UPMC - UPMC Advantage Silver $1,750/$50 - Premium Network

Pennsylvania, 2019

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $1,750

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,750
Deductible (Family) $3,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility $100 Copay after deductible
Outpatient Surgery $100 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 50% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $1,400
Deductible (Family) $2,800
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 50% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $75
Deductible (Family) $150
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan UPMC Advantage Catastrophic $7,900/$0 - Partner Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Silver $3,500/$25 - Tower Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Platinum $250/$20 - Premium Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Catastrophic $7,900/$0 - Premium Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Bronze $6,950/$35 - Partner Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $1,750/$50 - Select Network Deductible $1,750 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Gold $800/$20 - Partner Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan Tower UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Platinum $250/$20 - Partner Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Bronze $6,950/$35 - Select Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Select Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Catastrophic $7,900/$0 - Select Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $1,750/$50 - Partner Network Deductible $1,750 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Select Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Silver $0/$50 - Premium Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Gold $800/$20 - Tower Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Platinum $250/$20 - Select Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Silver $3,500/$25 - Partner Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Silver $0/$50 - Select Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Bronze $6,950/$35 - Tower Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $0/$50 - Partner Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,750
Deductible (Family) $3,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 20% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility $100 Copay after deductible
Outpatient Surgery $100 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 50% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $1,400
Deductible (Family) $2,800
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 50% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $700
Deductible (Family) $1,400
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $75
Deductible (Family) $150
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan UPMC Advantage Catastrophic $7,900/$0 - Partner Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Silver $3,500/$25 - Tower Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Platinum $250/$20 - Premium Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Catastrophic $7,900/$0 - Premium Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Bronze $6,950/$35 - Partner Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $1,750/$50 - Select Network Deductible $1,750 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Gold $800/$20 - Partner Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan Tower UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Platinum $250/$20 - Partner Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Bronze $6,950/$35 - Select Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Select Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Catastrophic $7,900/$0 - Select Network Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $1,750/$50 - Partner Network Deductible $1,750 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Select Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Silver $0/$50 - Premium Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Gold $800/$20 - Tower Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Platinum $250/$20 - Select Network Deductible $250 Coinsurance Not applicable Out of Pocket $1,500
Plan UPMC Advantage Silver $3,500/$25 - Partner Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Silver $0/$50 - Select Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Tower UPMC Advantage Bronze $6,950/$35 - Tower Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $0/$50 - Partner Network Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Silver $3,500/$25 - Premium Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Gold $800/$20 - Premium Network Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900
Plan UPMC Advantage Bronze $6,950/$35 - Premium Network Deductible $6,950 Coinsurance Not applicable Out of Pocket $7,900