UPMC for Life PPO Salute (PPO) Medicare Advantage Plan H5533-016-1 • 2027
CMS Rating:
(4.5 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$50.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,453 beneficiaries
Last update:
UPMC for Life PPO Salute (PPO) Introduction
This Medicare Advantage PPO plan, UPMC for Life PPO Salute, is offered by UPMC for Life and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $9850.00. The plan is identified by CMS Plan ID H5533-016-1.
Plan Benefits
UPMC for Life PPO Salute 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 H5533-016-1.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Specialist | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Not covered |
| Telehealth benefit | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Outpatient x-rays | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | 20% coinsurance | 20% coinsurance |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | 20% coinsurance | 20% coinsurance |
| Inpatient hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $217 per day for days 21-100 Out-of-network: |
In-network: Tier 1 $0 per day for days 1-20 $209.5 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $209.5 per day for days 21-100 |
| Ground ambulance | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Outpatient group therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Occupational therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Periodontics | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 50% coinsurance Out-of-network: 50% coinsurance |
| Endodontics | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 50% coinsurance Out-of-network: 50% coinsurance |
| Restorative services | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 50% coinsurance Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 50% coinsurance Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Prescription hearing aids | In-network: $690-$1890 copay Out-of-network: $5000 copay |
In-network: $690-$1890 copay Out-of-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 Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Certain preventive services are covered 100% by UPMC for Life PPO Salute 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: H5533)
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
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 PPO Salute (H5533-016-1) is available in the following locations:
Pennsylvania Counties Served
- Adams
- Allegheny
- Armstrong
- Beaver
- Bedford
- Berks
- Blair
- Bradford
- Butler
- Cambria
- Cameron
- Carbon
- Centre
- Clarion
- Clearfield
- Clinton
- Columbia
- Crawford
- Cumberland
- Dauphin
- Elk
- Erie
- Fayette
- Forest
- Fulton
- Greene
- Huntingdon
- Indiana
- Jefferson
- Juniata
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Luzerne
- Lycoming
- Mckean
- Mercer
- Mifflin
- Monroe
- Montour
- Northampton
- Northumberland
- Perry
- Potter
- Snyder
- Somerset
- Sullivan
- Susquehanna
- Tioga
- Union
- Venango
- Warren
- Washington
- Wayne
- Westmoreland
- Wyoming
- York
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 PPO Salute (PPO)
Is there a monthly premium for this plan in 2027?
For 2027, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the in-network MOOP for plan H5533-016-1?
For 2027, the in-network maximum out-of-pocket is $9850.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H5533-016-1?
Total enrollment is 1,453 beneficiaries based on the latest CMS data.
Is there a Part D deductible for this plan?
The Part D deductible is $0.00.
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 |
| 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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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.