UPMC for Life HMO Rx Choice (HMO) Medicare Advantage Plan H3907-057-3 • 2027
- Monthly Premium
- $33.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6000.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 42,693 beneficiaries
UPMC for Life HMO Rx Choice (HMO) Introduction
This Medicare Advantage HMO plan, UPMC for Life HMO Rx Choice, is offered by UPMC for Life and uses a Health Maintenance Organization (HMO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $33.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $6000.00. The plan is identified by CMS Plan ID H3907-057-3. The 2027 Part D prescription drug deductible is $700.00.
Plan Benefits
UPMC for Life HMO Rx Choice includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H3907-057-3.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $35 copay | In-network: $35 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Not covered |
| Telehealth benefit | In-network: $0-$35 copay | In-network: $0-$35 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 | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $275 copay | In-network: $220 copay |
| Lab services | In-network: $10 copay | In-network: $5 copay |
| Outpatient x-rays | In-network: $25 copay | In-network: $25 copay |
| Diagnostic tests and procedures | In-network: $10 copay | In-network: $5 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $130 copay |
| Worldwide emergency care | Coming soon | $130 copay |
| Urgent care | $50 copay | $50 copay |
| Inpatient hospital care | Tier 1 $250 per stay Tier 2 $395 per stay |
Tier 1 $250 per stay Tier 2 $395 per stay |
| Skilled Nursing Facility | Tier 1 $10 per day for days 1-20 $221 per day for days 21-100 |
Tier 1 $10 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $50-$270 copay | In-network: $50-$270 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $35 copay | In-network: $35 copay |
| Outpatient group therapy | In-network: $35 copay | In-network: $35 copay |
| Inpatient psychiatric hospital care | Tier 1 $250 per stay Tier 2 $395 per stay |
Tier 1 $250 per stay Tier 2 $395 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay | In-network: $35 copay |
| Occupational therapy | In-network: $35 copay | In-network: $35 copay |
Medical Equipment and Supplies
| 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
| 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
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 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
| 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
| 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
| 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 Choice as a Part B benefit.
Prescription Drug Coverage
UPMC for Life HMO Rx Choice 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: | $30.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $30.00 |
| Low-Income Premium Subsidy: | $12.80 |
| Low-Income Premium Subsidy Paid by CMS: | $12.80 |
| Low-Income Subsidy Premium: | $17.20 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 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 Choice 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 | 28% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
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.
| 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.
Plan Availability
UPMC for Life HMO Rx Choice (H3907-057-3) is available in the following locations:
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 Choice (HMO)
Is there a monthly premium for this plan in 2027?
For 2027, the monthly premium is $33.00. Medicare Part B premiums apply in addition to this amount.
What is the in-network MOOP for plan H3907-057-3?
The 2027 in-network MOOP is $6000.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for this plan?
The 2027 CMS star rating for UPMC for Life HMO Rx Choice is ★4.5 out of 5.
What is the current enrollment for UPMC for Life HMO Rx Choice?
The plan has 42,693 enrolled beneficiaries according to CMS.
What is the Part D deductible for plan H3907-057-3?
For 2027, the prescription drug deductible is $700.00.
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 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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