Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
UPMC for Life PPO Rx Choice, 2027
H5533Contract019Plan
PPO · 1 county in Pennsylvania
Run by UPMC Health Network, Inc. (contract H5533), sold as UPMC for Life, owned by UPMC Health System
UPMC for Life PPO Rx Choice (H5533-019) costs $33 a month in 2027, with an in-network out-of-pocket limit of $5,500. It is a new plan for 2027. It takes in the members of H5533-015.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | not offered | $33 | new for 2027 |
| In-network out-of-pocket limit | not filed | $5,500 | new for 2027 |
| Drug deductible | not filed | $700 | new for 2027 |
| Part B premium reduction, monthly | none | $1 | ▲added |
| Primary care visit | not offered | $0 copay | changed |
| Specialist visit | not offered | $20 copay | changed |
| Emergency room | not offered | $130 copay | changed |
| Hospital stay, in network | not offered | $175 a day for days 1–3, then $0 a day for days 4–90 | changed |
| Skilled nursing facility, in network | not offered | $10 a day for days 1–20, then $221 a day for days 21–100 | changed |
| Ground ambulance, in network | not offered | $50 copay | changed |
| Comprehensive dental, yearly limit | not offered | $6,000 a year | ▲added |
| Eyewear, yearly limit | not offered | $175 a year | ▲added |
| 4 lines do not change | |||
| Medical deductible, in network | none | none | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Over-the-counter items, yearly | not offered | not offered | no change |
| Counties served | not offered | 1 | new for 2027 |
Source: 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; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026, standard pharmacy | 2027, standard pharmacy | 2027, preferred pharmacy |
|---|---|---|---|---|
| Tier 1 | Preferred Generic | not offered | $15 | $0 |
| Tier 2 | Generic | not offered | $20 | $0 |
| Tier 3 | Preferred Brand | not offered | 25% of the cost | 25% of the cost |
| Tier 4 | Non-Preferred Drug | not offered | 28% of the cost | 28% of the cost |
| Tier 5 | Specialty Tier | not offered | 25% of the cost | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 60 plans open to everyone are sold for 2027, this one included. Against the others, 8 plans have a lower out-of-pocket limit, 7 the same, 44 a higher one. On the premium, 40 plans have a lower premium, 1 the same, 18 a higher one.
Out-of-pocket limits of the 60 plans open to everyone
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 1 county: $33 a month and $5,500.
Pennsylvania
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Which 2026 plans move into it, and what changes for their members?
For 2027 this plan takes in the members of 1 other plan. In 2027 it costs $33 a month with a $5,500 limit; each row compares that with the plan its members had in 2026.
| 2026 plan | Members, Sept. 2026 | Members who move | Premium 2026 | Premium change | Limit 2026 | Limit change |
|---|---|---|---|---|---|---|
| UPMC for Life PPO Rx ChoiceH5533-015 | 34,482 | 17,993 | $25 to $34 | ▲up $8 | $5,500 | no change |
Only the members of UPMC for Life PPO Rx Choice (H5533-015) who live in the 1 county where this plan is sold move into it (17,993 of its 34,482 members); in its other 29 counties the plan ends and members choose a new one. What happens where.
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision). Each moving plan's own page lists every line that changes for its members.
Who runs this plan?
- Plan ID
- H5533-019
- Legal name of the contract
- UPMC Health Network, Inc.
- Sold as
- UPMC for Life
- Parent company
- UPMC Health System
- Plan type
- PPO
- 2026 star rating of the contract
- 4.5 of 5 overall; health plan 4.5 of 5, drug plan 4.5 of 5
- Plan website, as filed with CMS
- https://www.upmchealthplan.com/medicare/
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Allegheny, PAWhere most of its members live; premiums and limits side by side
- Every UPMC for Life plan for 2027Its contracts, counties and plans that end
- The other 7 plans of contract H5533Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.