plans.upmcmedicare.com
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Submitted URL: https://retiree.upmcmedicare.com/
Effective URL: https://plans.upmcmedicare.com/late-retiree-control?utm_medium=Direct&utm_campaign=agein&utm_source=retiree
Submission: On June 13 via api from US — Scanned from DE
Effective URL: https://plans.upmcmedicare.com/late-retiree-control?utm_medium=Direct&utm_campaign=agein&utm_source=retiree
Submission: On June 13 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
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<div class="col-12">
<p class="open-sans">Fill out the information below to receive the FREE <em><strong>Medicare Dollars and Sense</strong></em> by mail. You will also have the option to receive an electronic copy by providing your email address.</p>
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<div class="form-group mt-0">
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<div class="form-group mt-0">
<label for="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-emailAddress">Email</label>
<input type="input" class="form-control" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-emailAddress" placeholder="Email" value="" pattern="^.+@[^.].*.[a-z]{2,}$">
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<div class="form-group mt-0">
<label for="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-phoneNumber">Phone</label>
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<div class="col-12">
<p><span class="phone-disclaimer"><small>When I provide my phone number, I am giving UPMC <em>for Life</em> permission to contact me about UPMC <em>for Life</em> plans and how to enroll. </small></span></p>
</div>
<div class="col-md-12">
<div class="form-group mt-0">
<label for="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-addressLine1">Street Address*</label>
<input type="input" class="form-control" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-addressLine1" placeholder="Street Address" value="">
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<div class="col-md-12">
<div class="form-group mt-0">
<label for="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-city">City*</label>
<input type="input" class="form-control" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-city" placeholder="City" value="">
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<div class="col-md-12">
<div class="form-group mt-0">
<label class="mb-2 mt-0">State*</label>
<select class="custom-select" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-stateCode">
<option selected="" value="">- Select State -</option>
<option value="PA">PA</option>
<option value="OH">OH</option>
</select>
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<div class="col-md-12">
<div class="form-group mt-0">
<label for="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-zipcode">Zip Code*</label>
<input type="input" class="form-control" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-zipcode" placeholder="Zip Code" value="" maxlength="5" minlength="5" pattern="[0-9]*">
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<div class="col-md-12">
<div class="form-group mt-0">
<label class="mb-2 mt-0">County*</label>
<select class="custom-select" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-county">
<option selected="" value="">County</option>
<option value="Adams">Adams</option>
<option value="Allegheny">Allegheny</option>
<option value="Armstrong">Armstrong</option>
<option value="Beaver">Beaver</option>
<option value="Bedford">Bedford</option>
<option value="Blair">Blair</option>
<option value="Butler">Butler</option>
<option value="Cambria">Cambria</option>
<option value="Cameron">Cameron</option>
<option value="Chester">Chester</option>
<option value="Clarion">Clarion</option>
<option value="Clearfield">Clearfield</option>
<option value="Clinton">Clinton</option>
<option value="Crawford">Crawford</option>
<option value="Cumberland">Cumberland</option>
<option value="Dauphin">Dauphin</option>
<option value="Elk">Elk</option>
<option value="Erie">Erie</option>
<option value="Fayette">Fayette</option>
<option value="Forest">Forest</option>
<option value="Fulton">Fulton</option>
<option value="Greene">Greene</option>
<option value="Huntingdon">Huntingdon</option>
<option value="Indiana">Indiana</option>
<option value="Jefferson">Jefferson</option>
<option value="Juniata">Juniata</option>
<option value="Lancaster">Lancaster</option>
<option value="Lawrence">Lawrence</option>
<option value="Lebanon">Lebanon</option>
<option value="Lycoming">Lycoming</option>
<option value="McKean">McKean</option>
<option value="Mercer">Mercer</option>
<option value="Mifflin">Mifflin</option>
<option value="Perry">Perry</option>
<option value="Somerset">Somerset</option>
<option value="Tioga">Tioga</option>
<option value="Union">Union</option>
<option value="Venango">Venango</option>
<option value="Warren">Warren</option>
<option value="Washington">Washington</option>
<option value="Westmoreland">Westmoreland</option>
<option value="York">York</option>
</select>
</div>
</div>
<div class="col-md-12">
<div class="form-group mt-0">
<label class="mb-2 mt-0">Retirement Date</label>
<select class="custom-select" id="JsonForm-form-93d97c58-96ce-4d05-9b37-7e40684e8d90-Input-retirementDate">
<option selected="" value="">Retirement Date</option>
<option value="20240101">In 2024</option>
<option value="20250101">In 2025</option>
<option value="20260101">After 2025</option>
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<div class="col-12">
<div class="formDisclaimer required">
<p>*Required</p>
<p>*Please call us at the number below to get your free information kit if your county is not listed.</p>
<p>Personal information collected here will be kept strictly confidential.</p>
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<button type="submit" class="btn btn-primary">GET MY BOOKLET</button>
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</form>Text Content
1-866-699-4740 (TTY: 711) seven days a week from 8 a.m. to 8 p.m.* HERE’S WHAT YOU NEED TO MAKE THE RIGHT DECISIONS ABOUT HEALTH CARE WHEN YOU RETIRE. REQUEST YOUR FREE COPY OF MEDICARE DOLLARS AND SENSE TODAY. THIS IMPORTANT INFORMATION IS OFFERED TO YOU WITH NO COST AND NO OBLIGATION TO ENROLL. FIND THE MEDICARE PLAN THAT WILL KEEP YOU —AND YOUR BUDGET— HEALTHY. THIS FREE BOOKLET FROM UPMC FOR LIFE CAN SHOW YOU HOW TO GET MORE BENEFITS AND SPEND LESS ON HEALTH CARE DURING YOUR RETIREMENT. Fill out the information below to receive the FREE Medicare Dollars and Sense by mail. You will also have the option to receive an electronic copy by providing your email address. First Name* Last Name* Email Phone When I provide my phone number, I am giving UPMC for Life permission to contact me about UPMC for Life plans and how to enroll. Street Address* City* State* - Select State - PA OH Zip Code* County* County Adams Allegheny Armstrong Beaver Bedford Blair Butler Cambria Cameron Chester Clarion Clearfield Clinton Crawford Cumberland Dauphin Elk Erie Fayette Forest Fulton Greene Huntingdon Indiana Jefferson Juniata Lancaster Lawrence Lebanon Lycoming McKean Mercer Mifflin Perry Somerset Tioga Union Venango Warren Washington Westmoreland York Retirement Date Retirement Date In 2024 In 2025 After 2025 *Required *Please call us at the number below to get your free information kit if your county is not listed. Personal information collected here will be kept strictly confidential. GET MY BOOKLET MEDICARE 101 Medicare can be confusing, and that’s why we’re here to help! Find information on how it works, enrollment periods, Extra Help, and more. * Learn more about Medicare PROVIDER ACCESS Get access to UPMC plus other community doctors and hospitals across PA and out of state. * Find a provider CONTACT US Our Medicare Advisors are standing by to provide you with the personal help you need. * Ways to connect Compare plans and costs UPMC for Life offers high-quality Medicare Advantage plans that provide you with more benefits than Original Medicare alone. Our plans can give you medical and prescription drug coverage combined. Shop Now HAVE A QUESTION? CALL US! WE’RE HERE TO HELP. Have a quick question you'd like to get answered? We're here to help! Call toll-free: 1-866-699-4740 (TTY: 711) seven days a week 8 a.m. to 8 p.m.* *You can call us Oct. 1 through Dec. 31, seven days a week, from 7 a.m. to 9 p.m. and from Jan. 1 through Sept. 30, seven days a week, from 8 a.m. to 8 p.m. UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., and UPMC Health Coverage Inc. Copyright © 2024 UPMC Health Plan Inc. All rights reserved. * Legal Disclaimer * Notice of Privacy Practices Y0069_241534_C Last Updated: 01/11/2024