Medicare Options
UPMC for Life Retirees Plan FAQ
What is the UPMC for Life FEHB Retirees plan?
UPMC for Life FEHB Retirees is a Medicare Advantage plan specifically tailored for FEHB retirees. When it is combined with the Standard Option HMO Plan for annuitants (retirees), it provides a high-value option exclusively for FEHB retirees.
Who is eligible?
You are eligible to enroll if you:
- Are retired.
- Are enrolled or are enrolling in UPMC Health Plan's Standard Option HMO (UW4-6).
- Have Medicare Parts A and B.
How does the UPMC for Life FEHB Retirees plan work?
- FEHB retirees with Medicare Parts A and B continue to pay Part B premiums with the UPMC for Life FEHB Retiree plan. You receive additional benefits, such as a $0 deductible, $0 copay for many services, and excellent prescription benefits.
- It offers a premium reimbursement opportunity of up to $800 per year.
- You must use providers that participate with UPMC for Life.
- The premium rates with FEHB remain the same as the Standard Option HMO.
How do I enroll?
Enrollment is easy for retirees with Medicare Parts A and B.
- Enroll through the OPM Retirement website or by calling 1-888-767-6738 (TTY: 1-800-878-5707).
- Enroll in UPMC Health Plan’s Standard Option HMO using enrollment code UW4, UW5, or UW6. OPM will transfer your enrollment to UPMC Health Plan within 10 business days.
- Enroll in the UPMC for Life FEHB Retirees plan through our online form, or by calling 1-844-383-1819 (TTY: 711).
- Call UPMC Health Plan at 1-844-383-1819 (TTY: 711) to opt in to the UPMC for Life FEHB Retirees plan.
- Have your original Medicare effective date for Parts A and Part B, along with your Medicare Beneficiary Identifier (MBI).
What do I pay?
The FEHB premiums for the Standard Option HMO with UPMC for Life FEHB Retirees coverage will be as follows for 2026:
| Monthly Rates | Enrollment Code | Premium |
|---|---|---|
| Standard Self | UW4 | $192.96 |
| Standard Self and Family | UW5 | $453.89 |
| Standard Self Plus One | UW6 | $462.41 |
Should I suspend my FEHB coverage if I choose UPMC for Life FEHB Retirees?
No, you will keep your FEHB coverage while enrolled in UPMC for Life FEHB Retirees.
Will I receive two ID cards?
Then, after you enroll in the UPMC for Life FEHB Retirees plan, you will receive a separate ID card for the Medicare Advantage HMO plan.
When a provider asks you for your ID card, please provide both cards.
How can I learn more about the UPMC for Life FEHB Retirees plan?
- Visit upmchealthplan.com/fehb
- Review the FEHB UPMC Health Plan brochure.
- Call UPMC Health Plan at 1-844-383-1819 (TTY: 711).
When will my coverage begin?
Coverage and 2026 benefit changes for current UPMC Health Plan members and annuitants will begin on Jan. 1, 2026.
Coverage for new UPMC Health Plan members who are actively employed during Open Season will begin on the first day of the first pay period in January 2026.
If you are a new federal employee, you have 60 days to enroll in an FEHB plan. Your enrollment will begin at the start of the pay period after your enrollment is received.
What are my pharmacy options?
Our Medicare pharmacy network includes standard pharmacies and preferred pharmacies. You can go to either type of pharmacy to pick up your prescriptions.
Preferred pharmacies have agreed to offer our lowest copays for covered prescription drugs. Standard pharmacies do not offer our lowest copays. That means you can save money if you use pharmacies in our preferred pharmacy network. You will have a $0 copay when you fill a preferred generic prescription (Tier 1) at a preferred pharmacy during the initial coverage phase. Our preferred pharmacy locations include but are not limited to: Giant, Giant Eagle, Sam’s Club, Walgreens, Walmart, and Weis.
Medicare Prescription Payment Plan
Medicare members with high prescription drug costs can get help with their payments through the Medicare Prescription Payment Plan. This payment option allows you to spread your prescription drug costs across monthly payments throughout the year instead of paying them up front at the pharmacy.
Learn more about the Medicare Prescription Payment Plan.
| 30-day supply | 100-day supply | |||||
|---|---|---|---|---|---|---|
| Retail | Retail | Mail Order | ||||
| Tier | Preferred pharmacy | Standard Pharmacy | Preferred pharmacy | Standard Pharmacy | Preferred pharmacy | Standard Pharmacy |
| Tier 1 Preferred Generic | $0 copay |
$15 copay | $0 copay | $30 copay | $0 copay | $30 copay |
| Tier 2 Generic | $10 copay | $20 copay | $20 copay | $40 copay | $20 copay | $40 copay |
| Tier 3 Preferred Brand | $47 copay | $47 copay | $129.50 copay | $141 copay | $117.50 copay | $141 copay |
| Tier 4 Non-Preferred | $100 copay | $100 copay | $300 copay | $300 copay | $300 copay | $300 copay |
| Tier 5 Specialty | 33% coinsurance | 33% coinsurance | Not offered | Not offered | 33% coinsurance limited to a 30-day supply | 33% coinsurance limited to a 30-day supply |
|
Pharmacy Total Out-of-Pocket (TrOOP): $2,100 |
||||||
| If you receive Extra Help (Low Income Subsidy) from Medicare for prescription drug costs, you may have a lower copay or coinsurance than what is listed above. You may not receive cost savings from using a preferred pharmacy. | ||||||
*Go to Medicare.gov for information on how to enroll in Medicare Part B.
**Office visit and prescription drug copayments apply for the Standard Option HMO plan, including when it is paired with a Medicare plan.