Is UPMC For You a Medicare Plan or Medicaid Plan?

UPMC For You is primarily a Medicaid plan, not Medicare

UPMC For You is a managed Medicaid health plan offered by UPMC Health Plan, Inc. in Pennsylvania. It covers low-income adults and families who meet Pennsylvania's Medicaid income limits. If you are looking for Medicare coverage, UPMC For You is not the plan for you — you would need to look at UPMC's Medicare Advantage plans instead, which are separate products with different may be able to access rules and costs.

The confusion arises because UPMC offers both Medicaid and Medicare plans under similar brand names. UPMC For You specifically serves people under 65 who may have access to for Medicaid based on income. UPMC also sells Medicare Advantage plans (like UPMC Medicare Advantage) for people 65 and older, but those are different plans with different enrollment periods and different out-of-pocket costs.

Key Takeaways

UPMC For You covers low-income Pennsylvania residents under 65 who meet Medicaid income thresholds, not people on Medicare.
UPMC offers separate Medicare Advantage plans for people 65 and older, which have their own premiums, deductibles, and enrollment windows.
If you turn 65 while on UPMC For You Medicaid, you will need to switch to a different plan — Medicaid and Medicare do not overlap in coverage.
Your income and age determine which UPMC plan you can use; income alone is not enough if you are already on Medicare.

Who UPMC For You Medicaid covers

UPMC For You covers Pennsylvania residents who meet both an income test and a citizenship or immigration status test. The income limits change each year and depend on family size. For example, a single adult might may have access to if their income falls below a certain percentage of the federal poverty level, but a family of four would have a higher income limit. You can find the current limits on the Pennsylvania Department of Human Services website or by calling your county information office.

The plan also covers pregnant women, children, and parents or caretakers of children under different income rules — sometimes higher than the standard adult limit. If you are 65 or older, you are not may be able to access for UPMC For You Medicaid; instead, you would look at Medicare plans, which may include UPMC Medicare Advantage if it is sold in your area.

How UPMC For You differs from Medicare plans

UPMC For You Medicaid is funded by federal and state tax dollars and has no monthly premium for most members. Medicare plans, including UPMC's Medicare Advantage offerings, are funded through Medicare payroll taxes and require a monthly premium (though some plans have $0 premiums). The deductibles, copays, and covered services also differ between the two systems.

Medicaid plans like UPMC For You typically cover dental, vision, and hearing services as part of the base plan. Medicare Advantage plans may offer these as add-ons, and Original Medicare does not cover them at all. The provider networks are also separate — a doctor who accepts UPMC For You Medicaid may not accept UPMC Medicare Advantage, and vice versa.

What happens if you turn 65 while on UPMC For You

When you turn 65, you become ineligible for Medicaid (with rare exceptions) and must switch to Medicare. UPMC For You will end your coverage, usually at the end of the month in which you turn 65. You will then need to choose a Medicare plan during your Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after.

If you do not choose a plan during that window, you may face a late enrollment penalty on your premiums. UPMC will send you a notice before your coverage ends, but it is your responsibility to act. If you want to stay with UPMC after 65, you can look at UPMC Medicare Advantage plans available in your county, but you must enroll separately.

How to learn about you may have access to for UPMC For You

Contact your county information office in Pennsylvania — they handle Medicaid determinations, not UPMC directly. You can also call the Pennsylvania Department of Human Services at 1-800-692-7462 or visit their website to find your county office. Have your Social Security number, proof of income (recent pay stubs or tax returns), and proof of Pennsylvania residency ready.

You can also call UPMC directly at 1-800-624-8762 to ask whether UPMC For You is sold in your county and to request an process, but the county office is where you actually submit it and where may be able to access is decided. Processing typically takes 30 to 45 days.

UPMC Medicare Advantage plans if you are 65 or older

If you are 65 or older and looking for a UPMC plan, you need a Medicare Advantage plan, not UPMC For You. UPMC Medicare Advantage plans vary by county in Pennsylvania. Some have $0 monthly premiums; others charge a premium. Most include prescription drug coverage, dental, vision, and hearing benefits.

You can enroll in a Medicare Advantage plan during the Annual Enrollment Period (October 15 to December 7 each year) or during your Initial Enrollment Period if you just turned 65. You can also switch plans during the Medicare Advantage Open Enrollment Period (January 1 to March 31). Visit Medicare.gov or call 1-800-MEDICARE to compare UPMC Medicare Advantage plans in your area.

Common mistakes to avoid

Do not assume that because UPMC offers both Medicaid and Medicare plans, you can use the same plan at any age. Medicaid ends at 65; Medicare begins at 65. The two systems do not overlap, and UPMC For You will not cover you once you are may be able to access for Medicare.

Do not wait until after you turn 65 to enroll in a Medicare plan. If you miss your Initial Enrollment Period, you will pay a penalty for the rest of your life, even if you enroll later. Also, do not confuse UPMC For You with UPMC Community HealthPlan or other UPMC products — they serve different populations and have different rules.

Frequently Asked Questions

Can I use UPMC For You if I am on Social Security?

Being on Social Security does not disqualify you from Medicaid. What matters is your total monthly income. If your Social Security payment is low enough to meet Pennsylvania's Medicaid income limit, you can use UPMC For You. Contact your county information office to check your specific income against the current limit.

What if I am 65 but my income is very low?

Once you turn 65, you are not may be able to access for Medicaid, even with a very low income. Instead, you would look at Medicare plans. If your income is low, you may be able to get help paying Medicare premiums and cost-sharing through programs like the Medicare Savings Program or Extra Help. Contact your county information office or call 1-800-MEDICARE to learn more.

Can I switch from UPMC For You to a UPMC Medicare Advantage plan?

You cannot switch directly. When you turn 65, your UPMC For You coverage ends and you must enroll in a new plan. You can choose a UPMC Medicare Advantage plan if one is available in your county, but you enroll through Medicare, not through UPMC For You. Enroll during your Initial Enrollment Period to avoid penalties.

Does UPMC For You cover prescription drugs?

Yes, UPMC For You Medicaid includes prescription drug coverage with no separate premium. Your copay for each drug depends on the specific plan and the drug's tier. Medicare Advantage plans also include prescription drug coverage, but the copays and covered drugs may differ from UPMC For You.

How do I know which UPMC plan is available in my county?

Call UPMC at 1-800-624-8762 and tell them your county and age. They can tell you whether UPMC For You Medicaid or UPMC Medicare Advantage plans are sold where you live. You can also visit the Pennsylvania Department of Human Services website for Medicaid plans or Medicare.gov for Medicare Advantage plans in your area.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.