Prospective Members

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For Contract Year 2018:

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

Contract Year 2018 Upper Peninsula Health Plan Choice (HMO) Upper Peninsula Health Plan Advantage (HMO) Upper Peninsula Health Plan MI Health Link
(Medicare-Medicaid Plan)
Plan Premium $0 $113 $0
Yearly Part B Deductible $100 $0 $0
Yearly Part D Deductible $405

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

$0 $0
Maximum Out-of-Pocket for Medicare-Covered Services $6,700 $6,700 $0
Co-Payments There are co-payments under this plan.  See the benefits chart in Chapter 4 of the 2018 UPHP Choice Evidence of Coverage to learn about co-payments and the benefits they apply to. There are co-payments under this plan.  See the benefits chart in Chapter 4 of the 2018 UPHP Advantage Evidence of Coverage to learn about co-payments and the benefits they apply to. There are no co-payments under this plan.
Coinsurance There are coinsurance amounts under this plan.  See the benefits chart in Chapter 4 of the 2018 UPHP Choice 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 2018 UPHP Advantage Evidence of Coverage to learn about coinsurance amounts and the benefits they apply to. There are no coinsurance amounts under this plan.
Patient Pay Amount Not Applicable Not Applicable If you reside in a nursing facility you may be responsible for a patient pay amount.  See the benefits chart in Chapter 4 of the 2018 UPHP MHL Evidence of Coverage to learn more about the patient pay amount.
Doctor Office Visits Covered Covered Covered
Specialist Office Visits Covered Covered Covered
Hospitalization Covered Covered Covered
Prescriptions Covered Covered Covered
Emergent and Urgent Care Covered Covered Covered
Eyeglasses Not Covered Covered Covered
Hearing Aids Not Covered Covered Not Covered
Dental Care Covered Covered Covered
Eligibility Requirements 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. Must live in Michigan’s Upper Peninsula; must have Medicare Parts A and B and have full Medicaid benefits.  Click here for more information (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website).
Formulary (Drug List) Click here to view the 2018 UPHP Choice Formulary (List of Covered Drugs) (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website). Click here to view the 2018 UPHP Advantage Formulary (List of Covered Drugs) (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website). Click here to view the 2018 UPHP MI Health Link Formulary (List of Covered Drugs) (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website).
ENROLL NOW! ENROLL NOW! ENROLL NOW!

For Contract Year 2017:

Calendar Year 2017 Upper Peninsula Health Plan Advantage (HMO) Upper Peninsula Health Plan MI Health Link
(Medicare-Medicaid Plan)
Plan Premium $113 $0
Yearly Part B Deductible $0 $0
Yearly Part D Deductible $0 $0
Maximum Out-of-Pocket for Medicare-Covered Services $6,700 $0
Co-Payments There are co-payments under this plan.  See the benefits chart in Chapter 4 of the 2017 UPHP Advantage Evidence of Coverage to learn about co-payments and the benefits they apply to. There are no co-payments under this plan.
Coinsurance There are coinsurance amounts under this plan.  See the benefits chart in Chapter 4 of the 2017 UPHP Advantage Evidence of Coverage to learn about coinsurance amounts and the benefits they apply to. There are no coinsurance amounts under this plan.
Patient Pay Amount Not Applicable If you reside in a nursing facility you may be responsible for a patient pay amount.  See the benefits chart in Chapter 4 of the 2017 UPHP MHL Evidence of Coverage to learn more about the patient pay amount.
Doctor Office Visits Covered Covered
Specialist Office Visits Covered Covered
Hospitalization Covered Covered
Prescriptions Covered Covered
Emergent and Urgent Care Covered Covered
Eyeglasses Covered Covered
Hearing Aids Covered Not Covered
Dental Care Covered Covered
Eligibility Requirements 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.  Click here for more information (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website).
Formulary (Drug List) Click here to view the 2017 UPHP Advantage Formulary (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website). Click here to view the 2017 UPHP MI Health Link Formulary (Clicking on this link will take you away from the Upper Peninsula Health Plan’s website).
ENROLL NOW! ENROLL NOW!

Upper Peninsula Health Plan is an HMO plan with a Medicare contract.  Enrollment in the Upper Peninsula Health Plan depends on contract renewal.  The benefit information provided is a brief summary, not a complete description of benefits.  For more information, contact the plan at 1-877-349-9324 (TTY 711), 7 days a week from 8:00 a.m. to 9:00 p.m. Eastern time.  The call is free. Benefits, formulary, pharmacy network, provider network, premium, and/or co-payments/coinsurance may change on January 1 of each year. Limitations, co-payments, 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 the Upper Peninsula Health Plan, 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 on this link will take you away from the Upper Peninsula Health Plan’s website).

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H2161_003_2018_WP0001, Pending
Page Last Updated: 10/2/2017