Medicare Options
UPMC for Life Retirees Plan FAQ
What is the UPMC for Life PSHB Retirees plan?
UPMC for Life PSHB Retirees isa Medicare Advantage plan specifically tailored for PSHB retirees. When it is 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 retired.
- Are enrolled or are enrolling in UPMC Health Plan's Standard Option HMO (UW4-6).
- Have Medicare Parts 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 Retirees 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 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 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 Health Plan 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 B, along with your Medicare Beneficiary Identifier (MBI).
What do I pay?
The PSHB premiums for the Standard Option HMO with UPMC for Life PSHB Retirees coverage will be as follows for 2026:
| 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 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?
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?
- Visit upmchealthplan.com/pshb.
- Review the PSHB UPMC Health Plan brochure.
- Call UPMC Health Plan at 1-844-451-1261 (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 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 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 Eagle, Sam’s Club, Walgreens, Walmart, and Weis.
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.
| 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 Generic Medications | $0 copay |
$0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Tier 2 Brand Medications | $42 copay | $47 copay | $115.50 copay | $141 copay | $100 copay | $100 copay |
| Tier 3 Specialty Medications | $245 copay | $250 copay | N/A | N/A | $245 copay 30 Day | $250 copay 30 Day |
|
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 option.