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UPMC for Life PPO Salute (PPO)

H5533 - 016 - 2
4.5 out of 5 stars (4.5 / 5)

UPMC for Life PPO Salute (PPO) is a Medicare Advantage Plan by UPMC for Life.

This page features plan details for 2025 UPMC for Life PPO Salute (PPO) H5533 – 016 – 2 available in Western, Central, and Northeastern Pennsylvania.

Locations

UPMC for Life PPO Salute (PPO) is offered in the following locations.

Bucks County, Pennsylvania
Chester County, Pennsylvania
Delaware County, Pennsylvania

Click to see more locations

Plan Overview

UPMC for Life PPO Salute (PPO) offers the following coverage and cost-sharing.

Insurer:UPMC for Life
Health Plan Deductible:Coming soon
MOOP:$10,100 In and Out-of-network
$6,750 In-network
Drugs Covered:No

Ready to sign up for UPMC for Life PPO Salute (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

UPMC for Life PPO Salute (PPO) qualifies for a monthly Medicare Give Back Benefit of $45.00.

Premium Reduction:$45.00

Premium Breakdown

UPMC for Life PPO Salute (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $45.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

UPMC for Life PPO Salute (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Endodontics
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: 50 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: 20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 20% coinsurance (Authorization Required)
    • In-Network: 20% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: 20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Specialist
    • Out-of-Network: 20% coinsurance per visit
  • Primary
    • In-Network: 20% coinsurance per visit
  • Specialist
    • In-Network: 20% coinsurance per visit
  • Primary
    • Out-of-Network: 20% coinsurance per visit

Emergency care/Urgent care

  • Urgent care
    • 20% coinsurance per visit (always covered)
  • Emergency
    • 20% coinsurance per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: 20% coinsurance
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: 20% coinsurance

Ground ambulance

    • In-Network: 0-20% coinsurance
    • Out-of-Network: 20% coinsurance

Health plan deductible

    • Coming soon

Hearing

  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Hearing aids
    • Out-of-Network: $690-1,890 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: 20% coinsurance
    • Out-of-Network: 20% coinsurance
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $690-1,890 copay (Limits Apply)

Inpatient hospital coverage

    • Out-of-Network: Coming soon (Authorization Required)
    • In-Network: Coming soon (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $10,100 In and Out-of-network
      $6,750 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: Coming soon (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: 20% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: 20% coinsurance
  • Outpatient group therapy visit
    • Out-of-Network: 20% coinsurance
  • Outpatient individual therapy visit
    • Out-of-Network: 20% coinsurance
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: 20% coinsurance
    • Out-of-Network: 20% coinsurance
  • Inpatient hospital – psychiatric
    • Out-of-Network: Coming soon (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: 20% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 20% coinsurance per visit (Authorization Required)
    • In-Network: 20% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: 20% coinsurance (Authorization Required)
  • Occupational therapy visit
    • In-Network: 20% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: Coming soon (Authorization Required)
    • In-Network: Coming soon (Authorization Required)

Transportation

    • Not covered
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
    • In-Network: $0 copay (Limits Apply, Authorization Required)

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Upgrades
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Other
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for UPMC for Life PPO Salute (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on UPMC for Life PPO Salute (PPO)? See 2025 UPMC for Life PPO Salute (PPO) at MedicareAdvantageRX.com.

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