Health Care 2022 Pre-Medicare Retirees
Eligibility for Pre-Medicare Coverage
Eligibility requirements will only change for those retiring on or after Jan. 1, 2022. If you’re currently retired and eligible (or retire and are eligible prior to Jan. 1, 2022) to participate in the OPERS health care program, you will continue to be eligible after Jan. 1, 2022. This includes those who retired prior to Jan. 1, 2022 with 20 years of qualified service and currently are not in our health care program, you will still be able to enter at age 60. However, effective Jan. 1, 2022, all retirees will receive a monthly Health Reimbursement Arrangement (HRA). Medicare-eligible retirees already receive an HRA, but this will be new for pre-Medicare retirees.
If you are receiving a disability benefit with an effective date of Dec 1, 2021 or prior you are still under the eligibility rules that were in place as of your benefit effective date.
Health care eligibility requirements will change for new retirees on or after Jan. 1, 2022, see the Active Member section for details.
Health Reimbursement Arrangement Allowance
Currently, as a pre-Medicare retiree, you receive an allowance from OPERS to offset your monthly premium for coverage in the OPERS Retiree Health Plan administered by Medical Mutual.
Effective Dec. 31, 2021, OPERS will no longer offer a pre-Medicare group plan. Instead, effective Jan. 1, 2022, eligible pre-Medicare retirees will begin receiving a monthly Health Reimbursement Arrangement (HRA) allowance.
In addition to receiving a monthly allowance, you'll no longer pay a medical premium through OPERS, and your monthly benefit amount will increase by the amount currently deducted for that premium.
Step 1: Determining Your Allowance Percentage
To determine your allowance percentage, compare the table below to the following:
- Your age when you first enrolled in the OPERS Health Care Program
- Your qualifying years of service at retirement (Partial years are not rounded up to the next year.)
|Health Care Allowance Percentage|
Service / Age
Step 2: Determining Your Monthly HRA Deposit Amount
To determine your monthly allowance, compare the table above to the following:
- Your allowance percentage from the table
The base allowance amount for pre-Medicare retirees will be $1,200 from 2022 through 2024. The base allowance amount will then be re-evaluated based on market conditions and funding. Allowance Percentages and monthly HRA deposits will range from 51% ($612.00 per month) to 90% ($1,080.00 per month) of the base allowance amount.
($1,200 base allowance)
Step 3: Choosing Your Plan
This plan can be offered through:
- The OPERS Pre-Medicare Connector
- Healthcare.gov (The Affordable Care Act (ACA) health care marketplace)
- An employer (yours or your spouse's)
- Any private health care insurance carrier
OPERS will partner with a vendor to provide pre-Medicare retirees with assistance in identifying and enrolling in the health care coverage medical plan which best suits their needs. This vendor will be referred to as the OPERS Pre-Medicare Connector.
Once you know what your allowance amount will be, you can research private plans as well as plans on the open market offered through Healthcare.gov. Information on plans offered through the OPERS Pre-Medicare Connector will be available as we get closer to the 2022 open enrollment period.
The Affordable Care Act and Healthcare.gov
The Affordable Care Act (ACA) is a comprehensive health care reform law enacted in March 2010. The ACA requires that every state have an exchange, or marketplace, where consumers can buy individual health insurance policies.
The ACA also brought consumer protections to the individual marketplace including:
- Coverage of all pre-existing conditions and essential health benefits such as prescription drugs, hospitalization and emergency services
- Coverage for everyone regardless of health
- Tax credits for lower income buyers
Researching what's available in your area could help you prepare
Plans offered through healthcare.gov for 2021 are available for review. You'll be asked to answer a few questions about income and where you live, and then you can view 2021 plans in your area. Keep in mind that rates, plan options and carriers are likely to change each year.
All plans offered through Healthcare.gov for Ohioans are Health Maintenance Organizations (HMOs). HMO plans offer lower premiums and deductibles and typically require a referral from a primary care physician to see a specialist. Insurance carrier availability is based on ZIP code and there is coverage in all of Ohio's 88 counties.
The Ohio Department of Insurance is also an excellent resource for learning about insurance products and plans.
Via Benefits will serve as the OPERS Pre-Medicare Connector
Next fall, Via Benefits will help to transition pre-Medicare retirees to a new medical plan when we cease to offer the current group plan at the end of 2021. Via Benefits will also administer the Health Reimbursement Arrangement (HRA). The OPERS Medicare Connector is administered by Via Benefits and we're excited to have them on board for a number of reasons.
- Via Benefits is an experienced, informed, and unbiased Connector. They have already successfully transitioned the OPERS Medicare retiree population to an HRA model.
- Via Benefits is accountable to OPERS for the service provided to our members.
- Via Benefits will provide a guided enrollment experience. Researching plans can be overwhelming. Via Benefits has years of experience helping retirees navigate the health care market.
- Via Benefits will serve as a single point of contact, helping retirees with both plan selection and the administration of the HRA.
- Using Via Benefits to elect pre-Medicare health care coverage allows for a relationship to be built and, in turn, a seamless transition to the Medicare Connector when it's time.
- A retiree's spouse and dependents are also able to utilize the services of Via Benefits at no cost.
- OPERS and Via Benefits work hand in hand for you. We work together to constantly improve the retiree experience.
There's no need to reach out to Via Benefits now. You can visit marketplace.viabenefits.com/opers for some general information on the services Via Benefits will provide. Please pay close attention to all communications from OPERS. As we progress toward next year's open enrollment period, you will receive detailed communications from OPERS and Via Benefits about the enrollment and HRA opt in processes. In January 2021, we'll begin a monthly email series about this transition. Watch your inbox for that and take a moment to confirm we have your current email on file within your online account.
OPERS Board of Trustees set plan for re-employed retiree health care
Because all OPERS group medical plans are being eliminated in 2022, the trustees voted to implement new rules for re-employed retirees effective Jan. 1, 2022.
How re-employed retiree coverage works today
Currently, when retirees become re-employed in an OPERS-covered position, their health care coverage changes. OPERS requires all re-employed retirees to choose coverage offered by their employer if it's available to them. If employer coverage isn't available, re-employed retirees may enroll in a separate, OPERS group plan that closely aligns with our current plan for pre-Medicare retirees. Retirees pay a premium which is offset by the OPERS-provided allowance. For Medicare retirees, the allowance replaces monthly HRA deposits during the re-employment period. Participants are subject to new deductibles and co-insurance.
How re-employed retiree coverage will work effective Jan. 1, 2022
Regardless of Medicare eligibility, all re-employed retirees will be able to retain their private-market plans. The monthly HRA deposits will continue to accumulate during re-employment in a separate Re-Employed Accumulated HRA. However, because of federal rules, re-employed retirees will not be able to access the accumulated money while they're re-employed. It will become available once they terminate their re-employment and can be used to seek reimbursement for any expenses incurred outside of re-employment.
Similar to today, re-employed retirees will continue to have access to their HRA balance accrued prior to re-employment during the re-employment period to seek reimbursement for expenses incurred outside of re-employment.
Re-employed retirees can expect more communications regarding this change in 2021.
One-time Transition Deposit
Retirees who opt in to receiving the HRA effective Jan. 1, 2022 and are enrolled in the OPERS group pre-Medicare plan on Dec. 1, 2021 will receive a one-time transition deposit in the amount of $1,200. Retirees meeting these criteria will receive this deposit in their HRA during open enrollment next year (Nov. 1 – Dec. 15, 2021). When enrolling in a new medical plan next fall, retirees will be charged their first plan premium during the enrollment process. The transition deposit is designed to reimburse retirees for this initial premium. It can also be used to reimburse qualified medical expenses incurred after Jan. 1, 2022.
Retirees not enrolled in the OPERS group pre-Medicare plan on Dec. 1, 2021 are not eligible to receive the transition deposit.
Take advantage of our Educational Resources
We know you have questions, which is why we’re offering webinars designed specifically for the Medicare and pre-Medicare populations. We’ll also be offering an extensive education series for pre-Medicare retirees designed to help you transition to choosing health care coverage outside of the OPERS group plan.
- Webinar: Retiree Health Care Under 65
- Why does OPERS need to make changes to the current Pre-Medicare group medical plan?
The OPERS group medical plan has become unsustainable because of the high cost of coverage and the status of OPERS’ pension funding. All money that would be available to fund health care, which could come only from the contribution of employers, must go toward the pension fund. Projections indicate we will not be able to contribute money to our Health Care Fund for more than a decade. By switching from a group medical plan to a Health Reimbursement Arrangement, OPERS will be able to continue offering current and future retirees assistance with the cost of health care coverage.
- What sort of plan will be available to Pre-Medicare retirees beginning next year?
Effective Jan. 1, 2022, OPERS will no longer offer a group medical plan. Instead, we will provide eligible Pre-Medicare retirees with an opportunity to opt in to a Health Reimbursement Arrangement (HRA) and receive monthly deposits from OPERS. Retirees can use the funds within their HRA to be reimbursed for qualified medical expenses for both the retiree and their eligible dependents, including monthly premiums post-tax premiums for the medical plan of their choice.
- What is Via Benefits?
OPERS has partnered with Via Benefits to create the OPERS Pre-Medicare Connector. Via Benefits Insurance Services, founded in 2004, has helped more than 2 million people evaluate and enroll in individual health insurance. Via Benefits is a resource offering personal service to help retirees understand coverage options through a robust online experience supported by a customer service team. It operates the first and largest Medicare marketplace in the country and, in 2014, expanded to include individual and family plans for Pre-Medicare retirees.
- Will Pre-Medicare retirees select a new plan through OPERS?
No. Pre-Medicare retirees can enroll in any medical plan they choose for 2022. Although it's not required, we highly recommend that retirees explore their coverage options and select a new plan through the OPERS Pre-Medicare Connector (Via Benefits). Via Benefits is a resource that helps retirees understand and navigate individual and family health plan options.
Via Benefits isn't an insurance carrier. It's a company that provides:
- Education, support, and assistance to retirees and their dependents when selecting and enrolling in an individual or family medical plan
- Financial consulting -- Via Benefits will help Pre-Medicare retirees understand their funding options. If a retiree qualifies for a federal subsidy, Via Benefits will walk the retiree through a side-by-side comparison to help them decide between taking advantage of the federal subsidy or using the OPERS HRA.
- HRA administrative services
- Ongoing retiree support after medical plan enrollment
- What is a Health Reimbursement Arrangement?
An HRA is an account funded by OPERS that provides tax-free reimbursement for qualified medical expenses such as monthly insurance premiums, deductibles, co-insurance and copays incurred by eligible retirees. Via Benefits will administer the HRA.
Pre-Medicare retirees can use their HRA to get reimbursed for qualified medical expenses. Only OPERS can contribute funds to the HRA. Retirees cannot add their own funds. Pre-Medicare retirees must submit a request for reimbursement including supporting documentation for Via Benefits to approve and release the money from the HRA into the retiree’s personal bank account. Expenses are determined eligible for reimbursement based on IRS guidelines.
- How much money will OPERS deposit into an individual’s HRA?
Monthly HRA deposits will vary depending on the age when the retiree first enrolled in the OPERS Health Care Program and their qualifying years of health care service credit at retirement. The allowances will range from 51 percent to 90 percent of the base allowance amount. The Pre-Medicare base allowance amount will be $1,200 for the first three years, from 2022 through 2024. It will be re-evaluated based on market conditions and funding. Retirees can determine their allowance percentage and monthly HRA deposit amount in 2022 by visiting the Health Care 2022 page on OPERS.org.
OPERS also will provide a one-time, $1,200 transition deposit this fall for retirees who are enrolled in the OPERS Pre-Medicare group medical plan as of Dec. 1, 2021 and have opted in to the HRA. This transition deposit is designed to help defray up-front costs associated with enrolling in a new medical plan.
- Will the funds in my HRA expire at the end of each year?
No. Retirees can carry their HRA balance from year to year and continue using the funds to be reimbursed for qualified medical expenses.
- Will retirees receive HRA deposits for dependent children?
No. Dependent children will not receive an allowance effective Dec. 31, 2021 when OPERS no longer offers the current Pre-Medicare group plan. However, retirees will be able to use HRA dollars to be reimbursed for qualified medical expenses incurred by eligible dependents.
- If a retiree has primary health care coverage with another Ohio Retirement System, will they be able to receive HRA deposits if they also meet OPERS health care eligibility requirements?
Yes. Qualified Pre-Medicare retirees will receive HRA deposits from OPERS once they've opted in to the HRA through Via Benefits this fall. Having health care coverage through another Ohio Retirement System will be no different than enrolling in health care coverage through the OPERS Pre-Medicare Connector, healthcare.gov, or a private insurance company.
- Are Pre-Medicare retirees required to go through Via Benefits to receive an HRA deposit and select a plan?
A: Yes and No. Pre-Medicare retirees are required to contact Via Benefits, either over the phone or online, to opt in to the HRA. Pre-Medicare retirees will have an open HRA meaning they are not required to use Via Benefits to elect a medical plan. However, we encourage them to do so for the following reasons:
- Via Benefits licensed benefit advisors provide helpful support in understanding options and enrolling in a plan that can best meet the Pre-Medicare retiree's needs, all at no cost to the retiree.
- Retirees must opt in with Via Benefits to receive HRA contributions and have access to that money to be reimbursed for eligible expenses since Via Benefits is the HRA administrator.
- When Pre-Medicare retirees become Medicare-eligible, they must use Via Benefits to enroll in a medical plan. It is a requirement for Medicare HRA eligibility, so it makes sense to begin the relationship with Via Benefits now.
Retirees can shop for, compare and enroll in a new plan, and opt in to the HRA, using the Via Benefits website. Enrolling online allows retirees to explore options at their own pace. Enrolling over the phone takes about 30-60 minutes.
- Will I be charged to use the OPERS Pre-Medicare Connector to find and enroll in a new medical plan?
No. Services provided by the OPERS Pre-Medicare Connector are available to you at no cost. However, Via Benefits will charge a fee of $2.60 per month for the administration of the HRA.
- Can Pre-Medicare retirees cover dependents?
Yes. Retirees will be able to choose between individual and family medical plans.
- Will an individual medical plan be the same type of coverage that Medical Mutual provided through the group plan?
No, it will not. Medical Mutual is a preferred provider organization (PPO). The majority of individual and family medical plans offered through the OPERS Pre-Medicare Connector are Health Maintenance Organizations (HMOs) – all plans secured through healthcare.gov for Ohioans are HMOs. HMO plans offer lower premiums and deductibles and typically require a referral from a primary care physician to see a specialist. They also require services through a specific network of providers and hospitals.
- Will retirees have to find new doctors?
It's possible. Some retirees may find that their current providers are not in the network of the plan they want to select. In those cases, retirees can choose to enroll in a different plan or choose to see a different provider who practices within the network of their selected medical plan.
- If I choose to go with a plan through the OPERS Pre-Medicare Connector, what's that market like now?
The Ohio insurance marketplace has stabilized and is expected to strengthen as premiums drop and carriers expand their offerings. In a presentation to the OPERS Board of Trustees, John Barkett, Senior Director of Policy Affairs for Via Benefits, said there are nine insurers in the Ohio market, compared to a U.S. average of 5.4 per state. The carriers define their territories by county, and 95 percent of Ohio residents have access to three or more carriers. Competition is increasing, which will lead to a better environment for consumers. The OPERS Pre-Medicare Connector will also offer plans not available on healthcare.gov. A licensed benefit advisor can walk you through a comparison of all the plans available to you.
- I've done some research on healthcare.gov and noticed that there are limited carriers and plan options in my county. Why is that and what can I do?
Insurance carriers determine where to offer their plans based on many variables. For example, an insurance carrier may think a particular ZIP code is over-saturated with insurance options or a ZIP code doesn't have a high enough population to warrant offering many plans.
Prior to making the decision to change the OPERS health care program from a group medical plan to an HRA model, OPERS performed an evaluation of the health care plan availability in the state and determined that all areas had at least one carrier available and in most cases, those carriers offered more than one plan option.
Plan options available on healthcare.gov may not be the only plans available in a specific area. Remember that with an open HRA, you may enroll in any health care plan through the OPERS Pre-Medicare Connector, healthcare.gov, an insurance broker, or even directly with an insurance company.
- How much more is a new individual medical plan going to cost?
It won't necessarily cost more. In fact, depending on their HRA allowance and which plan they choose, some retirees will find the HRA covers their entire premium and they will have extra funding to pay for out-of-pocket costs. Further, money can accumulate from year to year in the HRA to be used for future health care expenses.
All retirees will have choice and flexibility in plans. Some retirees may find that they like the additional choices and are better off financially, while others may find that they will have to pay more in premiums and/or out-of-pocket costs. This will depend on the available plans in your county.
- Based on what I'm going to receive monthly in my HRA, I don't think OPERS is providing me enough money to cover my premiums.
Covering the entire cost of health insurance is not the intention of the OPERS Health Care Program. In the current group plan, all retirees pay some percentage of the monthly premium, based on age and years of service credit. (See allowance table on OPERS website.) It will be the same way with the new coverage. However, there's more flexibility. To the extent that a participant opts for lesser coverage, he or she may be able to cover the full premium, and even have money left over to go toward dependent coverage or to save for future health care expenses.
- What about out-of-pocket costs?
Some retirees, especially those with chronic conditions or those taking high cost prescription drugs, may be required to pay more up front than they're used to paying, in terms of higher deductibles and co-insurance amounts.
- What if a retiree chooses not to enroll in a plan and just pays for expenses out-of-pocket, will they still receive HRA deposits?
Enrolling in a medical plan is not a requirement for Pre-Medicare retirees to receive HRA deposits. Pre-Medicare retirees only need to meet eligibility guidelines and opt-in to receive the HRA deposits.
- If a Pre-Medicare retiree is covered as a dependent on their spouse's medical plan or enrolled in an employer's plan, are they still eligible to receive HRA deposits?
Yes, once they've opted in, retirees will receive HRA deposits regardless. This is how an open HRA works. Retirees can use the funds within their HRA to be reimbursed for qualified medical expenses such as premiums, deductibles, co-insurance and other out-of-pocket expenses.
- Will Pre-Medicare retirees living outside the United States and the District of Columbia receive HRA deposits?
Yes. Provided they meet the health care eligibility requirements, retirees living outside of the United States of America and the District of Columbia will be able to opt in to the HRA and receive monthly deposits from OPERS. They may seek health care coverage through the foreign country in which they live or enroll in an insurance carrier that offers international coverage. When seeking reimbursement from the HRA, qualified expenses will need to be translated into English and US currency as of the date the expense was incurred.
- Can contributions be made to both a Health Savings Account (HSA) and an HRA at the same time?
Except in certain situations, the law does not allow an individual to have an HRA and contribute to an HSA at the same time. Please refer to your HSA provider or a tax advisor for more details.
- If a retiree is no longer contributing to a Health Savings Account (HSA) but they have an existing balance, can they receive reimbursements from both an HSA and their OPERS HRA?
Yes, but the IRS has specific rules that must be followed for an individual to seek reimbursement from an HSA and an HRA. Typically, an individual cannot be reimbursed for the same expense from both accounts. Please refer to the HSA provider you are seeking reimbursement from or a tax advisor for more details.
- Will OPERS still take money out of retirees' pension checks to pay for health care?
No. All retirees who currently are enrolled in the OPERS group medical plan will see more money in their pension checks effective with their January 2022 benefit payment because OPERS no longer will deduct the retirees' share of the premium for the OPERS group medical plan.
- Will OPERS still offer dental and vision plans?
Yes. OPERS will continue to offer optional group dental and vision plans. All retirees can choose to enroll in these plans even if they're not eligible for other parts of the health care program. Eligible dependents also can be enrolled. Participants will pay the full premium for these plans, as they do now.
- When will Pre-Medicare retirees sign up for a new plan?
Open enrollment for 2022 will run from Nov. 1 through Dec. 15, 2021.
- What should Pre-Medicare retirees consider in choosing a new medical plan?
They will need to carefully consider the details of the plans that are available in their area. Weigh the pros and cons of having more or less coverage. For instance, would they prefer to pay higher premiums up front to pay less costs for treatment? Or would they be better off with lesser coverage and lower premiums, which could allow them to save a portion of the HRA deposit each month? Via Benefits licensed benefit advisors can help guide retirees through this decision-making process.
- Will a Pre-Medicare retiree with a pre-existing condition be refused coverage under a new plan?
No. Under the Affordable Care Act, health insurance companies can't refuse to cover individuals or charge them more just because they have a pre-existing condition — that is, a health problem you had before the date that new health coverage starts. This protection applies to all plans.
- Will Pre-Medicare individual and family medical plans offer "Guaranteed Issue"?
"Guaranteed Issue" is a term typically associated with Medicare plans. It is a provision which protects individuals from being denied coverage based on a pre-existing condition. Under the Affordable Care Act, health insurance companies can't refuse to cover individuals or charge them more because they have a pre-existing condition. This protection applies to all Pre-Medicare plans.
- Will all the medical plans offered through the OPERS Pre-Medicare Connector be compliant with the Affordable Care Act?
Yes. All individual and family medical plans offered by healthcare.gov and the OPERS Pre-Medicare Connector's private market are compliant with the Affordable Care Act (ACA).
However, there are some differences between plans. The ACA designation of qualified health plan (QHP) is given to health insurance plans that are sold within the government-run marketplace (healthcare.gov). Basic rules apply to plans sold via healthcare.gov: they must be guaranteed issue (not impose pre-existing condition restrictions), follow the ACA's cost-sharing guidelines, and cover "essential health benefits" with no lifetime or annual maximums for coverage. A QHP is also eligible to be purchased using a premium tax credit.
Medical plans offered through the private market are considered non-qualified plans because they are not certified by healthcare.gov but they are ACA-compliant medical plans and follow the same basic rules as qualified health plans. Non-qualified plans are not eligible to be purchased with a premium tax credit.
- This sounds nerve wracking. What is OPERS doing to help smooth this transition?
For those who feel that they might be worse off under a new individual medical plan, OPERS knows that this can cause anxiety and concern; that's why we are providing as much advanced information, support and resources as possible to help retirees think about their individual situations and plan and budget effectively.
We also are fully committed to providing plenty of communication to you along the way. Refer to the Health Care 2022 section of the OPERS website for more information.