMC for Life HMO No Rx The Health Plan SecureCare - Option II DEVOTED GIVEBACK 003 OH
CMS Plan ID H3907-002-0 H3672-020-0 H2697-003-0
Local Enrollment 0 27 11
Monthly Premium $0.00 $13.00 $0.00
Medical Deductible $0.00 $0.00 $165
Maximum Out-of-Pocket $6,500.00 $7,500.00 $8,000.00
Part B Giveback −$140.00 reduction Not offered −$184.70 reduction
Primary Care $0 copay $15 copay $0 copay
Specialist $40 copay $45 copay $45 copay
Part D Deductible Not Applicable $395.00 $461.00
CMS Star Rating 4.5 3.5 4.0
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

Cost-sharing for UPMC for Life HMO No Rx includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H3907-002.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3907-002-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $40 copay

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
In-network: $0-$40 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
In-network: $0 copay
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $200 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$130 copay
Worldwide emergency care
Coming soon
Urgent care
$50 copay
Inpatient hospital care
Tier 1
$495 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$80 per day for days 21-100
Ground ambulance
In-network: $50-$290 copay

Mental Health Services

Outpatient individual therapy
In-network: $40 copay
Outpatient group therapy
In-network: $40 copay
Inpatient psychiatric hospital care
Tier 1
$495 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $40 copay
Occupational therapy
In-network: $40 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: 0%-20% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Dental x-rays
In-network: $0 copay
Cleaning
In-network: $0 copay
Periodontics
In-network: 50% coinsurance
Endodontics
In-network: 50% coinsurance
Restorative services
In-network: 50% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: 50% coinsurance

Vision Services

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
In-network: $0 copay

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Prescription hearing aids
In-network: $690-$1890 copay
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
In-network: $0 copay

Certain preventive services are covered 100% by UPMC for Life HMO No Rx as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H3907)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H3907
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
UPMC for Life (official source) https://www.upmchealthplan.com October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Your coverage options 25 May, 2025

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.