Ways to Enroll

Applying for enrollment in UPMC for Life is easy

Follow the steps below to apply for enrollment in a UPMC for Life plan. If you are a UPMC for Life member and would like to change your plan, please visit our member plan change form.

1. Choose the UPMC for Life plan to which you would like to apply for enrollment.
   Compare plan options and benefits.
   
   
2. Apply for enrollment. We offer three different ways to apply:
   • By Phone: Call us toll-free at 1-866-400-5077 (TTY: 711) to apply for enrollment over the phone.
   • Online: Apply online using our secure enrollment website.
   • Print: Complete, sign, and date the enrollment application and mail or fax it to us.
     2023 Enrollment Application
     2024 Enrollment Application

     Mail: UPMC for Life
     PO Box 2967
     Pittsburgh, PA 15230

     Fax: 412-454-7766

3. We will contact you once your enrollment application has been processed.

You can also enroll online via the Medicare website at Medicare.gov.