OPERS Medicare Connector Glossary
Below is a list of commonly used terms of the OPERS Medicare Connector, administered by Via Benefits.
Licensed Benefit Advisor
An employee who works for Via Benefits and provides support to participants in selecting individual Medicare plans, discussing claim issues with insurance carriers and changing Medicare plans. Licensed Benefit Advisors are licensed by state departments of insurance and must be certified by the health insurance carriers before they can enroll retirees into their products. Additionally, Licensed Benefit Advisors must complete stringent Medicare and senior sensitivity training before they can assist retirees.
Health Reimbursement Arrangement (HRA)
An account funded by OPERS that provides tax-free reimbursement for qualified medical expenses such as monthly insurance premiums, Medicare Part B premiums and copays incurred by eligible participants. Via Benefits administers the HRA.
Eligible participants will receive a monthly amount deposited into an HRA upon enrolling in a medical plan through Via Benefits. The amount of the allowance is dependent on years of service credit and age at retirement.
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. These plans have lower premiums, but higher costs when individuals access health care. Individuals must be enrolled in Medicare Parts A and B to be eligible for a Medicare Advantage plan.
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). Retirees must enroll in Part D as soon as they are eligible or they will incur financial penalties.
Medigap (Medicare Supplement) Plan
A private health insurance that supplements or fills in the "gaps" where Medicare Parts A and B leave an individual uncovered. Medigap plans do not have networks. They typically have higher monthly premiums, but little to no out-of-pocket costs. A separate Medicare Part D drug plan needs to be selected for prescription coverage.
OPERS Medicare Connector
A service offered to OPERS participants enrolled in Medicare Parts A and B that provides support for Medicare education, plan selection and enrollment and advocacy efforts. This model offers more affordable choices to Medicare retirees than a group Medicare plan. The Connector is administered by Via Benefits.
The company in which OPERS selected to administer the OPERS Medicare Connector and HRA. Via Benefits is an experienced Medicare Connector and is a division of Willis Towers Watson, a century-old benefits consulting firm.
Qualified Medical Expenses
These are expenses incurred by participants that can be submitted for reimbursement from a retiree's HRA and include medical, prescription, vision and dental premiums, Medicare Part B premiums and doctor and prescription copays. Refer to IRS publication 502 for a full list of eligible expenses.