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 is 66 years old and retired at the end of 2016.

Sam is an avid fisherman who lives lakeside in northern Ohio and plans to stay there during retirement.

Sam does not currently take on a lot of health care expenses, but likes the idea of having a safety net should a significant health problem surface.

He does not intend to move, so staying within a network of participating providers is not a problem

Sam chose a Medicare Advantage plan which includes prescription coverage. With the money left over in his account every month, he receives reimbursement for his Medicare Part B premium and OPERS dental plan premium. Sam even has money remaining to be reimbursed for any office visits, co-pays, and other qualified medical expenses as defined by the IRS.

Sam's Coverage costs
OPERS allowance $337.00
Medicare Advantage plan premium - $64.59
Medicare Part B Premium - $ 134.00
OPERS dental plan -$5.62

Remaining monthly allowance for other health care expenses = $ 132.79


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.




Dan is 70 years old, retired and receiving an OPERS pension.

His wife, JoAnn, hasn’t worked outside their home and relies on Dan’s retirement to receive health care coverage.

Dan has a chronic condition and doesn’t want to have to stay within a network of physicians, so he’s chosen a Medigap plan and a stand-alone Medicare Part D prescription drug plan through OneExchange.

JoAnn selects a Medicare Advantage plan with prescription drug coverage (MAPD). Effective January 2018, JoAnn will not receive an allowance toward the cost of her Medicare plan, but she decides to remain enrolled.

After paying for his and JoAnn’s medical premiums, Dan has $72.99 remaining in his HRA account monthly that he can use to receive reimbursement for dental or vision premiums as well as other qualified expenses.

Dan and JoAnn
OPERS allowance amount $ 337.00
Medigap plan premium (Dan) - $ 172.15
Medicare Part D premium (Dan) - $ 27.17
Medicare Advantage plan premium (JoAnn) - $ 64.69

Total left in HRA account = $ 72.99.00

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

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.