OPERS Medicare Connector Retirees Like Me

Below are health care scenarios of retirees. Read each of their stories to understand how they determined which plan(s) best fit their lifestyles.

Click on a tab below to read their stories.

Sam

Sam just turned 65 and is retired. He's in good shape and generally healthy. He takes a daily blood pressure prescription drug which costs him about $25 each month. Sam takes good care of himself and budgets for health care expenses accordingly.

Sam's Health Care Needs:

  • Access to comprehensive health care services, including preventive care
  • Coverage that provides a safety net in case of a serious illness
  • Access to specialists if he needs them; he's OK staying within a plan's network
  • Access to prescription drug coverage in case he needs additional medications at some point
  • Sam does not travel
Sam's Choice: Medicare Advantage plan

Sam chooses a plan to fit his lifestyle. He opts for a Medicare Advantage plan that includes prescription drug coverage.

To qualify for this plan, he must enroll in Medicare Parts A and B. As part of this plan, he will continue to pay the Part B premium to Medicare and then submit for reimbursement from his HRA. Had Sam not enrolled in a plan through the Connector, he would not have access to an HRA to help pay for qualified medical expenses such as his Medicare Part B premium.



Sasha

Sasha is a 65 year old Medicare-eligible retiree with a healthy pension benefit. She takes a generic medication and visits her doctor on an annual basis to check in on her health.

Sasha decides to return to work in an OPERS-covered position. As a re-employed retiree, she understands she cannot receive HRA allowances or access her HRA balance to reimburse expenses incurred during reemployment. She will, however, be able to reimburse eligible expenses incurred outside of her period of re-employment.

Sasha's Health Care Needs:

  • Minimal out-of-pocket expenses
  • Discounted prescription drugs
Sasha's Choice: Medigap Plan

Sasha selects a Medigap plan and because she has little pharmacy expenses, chooses not to enroll in a prescription drug plan until next year.

Sasha may not have realized that by not enrolling in a prescription drug plan, she will incur a late enrollment penalty for as long as she has a Medicare drug plan. The cost of the late enrollment penalty will depend on how long she goes without Medicare Part D or creditable prescription drug coverage.




David and Eleanor

David and Eleanor are over 65 and married. David is an OPERS retiree. Last year, David enrolled in a medical plan through Via Benefits and set up recurring reimbursement for his Medicare Part B premiums. David and Eleanor have car and life insurance through a family broker and decide to use this same broker to enroll in new health care plans for the upcoming year.

Because David did not enroll in health coverage through Via Benefits and Via Benefits is no longer his Agent of Record, David is not eligible to receive monthly allowances into his existing HRA. This means he can no longer receive new allowances; however, he can still access the account to exhaust the remaining account balance.

Should David choose to re-enroll in a medical and/or prescription drug plan through the Connector next year, he may be subject to medical underwriting and could be denied future medical coverage.


Maria and Lorenzo

Maria is retiring and she and her husband Lorenzo recently turned 65. They contacted SSA to enroll in Medicare Parts A and B. Now that they are enrolled in Original Medicare, Maria and Lorenzo called Via Benefits to set up their enrollment call to enroll in a plan that would have additional health care coverage not covered by Original Medicare.

Prior to making plan selections, Maria and Lorenzo reviewed enrollment materials received from Via Benefits. Before scheduling their calls, they researched plans in their area and both set up online personal profiles through https://My.ViaBenefits.com/OPERS. About a month before they turned 65, they both had their medical plan enrollment call with Via Benefits and selected different plans based on their individual needs. With Via Benefits documented as Maria's Agent of Record, she will begin to receive monthly allowance deposits in her Health Reimbursement Arrangement when her coverage becomes effective.

Maria has high blood pressure and arthritis and takes daily medication to help manage her illness and pain. She's on a budget and doesn't feel she can afford high out-of-pocket costs should she get sick. She also prefers not to change doctors. Her husband Lorenzo is in excellent health.

Maria has high blood pressure and arthritis and visits a few different specialists. The specialists have prescribed her a daily medication to help manage her illness and pain. She's on a budget and doesn't feel she can afford high out-of-pocket costs should she get sick. She also prefers not to change doctors. Her husband Lorenzo is in excellent health.

Maria's health care needs:

  • Minimal out-of-pocket costs
  • Access to her trusted doctors
  • Generic prescription drugs

Lorenzo's health care needs:

  • Access to a full range of health care services, including preventive care
  • Coverage that provides a safety net in case of a serious illness
  • Access to prescription drug coverage for future medications
Maria's Choice: Medigap Plan

Maria determined that a Medigap plan would be most beneficial to her lifestyle.

Along with the Medigap plan, she selected a supplement Medicare Part D prescription drug plan. Maria's HRA allowance will cover her monthly premiums; she will use her remaining allowance dollars for her Medicare Part B premium.

Lorenzo's Choice: Medicare Advantage plan

Lorenzo picks a Medicare Advantage plan with prescription drug coverage with no monthly premium. He likes the flexibility, but knows if he is hospitalized he will have deductibles to meet.



In all the examples listed here, using the OPERS Medicare Connector, the retirees will take advantage of a telephonic counseling session with a Licensed Benefit Advisor to help determine the right Medicare plan option for them. This representative would also enroll them in the plan.