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UPMC for Life HMO Rx Enhanced (HMO) Medicare Advantage Plan H3907-006 • 2027

CMS Rating: ☆☆☆☆☆ (4.5 out of 5 stars*)
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
See List
Total Enrollment
880 beneficiaries
Last update:

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.

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.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $10 copay In-network: $10 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam Not covered Not covered
Telehealth benefit In-network: $0-$10 copay In-network: $0-$10 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services In-network: $0 copay In-network: $0 copay
Over-the-counter drug benefits Not covered Not covered
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $75 copay In-network: $75 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $10 copay In-network: $10 copay
Diagnostic tests and procedures In-network: $0 copay In-network: $0 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $115 copay $115 copay
Worldwide emergency care Coming soon $115 copay
Urgent care $40 copay $40 copay
Inpatient hospital care Tier 1
$125 per stay		 Tier 1
$125 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$125 per day for days 21-100		 Tier 1
$0 per day for days 1-20
$60 per day for days 21-100
Ground ambulance In-network: $50-$100 copay In-network: $50-$100 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $10 copay In-network: $10 copay
Outpatient group therapy In-network: $10 copay In-network: $10 copay
Inpatient psychiatric hospital care Tier 1
$125 per stay		 Tier 1
$125 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $10 copay In-network: $10 copay
Occupational therapy In-network: $10 copay In-network: $10 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $15 copay
Dental x-rays In-network: $0 copay In-network: $15 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: 50% coinsurance In-network: 50% coinsurance
Endodontics In-network: 50% coinsurance In-network: 50% coinsurance
Restorative services In-network: 50% coinsurance In-network: 50% coinsurance
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 50% coinsurance In-network: 50% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades In-network: $0 copay In-network: $0 copay

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $690-$1890 copay In-network: $690-$1890 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices In-network: $0 copay 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.

UPMC for Life HMO Rx Enhanced (H3907-006-0) Prescription Drug Plan Premium Details
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.

UPMC for Life HMO Rx Enhanced (H3907-006-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$0.00 copayComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug38% coinsuranceComing soon
Specialty Tier33% coinsuranceComing 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.

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 ☆☆☆☆☆

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.

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About UPMC for Life HMO Rx Enhanced (HMO)

How much does plan H3907-006 cost per month?

For 2027, the monthly premium is $295.00. Medicare Part B premiums apply in addition to this amount.

What is the MOOP for UPMC for Life HMO Rx Enhanced in 2027?

The 2027 in-network MOOP is $7550.00. Once this limit is reached, covered in-network costs are fully covered.

What is the CMS star rating for this plan?

For 2027, plan H3907-006 has a CMS star rating of ★4.5 out of 5 stars.

What is the total enrollment for plan H3907-006?

Total enrollment is 880 beneficiaries based on the latest CMS data.

What is the Part D deductible for plan H3907-006?

The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
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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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.