UPMC for Life HMO Rx Enhanced (HMO) Medicare Advantage Plan H3907-006 • 2027 • Jefferson County, OH
- Monthly Premium
- $295.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7550.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Jefferson County, OH
- Local Enrollment
- 0 beneficiaries in Jefferson County
UPMC for Life HMO Rx Enhanced (HMO) Introduction
CMS Plan ID H3907-006 identifies UPMC for Life HMO Rx Enhanced, a Medicare Advantage HMO plan offered by UPMC for Life. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $295.00 monthly premium, $0.00 medical deductible, and $7550.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.
This plan is available to eligible beneficiaries who live in Jefferson County, Ohio. CMS reports local enrollment of 0 beneficiaries for this plan in Jefferson County. New members can contact the plan at (877)381-3765 (TTY 711) for help and additional plan information.
Compare Similar Plans in Jefferson County
Compare this plan with the two most-enrolled HMO plans available in Jefferson County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | UPMC for Life HMO Rx Enhanced | The Health Plan SecureCare - Option II | UPMC for Life HMO Rx Choice |
|---|---|---|---|
| CMS Plan ID | H3907-006-0 |
H3672-020-0 |
H3907-057-2 |
| Local Enrollment | 0 | 89 | 37 |
| Monthly Premium | $295.00 | $13.00 | $33.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $7,550.00 | $7,500.00 | $6,000.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $15 copay | $0 copay |
| Specialist | $10 copay | $45 copay | $35 copay |
| Part D Deductible | $0.00 | $395.00 | $700.00 |
| CMS Star Rating | 4.5 | 3.5 | 4.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Jefferson County, or compare Medicare Advantage plans across Ohio, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
UPMC for Life HMO Rx Enhanced has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3907-006.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3907-006-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $10 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0-$10 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- In-network: $0 copay
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $75 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $10 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- Tier 1
$125 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$125 per day for days 21-100 - Ground ambulance
- In-network: $50-$100 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $10 copay
- Outpatient group therapy
- In-network: $10 copay
- Inpatient psychiatric hospital care
- Tier 1
$125 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $10 copay
- Occupational therapy
- In-network: $10 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 Rx Enhanced as a Part B benefit.
Prescription Drug Coverage
UPMC for Life HMO Rx Enhanced includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $68.80 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $68.80 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $12.80 |
| Low-Income Subsidy Premium: | $56.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UPMC for Life starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, UPMC for Life HMO Rx Enhanced may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 38% coinsurance | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3907)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| 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 |
Contact Information for UPMC for Life
- Website
- UPMC for Life Plan Page
- Providers
- UPMC for Life Providers Page
- Formulary
- UPMC for Life Formulary Page
- Pharmacy
- UPMC for Life Pharmacy Page
- New Member Health Plan Help
- (877)381-3765
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)381-3765
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
UPMC for Life HMO Rx Enhanced is available to eligible Medicare beneficiaries residing in Jefferson County, Ohio, including communities such as Adena, Amsterdam, Bergholz, Bloomingdale, Dillonvale, Mingo Junction, Rayland, Richmond, Steubenville, Toronto, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| UPMC for Life (official source) | https://www.upmchealthplan.com/medicare/ | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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