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.

Retirees like me: 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 health care services including preventive care
  • Coverage that provides a safety net in the event 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 chooses a plan to fit his lifestyle. He opts for a Medicare Advantage plan that includes prescription drug coverage (MAPD). To qualify for this plan, he must enroll in Medicare Part A and Part B. As part of this plan, he will continue to pay the Part B premium to Medicare. He enjoys a low premium knowing he may have out-of-pocket costs for nonpreventive medical care.

Sam's Coverage costs
Monthly allowance $337.00
Medical and Rx Premium - $20.00

Total monthly remaining allowance dollars = $317.00
Medicare Part B Premium - $ 121.80
Medicare Part B reimbursement +31.81

Remaining monthly allowance for other health care expenses = $ 227.01


Retirees like me: Anne

Anne will be 65 next month. Her income is limited since her husband passed away so she's working in the private sector part-time to earn extra money. Anne has heart disease and visits a specialist. The specialist has prescribed her several medications to help manage her illness. Because she's on a budget, she doesn't feel she can afford high out-of-pocket costs should she get sick. She also prefers not to change doctors.

Anne's health care needs:

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

Anne determined that a Medigap plan would be most beneficial to her needs and budgetary concerns. She also selected a Medicare Part D prescription drug plan. Anne's OPERS allowance will cover her monthly premiums.

Anne will use her remaining allowance dollars for her Medicare Part B premium.




Retirees like me: Brenda and Carl

Brenda and her husband are both 70 years old. Brenda has diabetes and a heart condition. She has a number of doctors and wants to be sure she can continue seeing them with comprehensive coverage. Brenda's husband, Carl, is in excellent health.

Brenda's health care needs:

  • Access to her trusted team of doctors without worrying about out of network costs
  • Prescription drug plan

Carl's health care needs:

  • Access to a full range of health care services, including preventive care
  • Coverage that provides a safety net in the event of a serious illness
  • Access to prescription drug coverage in case he needs medications in the future

Brenda chooses a Medigap plan and a stand-alone Medicare Part D prescription drug plan. With a Medigap plan, she knows all her doctors are covered because there is not a defined network of physicians. Carl picks a Medicare Advantage plan with prescription drug coverage (MAPD) with no monthly premium. He likes the benefits, but knows if he is hospitalized he will have daily deductibles to meet.

Also, the premium they had been paying for the OPERS plan will no longer be taken out of Brenda's pension check in 2016. Brenda and Carl choose to use those dollars to pay for her Medicare Part B premium. They plan to use the dollars she no longer pays to OPERS toward deductibles and other costs if Carl was ever to be hospitalized.

Brenda and Carl ' Coverage costs
Monthly allowance $ 337.00
Medical plan cost - Brenda - $ 191.00
RX plan premiums - Brenda - $ 39.00
Medical and RX costs - Carl - $ 0

Total monthly remaining allowance dollars = $ 107.00


Brenda and Carl's Remaining allowance
Total monthly remaining allowance dollars $ 107.00
OPERS premium no longer deducted in 2016 + $ 100.00
Medicare Part B premium - Brenda - $ 121.80
Medicare Part B reimbursement - Brenda + $ 31.81

Remaining monthly allowance for other health care expenses = $ 117.01

Example does not include spouse allowance which will end in 2018

Retirees like me: Maria and Lorenzo

Maria is retiring and she and her husband Lorenzo are about to turn 65. They contacted SSA to enroll in Medicare Parts A and B. Once they received their Medicare card from Social Security, they sent copies to OPERS to confirm their enrollment. Now that they are enrolled in Original Medicare, Maria and Lorenzo called OneExchange to set up their enrollment call so they could 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 OneExchange. Before scheduling their calls, they researched plans in their area and both set up online personal profiles through www.medicare.oneexchange. com/opers. Setting up profiles ahead of time with prescription and personal account information allowed their enrollment calls with a Licensed Benefit Advisor to go a little faster because the information was readily available for the advisor.

About a month before they turned 65, they both had their enrollment call with OneExchange and selected different plans based on their individual needs. Here is the process they went through to make their plan decision.

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 in case he needs medications in the future

Maria chooses a plan that fits her best. She 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 coverage. Maria's OPERS allowance will cover her monthly premiums and will use her remaining allowance dollars for her Medicare Part B premium.

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

Maria and Lorenzo's Coverage Costs
Monthly allowance $337.00
Medical plan cost - Maria - $191.00
Prescription plan premiums - Maria - $39.00
Medical and prescription costs - Lorenzo - $0.00

Total monthly remaining allowance dollars = $107.00
Maria's Medicare Part B Premium - $121.80
Maria's Medicare Part B Reimbursement + $31.81

Remaining monthly amount available for other health care expenses = $17.01
Maria will have the $120 ($30 for her and $90 for Lorenzo) monthly health care premium added back to her monthly pension benefit as it will no longer be deducted in 2016.
Example does not include spouse allowance which will end in 2018

In all the examples listed here, using the OPERS Medicare Connector, the retirees will take advantage of a 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.