PlanMyDental

UPMC for Life PPO Rx Choice (PPO)

UPMC for Life01
Contract H5533 · Plan 015 · CMS Plan Year 2025
4.5★CMS Stars
Annual Maximum Benefit
per calendar year
$6,000

Preventive Care

Oral Exams
Cleanings
X-Rays
Fluoride / Preventive

Basic & Restorative

FillingsYou pay 50%
Extractions
Root CanalsYou pay 50%
PeriodonticsYou pay 50%

Major Services

CrownsYou pay 50%
Dentures
Orthodontia

Dental Implants

✗ Implants Not Covered

This plan does not include dental implant coverage.

Coverage varies — verify implant benefits directly with the carrier before enrolling.

Available In

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Data source: CMS Plan Benefit Package 2025 · Verify on Medicare.gov →