OPERS Medicare Connector Glossary

OPERS has compiled a list of helpful tools to help retirees understand the 2016 OPERS Medicare Connector.

Licensed Benefit Advisor

Employee who works for OneExchange and provides support to retirees and their spouses in selecting individual Medicare plans, resolving claims issues, and changing Medicare plans, if necessary. Benefit Advisors are licensed by the state departments of insurance and must be certified by the health insurance plans before they can enroll retirees into their products. Additionally, they must complete stringent Medicare and senior sensitivity training before they can assist retirees.

Guaranteed Issue

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.

Health Reimbursement Arrangement (HRA)

An account funded by OPERS that provides tax-free reimbursement for qualified medical expenses such as monthly insurance premiums, Part B premiums and copays incurred by a retiree and/or eligible dependent. OneExchange will administer the HRA, and will provide education to the retiree on how to use the account complete the reimbursement process.

HRA Allowance

Monthly amount that OPERS retirees eligible for OPERS health care and enrolled in Medicare Parts A and B will receive in an HRA upon enrolling in a medical plan through OneExchange. The amount of the allowance is dependent on years of service credit and age at retirement. 98% of retirees who retired prior to 2015 will not fall below a set minimum allowance of $337.

HRA Statement

A document personalized to each retiree that will explain their respective monthly allowance amount.

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.

Medicare Part A

Insurance that helps pay inpatient hospitalization, skilled nursing facilities and some skilled home health care. Retirees can enroll once they become Medicare eligible, and if they have made payroll contributions to Social Security for at least 10 years (40 quarters), Part A is free. If the retiree does not qualify for premium-free Medicare Part A, he or she may qualify through a spouse.

Medicare Part B

Insurance that helps pay outpatient costs such as doctor visits, lab work, diagnostic services (prostate cancer screenings, mammograms), outpatient surgery and durable medical equipment (oxygen, a wheelchair). Retirees must enroll in Part B as soon as they are eligible or they will incur financial penalties.

Medicare Part C (Medicare Advantage)

An insurance plan provided by a private insurance carrier that combines coverage for hospital costs, doctor visits and other medical services. Prescription drug coverage is typically included and range from $0 - $150 per month depending on carrier and the plan benefits. These plans have lower premiums, but higher costs when retirees access health care. Retirees must be enrolled in Parts A and B to be eligible for a Medicare Advantage plan. See definition for Medicare Advantage for additional information.

Medicare Part D (PDP)

Insurance that helps pay for prescription drugs. It is not automatic. Retirees can enroll in a stand-alone Prescription Drug Plan (PDP) or enroll in a Medicare Advantage plan that has Part D coverage (MAPD). There are some PDPs that have $0 copays for generics, and some that have additional coverage for the donut hole. Retirees must enroll in Part D as soon as they are eligible or they will incur financial penalties.

Medicare Supplement (Medigap)

Plans that range from $80 to $280 per month.
These plans have higher premiums, but little to no costs when retirees access health care. Medicare Supplement plans do not include prescription drug coverage so a retiree will need to select a separate Part D plan.

OPERS Medicare Connector

The OPERS Medicare Connector, administered by OneExchange, is available to retirees and spouses enrolled in Medicare Parts A and B. OneExchange employs Licensed Benefit Advisors who help retirees and spouses select a medical and prescription drug plan, resolve claims issues, and change Medicare plans. OPERS retirees aren’t required to select their medical plan through the Connector; however, retirees who do not use the Connector will not receive an HRA allowance from OPERS.

OneExchange

The company OPERS has chosen to administer the OPERS Medicare Connector after an extensive request for proposal process.

Qualified Medical Expenses

Expenses generated by the retiree and/or eligible dependent that can be submitted for reimbursement from a retiree’s HRA; including medical, prescription, dental and vision premiums, Medicare Part B premiums, doctor visit and prescription copays.