Prospective Members

Upper Peninsula Health Plan (UPHP) brings the residents of Michigan’s Upper Peninsula three Medicare plan options from a local, Upper Peninsula-based organization. Select the plan name below to learn more about each plan.

Contract 
UPHP Choice
(HMO)
UPHP Advantage (HMO)UPHP MI Health Link
(Medicare-Medicaid Plan)
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Plan Premium$0$110$0
Yearly Part B Deductible$0$0$0
Yearly Part D Deductible

$415

(Deductible applies to Tiers 3, 4, and 5.)

$0$0
Maximum Out-of-Pocket for Medicare-covered Services$6,700$6,700$0
CopaymentsThere are copayments under this plan.  See the benefits chart in Chapter 4 of the UPHP Evidence of Coverage to learn about copayments and the benefits they apply to.There are copayments under this plan.  See the benefits chart in Chapter 4 of the UPHP Evidence of Coverage to learn about copayments and the benefits they apply to.There are no copayments under this plan.
CoinsuranceThere are coinsurance amounts under this plan.  See the benefits chart in Chapter 4 of the UPHP Evidence of Coverage to learn about coinsurance amounts and the benefits they apply to.There are coinsurance amounts under this plan.  See the benefits chart in Chapter 4 of the UPHP Evidence of Coverage to learn about coinsurance amounts and the benefits they apply to.There are no coinsurance amounts under this plan.
Patient Pay AmountNot ApplicableNot ApplicableIf you reside in a nursing facility you may be responsible for a patient pay amount.  See the benefits chart in Chapter 4 of the UPHP MHL Member Handbook to learn more about the patient pay amount.
Doctor Office VisitsCoveredCoveredCovered
Specialist Office VisitsCoveredCoveredCovered
HospitalizationCoveredCoveredCovered
PrescriptionsCoveredCoveredCovered
Emergent and Urgent CareCoveredCoveredCovered
EyeglassesNot CoveredCoveredCovered
Fitness BenefitCoveredCoveredNot Covered
Hearing AidsNot CoveredCoveredCovered
Dental CareCoveredCoveredCovered
Eligibility RequirementsMust live in Michigan’s Upper Peninsula; must have Medicare Parts A and B.Must live in Michigan’s Upper Peninsula; must have Medicare Parts A and B.Must live in Michigan’s Upper Peninsula; must have Medicare Parts A and B and have full Medicaid benefits.  Learn more from the Michigan Department of Health & Human Services (clicking on this link will take you away from UPHP’s website).
Formulary (Drug List)View the UPHP Choice Formulary(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).View the UPHP Advantage Formulary (List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).View the UPHP MI Health Link Formulary(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
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Upper Peninsula Health Plan is an HMO plan with a Medicare contract.  Enrollment in the Upper Peninsula Health Plan depends on contract renewal.  This information is not a complete description of benefits. Call 1-877-349-9324 (TTY: 711), seven days a week from 8 a.m. to 9 p.m. Eastern time for more information.  The call is free. Benefits, formulary, pharmacy network, provider network, premium, and/or copayments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. You must continue to pay your Medicare Part B premium.  The Formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary.  As a member of UPHP, if you are unhappy with the care or service you receive, you may file a complaint with us by going to the Grievances and Appeals page.  You may also file a complaint electronically by using the Medicare Complaint Form  (clicking this link will take you away from UPHP’s website)

H1977_001_2019_WP0001v2 Accepted
H2161_2019_WP0001v2
Page Last Updated: 09/9/2019