Prospective Members

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

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).
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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. 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).

H1977_001_2017_WP0005, Pending
H2161_002_2017_WP0005, Approved
Page Last Updated: 08/2/2017