Plan year 2026 · coverage ends Dec. 31, 2026CMS crosswalk of Oct. 1, 2026
UPMC for Life PPO Rx Choice is not offered under this ID in 2027
H5533Contract015Plan
PPO · served 30 counties in Pennsylvania in 2026
Run by UPMC Health Network, Inc. (contract H5533), sold as UPMC for Life, owned by UPMC Health System
CMS crosswalk: renews as H5533-019 in 1 of its 30 counties; in the others the plan ends
UPMC for Life PPO Rx Choice (H5533-015) is not offered under this ID in 2027. The CMS plan crosswalk of October 1, 2026 moves its members into UPMC for Life PPO Rx Choice (H5533-019) (the plan renews under a new ID), in the 1 county where that plan is sold (17,993 members in September 2026). In its other 29 counties (16,457 members) there is no plan to move into: coverage ends December 31, 2026, and members there need to choose a new plan.
What changes for its members in UPMC for Life PPO Rx Choice?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $25 to $34 | $33 | ▲up $8 |
| In-network out-of-pocket limit, by county | $5,500 to $6,000 | $5,500 | ▼down $500 at the top |
| Drug deductible | $400 | $700 | ▲up $300 |
| Part B premium reduction, monthly (best in its area) | $2 | $1 | ▼down $1 |
| Hospital stay, in network (best in its area) | $250 a stay | $175 a day for days 1–3, then $0 a day for days 4–90 | changed |
| Skilled nursing facility, in network (best in its area) | $10 a day for days 1–20, then $210 a day for days 21–100 | $10 a day for days 1–20, then $221 a day for days 21–100 | ▲up $110for a 30-day stay |
| Eyewear, yearly limit (best in its area) | $300 a year | $175 a year | ▼down $125 |
| Counties served | 30 | 1 | ▼down 29 |
| Drug tier 4, non-preferred drug | 37% of the cost | 28% of the cost | ▼down 9 points |
| Drug tier 5, specialty tier | 28% of the cost | 25% of the cost | ▼down 3 points |
| 11 lines do not change | |||
| Primary care visit (best in its area) | $0 copay | $0 copay | no change |
| Specialist visit (best in its area) | $20 copay | $20 copay | no change |
| Emergency room (best in its area) | $130 copay | $130 copay | no change |
| Medical deductible, in network (best in its area) | none | none | no change |
| Ground ambulance, in network (best in its area) | $50 copay | $50 copay | no change |
| Comprehensive dental, yearly limit (best in its area) | $6,000 a year | $6,000 a year | no change |
| Hearing aids, yearly limit for both ears (best in its area) | not offered | not offered | no change |
| Over-the-counter items, yearly (best in its area) | not offered | not offered | no change |
| Drug tier 1, preferred generic | $15 | $15 | no change |
| Drug tier 2, generic | $20 | $20 | no change |
| Drug tier 3, preferred brand | 25% of the cost | 25% of the cost | no change |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026. Your plan's Annual Notice of Change is the letter that confirms your 2027 plan; confirm on Medicare Plan Finder.
What can members do, and by when?
If you live in Allegheny (PA)
- If you do nothing
- You are moved into UPMC for Life PPO Rx Choice on January 1, 2027.
- October 15 to December 7, 2026
- Open enrollment: choose another Medicare Advantage plan, or Original Medicare with a drug plan, instead.
If you live in Armstrong (PA), Beaver (PA), Butler (PA), Cameron (PA), Carbon (PA), Clarion (PA), Clearfield (PA), Crawford (PA), Cumberland (PA), Dauphin (PA), Erie (PA), Fayette (PA), Greene (PA), Indiana (PA), Lancaster (PA), Lawrence (PA), Lebanon (PA), Lycoming (PA), McKean (PA), Mercer (PA), Montour (PA), Perry (PA), Potter (PA), Union (PA), Venango (PA), Warren (PA), Washington (PA), Westmoreland (PA), York (PA)
- Your coverage
- Ends December 31, 2026: UPMC for Life PPO Rx Choice is not sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, without a drug plan unless you join one (with Extra Help or full Medicaid, Medicare enrolls you in one).
- Without a drug plan
- Going 63 days or more in a row without drug coverage can mean a late enrollment penalty if you join a drug plan later; joining by the end of February keeps a January and February gap under 63 days, waiting longer does not.
Source: Medicare.gov, “Special enrollment periods” and “Joining a plan” (read Oct. 7, 2026).
Where did its members live?
Where its members lived in September 2026; each county and state page lists the 2027 plans sold there.
| County | Members, Sept. 2026 | For 2027 |
|---|---|---|
| Allegheny, PA | 17,993 | moves into H5533-019 |
| Westmoreland, PA | 3,290 | plan ends here |
| Washington, PA | 1,429 | plan ends here |
| Butler, PA | 1,416 | plan ends here |
| Fayette, PA | 1,067 | plan ends here |
| Beaver, PA | 1,061 | plan ends here |
| Indiana, PA | 958 | plan ends here |
| York, PA | 829 | plan ends here |
| Erie, PA | 756 | plan ends here |
| Clearfield, PA | 606 | plan ends here |
| Lawrence, PA | 594 | plan ends here |
| Mercer, PA | 549 | plan ends here |
| Armstrong, PA | 458 | plan ends here |
| Lancaster, PA | 452 | plan ends here |
| Cumberland, PA | 422 | plan ends here |
| Venango, PA | 393 | plan ends here |
| Crawford, PA | 363 | plan ends here |
| Dauphin, PA | 339 | plan ends here |
| McKean, PA | 291 | plan ends here |
| Lycoming, PA | 267 | plan ends here |
Show the other 10 counties
Source: CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11).
What else should you check?
- 2027 plans in Allegheny, PAThe plans you can join instead
- UPMC for Life plans for 2027Plans the same company still offers
- Every plan not offered in 2027764 Medicare Advantage and drug plans