OPERS Medicare Connector Helpful Tools

Frequently Asked Questions

Below is a list of frequently asked questions, asked by you, our retirees.

Are retirees and/or eligible spouses required to use the OPERS Medicare Connector?

No one is required to use the OPERS Medicare Connector. However, retirees who do not use the Connector to enroll in a medical plan will not be eligible to receive an HRA allowance from OPERS.

Can an OPERS retiree use the OPERS Medicare Connector if he is not currently eligible for OPERS health care?

Yes. However, the retiree will not receive an HRA allowance from OPERS.

Can my spouse use the OPERS Medicare Connector now and once their allowance is phased out?

Yes. Using the OPERS Medicare Connector resources will help them access reasonably priced health care plans. It is important to note that one plan offered has $0 premium. While this plan has higher out-of-pocket and point of service costs, it does serve as a very affordable option for many retirees.

How will a retiree or spouse who worked in a public sector position for their full career and is not eligible for premium-free Part A be handled?

The Board approved OPERS staff to move forward in pursuing legislative change so that OPERS could reimburse retirees at 100% for their Part A premium and at 50% for their spouse's Part A premium. Reimbursement also will cover any penalties that may apply. The retiree must select a plan through the OPERS Medicare Connector to receive Medicare A premium reimbursement. Reimbursement will also cover any late enrollment penalties that may apply.

How is the Connector compensated?

The Connector receives commissions from the insurance companies whose product it sells. This is the model that's used in the Medicare individual marketplace in which 50 million people are enrolled. The Benefit Advisor does not know the commission structure so there is no incentive for the advisor to 'steer' retirees to one plan over another. Advisors are paid a salary; not a commission.

Will there be face-to-face appointments available with the Connector for retirees who need help with education and enrollment?

Plan selection appointments will take place over the phone. CMS guidelines are very strict about face-to-face enrollments, and encourage telephonic enrollments so that the dialogue can be recorded.

What does 'Guaranteed Issue' mean?

Medicare regulation that protects retirees by mandating that insurance companies will issue a Medicare plan to retirees when they first become eligible. Guaranteed issue also applies when people age into Medicare or when they first retire, if they are older than 65.

What is 'Medical Underwriting'?

Process through which a Medigap (Medicare Supplement) insurance carrier can ask a retiree about their health status – if the retiree failed to enroll in a Medicare plan during the open enrollment period. Medical underwriting may result in denied coverage or a higher premium due to health status.