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 Year 2019 UPHP Choice (HMO) UPHP Advantage (HMO) UPHP MI Health Link (Medicare-Medicaid Plan)
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
Copayments There are copayments under this plan.  See the benefits chart in Chapter 4 of the 2019 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 2019 UPHP Evidence of Coverage to learn about copayments and the benefits they apply to. There are no copayments under this plan.
Coinsurance There are coinsurance amounts under this plan.  See the benefits chart in Chapter 4 of the 2019 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 2019 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 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 2019 UPHP MHL Member Handbook 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
Fitness Benefit Covered Covered Not Covered
Hearing Aids Not Covered Covered 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.  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 2019 UPHP Choice Formulary
(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
View the 2019 UPHP Advantage Formulary
(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
View the 2019 UPHP
MI Health Link Formulary

(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
ENROLL NOW! ENROLL NOW! ENROLL NOW!


Contract Year 2018 UPHP Choice (HMO) UPHP Advantage (HMO) UPHP 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
Copayments There are copayments under this plan.  See the benefits chart in Chapter 4 of the 2018 UPHP Choice 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 2018 UPHP Advantage Evidence of Coverage to learn about copayments and the benefits they apply to. There are no copayments 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 Member Handbook 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.  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 2018 UPHP Choice Formulary
(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
View the 2018 UPHP Advantage Formulary
(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
View the 2018 UPHP
MI Health Link Formulary

(List of Covered Drugs) (Clicking on this link will take you away from UPHP’s website).
ENROLL NOW! 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.  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_WP0001 Accepted
H2161_2019_WP0001
Page Last Updated: 10/10/2018