medicare options with UPMC

Medicare Options

UPMC for Life PSHB Retirees (HMO) – Medicare Advantage Plan

Get a complete Medicare Advantage plan without suspending your PSHB coverage!

UPMC Health Plan is offering a Medicare Advantage Plan—UPMC for Life PSHB Retirees—for PSHB annuitants who are enrolled in our Standard Option HMO Plan and Medicare Part B.

UPMC Health Plan offers Medicare Advantage plans that can give you high-quality medical and prescription benefits at an affordable price. Our Medicare Advantage plans have some of our largest provider networks. That means you can choose from more doctors and hospitals in your community than ever before.

Signing up for UPMC for Life PSHB Retirees is simple, you can enroll online or by calling 1-844-383-1819 (TTY: 711).

Oct. 1 – Mar. 31: Seven days a week from 8 a.m. to 8 p.m.

Apr. 1 – Sept. 30: Monday through Friday from 8 a.m. to 8 p.m.

Saturday from 9 a.m. to 3 p.m.

Enroll online

 

Medicare Plan Options for Annuitants

UPMC Health Plan has designed the Standard Option HMO to assist you with your Medicare Part B premium payment.

Here are two options:

Option #1: Medicare Advantage

  1. Choose to enroll in the Standard Option HMO.
  2. Choose to enroll in UPMC for Life PSHB Retirees by submitting the enrollment form online or by calling 1-844-383-1819 (TTY: 711).
  3. Most services will have a $0 copay or lower out-of-pocket costs with $0 deductible.

Option #2: Medicare

  1. Enroll in Medicare Part B along with Medicare Part A.*
  2. Your deductible will be reduced to $700 for Self Only coverage.
  3. Your coinsurance will be reduced to 0 percent.
  4. PCP visits will have a $20 copay and specialist visits will have a $50 copay.

With both options, you are eligible to receive up to $800 in Part B premium reimbursement through a health reimbursement arrangement (HRA).

Set up your reimbursement by mail or online using these forms:

Remember, all plan options include a health incentive account (HIA) that enables you to earn up to $250 for Self Only coverage.

Medicare Part D (PDP)

Pharmacy Benefits

The Postal Service Reform Act of 2022 (PSRA) requires PSHB plans to provide prescription drug coverage through Medicare Part D to Postal Service annuitants and their family members who are Medicare-eligible.

If you enroll in the Standard HMO plan and are enrolled in Medicare, you have options for 2025. You can automatically be enrolled in our Part D Medicare Part D Plan (PDP) or select our Medicare Advantage Prescription Drug (MAPD) plan. Enrollment in Medicare Parts A and B is required to join our MAPD plan.

If you select the HDHP Option PPO plan and are enrolled in Medicare Part A or Parts A and B, you will automatically be enrolled in the PDP.

The PDP provides pharmacy benefits only, while the MAPD plan includes Medicare Parts A and B plus prescription drug coverage, including inpatient, outpatient, physician services, and pharmacy coverage.

Visit opm.gov/healthcare-insurance/pshb for more information.

 

Our members also enjoy extra benefits that provide significantly more coverage than what your current plan may offer. 

When you pair UPMC for Life PSHB Retirees with our PSHB Standard Option HMO plan, you will get:

Self Only Deductible $0
Annual Out-of-Pocket Max (Embedded) Individual $3,400 per retired member enrolled with MC Part A and B
PCP Office Visit $0
Specialist Office Visit $25
Virtual Urgent Care Visit $0
Urgent Care Visit $0
Emergency Room Visit $0
Preventive Care $0

 

For additional cost-sharing information reference the 2025 PSHB brochure.

UPMC for Life Retiree Plan FAQ

What is the UPMC for Life PSHB Retiree plan?

UPMC for Life PSHB Retirees is a Medicare Advantage plan specifically tailored for PSHB retirees. When combined with the Standard Option HMO Plan for annuitants (retirees), it provides a high-value option exclusively for PSHB retirees.

Who is eligible?

You are eligible to enroll if you are:

  • Are retired.
  • Are enrolled or are enrolling in UPMC Health Plan's Standard Option HMO (UW4-6).
  • Have Medicare Part A and Part B.

How does the UPMC for Life PSHB Retirees plan work?

  • PSHB retirees with Medicare Parts A and B continue to pay Part B premiums with the UPMC for Life PSHB 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 who participate with UPMC for Life.
  • The premium rates with PSHB remain the same as the Standard Option HMO.

How do I enroll?

Enrollment is easy for retirees with Medicare Parts A and B.

  • Learn more by visiting OPM’s PSHB Retirement Fact Sheet, or by calling 1-888-767-6738 (TTY:711).
  • Enroll in UPMC Health Plan’s Standard Option HMO using enrollment code UW4, UW5, or UW6. OPM will transfer your enrollment to UPMC within 10 business days.
  • Enroll in the UPMC for Life PSHB Retirees plan through our online form, or by calling 1-833-869-6924 (TTY: 711).
  • Have your original Medicare effective date for Parts A and Part B, along with your Medicare Beneficiary Identifier (MBI).

What do I pay?

The PSHB premiums for the Standard Option HMO will be as follows for 2024:


 Enrollment Code Premium
Standard Self UW4 $192.96
Standard Self & Family UW5 $453.89
Standard Self Plus One UW6 $462.41

Should I suspend my PSHB coverage if I choose UPMC for Life PSHB Retirees?

No, you will keep your PSHB coverage while enrolled in UPMC for Life PSHB Retirees.

Will I receive two ID cards?

Yes. You will receive an ID card from UPMC Health Plan for your Standard Option HMO.

Then, after you enroll in the UPMC for Life PSHB 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 PSHB Retirees plan?

When will my coverage begin?

Coverage and 2025 benefit changes for current UPMC Health Plan members and annuitants will begin on Jan. 1, 2025.

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 2025.

If you are a new federal employee, you have 60 days to enroll in an PSHB 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 when using 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.  Some of our preferred pharmacy locations include but are not limited to: Giant Eagle, Rite Aid, Sam’s Club, Walgreens, Walmart, and Weis.

 

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 
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 option.