Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5533-015-001

UPMC for Life PPO Rx Choice (PPO) · UPMC for Life · Allegheny County

Compact plan code: H5533015001

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

UPMC for Life PPO Rx Choice (PPO)

H5533-015-001 Allegheny County Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Cost-sharing tier 1

Per admission $250 per stay
Plan-listed inpatient copay $250

Cost-sharing tier 2

Per admission $275 per stay
Plan-listed inpatient copay $275

inpatient cost sharing varies by a CMS plan-defined group

02

Emergency transport

Ambulance

Ground · in-network$50–$340 copay
Air · in-network$340 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$5,500
Combined in + out$9,000
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNo cost share reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$25 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H5533-003-000 UPMC for Life PPO High Deductible Rx (PPO) Western and Central Pennsylvania · Local PPO H5533-005-000 UPMC for Life PPO Rx Enhanced (PPO) Western and Central Pennsylvania · Local PPO H5533-008-000 UPMC for Life PPO Rx Enhanced (PPO) Western and Central Pennsylvania · Local PPO H5533-011-000 UPMC for Life PPO Premier Rx (PPO) North Central and Central Pennsylvania · Local PPO H5533-013-000 UPMC for Life PPO Premier Rx (PPO) Western Pennsylvania · Local PPO H5533-015-002 UPMC for Life PPO Rx Choice (PPO) Western Pennsylvania (Excluding Allghny & Wstmld) · Local PPO H5533-015-003 UPMC for Life PPO Rx Choice (PPO) Northwest Pennsylvania · Local PPO H5533-015-004 UPMC for Life PPO Rx Choice (PPO) North Central and Central Pennsylvania · Local PPO

About this code

What H5533-015-001 identifies

H5533-015-001 is a Contract Year 2026 Medicare plan segment code. The compact form H5533015001 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.