Health care Q&A
OPERS provides answers to questions we’re being asked thus far
By Michael Pramik, Ohio Public Employees Retirement System
Jan. 23, 2020 – We’ve fielded many questions about health care since announcing last week that OPERS will be changing its health care coverage in 2022.
Here are answers to some of the questions we’re being asked most often.
Q: I fully understand why the change is needed. I hope I am provided with information, so I can fully understand how the changes will affect me and how I will find insurance in 2022.
A: We will be communicating extensively with retirees over the next two years until the changes go into effect on Jan. 1, 2022. We encourage all OPERS members and retirees to read their mail, refer to our website, blog and social media sites for more information, and take advantage of the extensive offerings made available by the OPERS education team. Visit the Member Education Center for seminars, dates and locations.
Q: Will the allowance for pre-Medicare coverage be added to the monthly pension benefit?
A: No, but current participants in the OPERS group pre-Medicare plan will likely see their pension checks increase as a result. Because we will no longer deduct the retiree’s portion of the premium from their pension check, current plan participants will see a net increase in their monthly payment. This amount can be used for medical expenses. The average premium amount deducted from a retiree’s benefit payment is about $345 per month in 2020.
The allowance will be deposited monthly into a Health Reimbursement Arrangement account we will set up for every participant in the plan. The HRA is an Internal Revenue Service-approved program that allows us to provide the allowance on a pre-tax basis. Retirees will pay for premiums and other expenses, then apply for reimbursement from the HRA account.
Q: I will be opting for pre-Medicare coverage in 2022. Will I be able to use the money for any health care plan?
A: Yes. OPERS anticipates offering an open coverage model in which participants will be able to select a plan that meets their individual needs from the OPERS selected vendor or from a vendor of their choice.
Q: What happens to children under age 26 who could have enrolled in the OPERS pre-Medicare plan when it is eliminated in 2022?
A: There will be no allowance for dependents as of Jan. 1, 2022. However, the retiree could use their own HRA dollars to be reimbursed for qualified medical expenses for an eligible dependent. Counseling will be available to help evaluate your options as well as identify any financial assistance available.
Q: I retired and enrolled in health care prior to 2015 with less than 20 years of service. My allowance percentage was grandfathered at 75 percent. I hear that the 75 percent grandfathering will no longer apply in 2022. What does this mean for me?
A: OPERS provides an allowance to both Medicare and pre-Medicare health care participants. The allowance amount is determined on an increasing scale based on age and years of service. Previous changes set the minimum allowance percentage at 75 percent for those already retired, even if they had fewer than 20 years of service at retirement.
Beginning in 2022, those who were subject to this grandfathering with fewer than 20 years of service will have their allowance amount reduced to 51 percent ($612 per month for pre-Medicare; $178.50 per month for Medicare).
Q: Where can we find a chart that shows the percentages for those who retired younger than age 60?
A: Anyone who retired under the age of 60 should use the age 60 column on the chart and their applicable years of service. The allowance table has not changed.
Q: If I retire between now and 2022, what are my options?
A: If you are considering a retirement date between now and when the changes become effective in 2022, we strongly encourage you to attend an OPERS educational seminar as well as schedule a meeting with an OPERS retirement counselor to evaluate your individual options. In general, current health care coverage will continue through 2021.
Q: What will the monthly pre-Medicare allowance be beginning in 2022?
A: The base allowance amount for calendar years 2022, 2023 and 2024 will be $1,200 per month. After 2024, we plan to continue to offer an allowance at an amount based on market conditions and funding.
Q: Do you have any estimates of what pre-Medicare medical, prescription, dental and vision coverage will cost per month in 2022?
A: It’s too early to say exactly what insurance will cost in two years. However, you can check HealthCare.gov for current rate examples. Based on research premiums for plans currently available range from $600-$1,200 monthly depending on your location.
Q: I’m currently a re-employed retiree and I’m enrolled in OPERS coverage because my employer doesn’t offer it to me. What will I do if I’m still working in this job two years from now, since OPERS is discontinuing its group plan?
A: More information regarding re-employed retirees will be available in the coming months.
Q: Do you have an estimate of how long the $350 base allowance for Medicare-eligible retirees will stay at that amount?
A: We anticipate the $350 base allowance to remain from 2022-2024. After 2024, we plan to continue to offer an allowance at an amount based on market conditions and funding.
Michael Pramik
Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.
In your analysis for medicare coverage, you state that the average cost for a medigap plan and drug plan is $275 per month so you are going to reduce the allowance to $350 per month. However, for some reason you are choosing to ignore the fact that the there is a cost for medicare part B of at least $144 per month plus dental and vision coverage of approximately $40 per month. That brings the total to $459 per month so the original allowance of $450 does not even cover the total amount. I do understand that your objective is to not cover the complete cost, but your analysis is misleading when it does not take into account the total cost to the medicare retiree.
Michael, I retired in 2002 how is this affect me. I’m hot disability retirement. Thank you.
Please call us at 1-800-222-7377 and a member of our staff can explain how the changes will impact you.
Hello, to be clear. The Medicare-eligible retirees group will be recalculated. So at age 60, 23years of service, what would the range be for the allowance? the current amount, a new base amount of $350.00 or something else. Thanks
How soon will individuals be made aware of what their new amount will be? Especially those losing any grandfathering?
Beginning in 2022, the Health Reimbursement Arrangement (HRA) base allowance will change for Medicare retirees. Your percentage remains the same but the base allowance amount changes to $350. The allowance is based on your years of service at retirement and your age when you first enroll in OPERS health care.
The base allowance fro pre-Medicare retirees is $1,200.
With the 23 years of service and age 60, your allowance percentage is 57%. To see the 2022 allowance charts, go to https://www.opers.org/healthcare/health-care-2022/index.shtml.
is the reason OPERS refuses to allow groups B and C to purchase our extended service time is to get those of us potentially eligible past the 2022 mark and keep us off the insurance for those couple of years?
For more information about purchasing service credit, including military and out-of-state public service, go to pgs. 4-10 of the Service Credit leaflet, https://www.opers.org/pubs-archive/leaflets/ISL-F.pdf.
Thanks for the post.
When money is withdrawn from an HRA, is it considered to be taxable income?
The HRA is used for reimbursement of qualified medical expenses only, therefore it is not considered taxable income.
Julie
The answer that Julie Graham-Price gave to John Swinger’s question does not seem to fit. I have the same question: Is the medicare allowance considered to be taxable income?
Susan,
As we note on our website, “A Health Reimbursement Arrangement, or HRA, is an account funded by OPERS that provides tax-free reimbursement for qualified medical expenses.” For more information about the HRA, go to https://www.opers.org/healthcare/plan-options/ViaBenefits/hra.shtml.
You can sign up for the seminar on how to use your HRA through your online account. You can find the list of dates at https://www.opers.org/retirees/education/retiree-health-care-65-and-older.shtml.
Julie, OPERS
This healthcare change is totally confusing. I have 34 years of service and can retire at anytime. However, I am not sure that is affordable because of my age and the length of time until I am eligible for medicare. I am only 57. If I am understanding correctly, PERS will only be putting around 250.00-300.00 into an account and I will have to pay the rest and then get reimbursed from the healthcare account. Is that correct? Most insurance premiums for people my age are much higher than that, with deductibles that are sky high. Am I understanding this correctly?
Beginning in 2022, you will receive a monthly Health Reimbursement Arrangement allowance, or HRA, based on your years of service and age when enrolling in OPERS health care.
From 2022-2024 the base allowance for pre-Medicare retirees is $1200. Once you become eligible for Medicare, your percentage stays the same but the base allowance changes to $350. Based on your age at enrollment and years of service at retirement, you will receive 51-90% of the base allowance each month to pay for qualified health care expenses. For more information go to https://www.opers.org/healthcare/health-care-2022/index.shtml
Julie, OPERS
I retired in April 2013, due to a medical condition, I did not take a disability, I was close to retiring, I had 28 years. I was eligible to take disability, now I am three years away from Medicare. I am wondering if I should apply for Medicare, and how the new changes will affect my medical from OPERS.
We encourage you to call us at 1-800-222-7377 or schedule a meeting with a Counselor to review your options.
According to all the info it looks like you will be paying my monthly premium..I retired in 2016 at 52 years old meaning I get 71 % of 1200 meaning if my premium is 600 you will cover it?? Seems to good to be true
The allowance is based on your years of service at retirement and your age when first enrolling in OPERS health care. Without knowing your years of service I can’t predict your allowance amount. For more information, go to the 2022 page on the website, https://www.opers.org/healthcare/health-care-2022/index.shtml.
Will this effect disability retirement also?
For disability recipients, health care eligibility requirements are not changing.
What is changing for all disability recipients and retirees is the allowance amount. The allowance charts on the OPERS website apply to disability recipients in the same manner as retirees. For more information, go to https://www.opers.org/healthcare/health-care-2022/index.shtml.
In addition, disability recipients returning to work in the private sector will not receive a monthly HRA allowance. Income thresholds will be determined.
Julie, OPERS
I am over 65 with 26 years of service. If I should retire and then go to work for a company that offers health care, will I still receive an HRA account?
In order to receive a Health Reimbursement Arrangement (HRA) allowance, you must be enrolled in a plan through Via Benefits.
Julie, could you please answer Patricia’s question
with a yes or no? i have the same question as patricia and i dont understand your ans.
Eli,
The OPERS Board of Trustees last month approved a new health care plan for re-employed retirees, beginning in 2022.
Here is an explanation from the August Board Report, which we email to members. If you have additional questions, please contact us at 800-222-7377.
Because group plans are being eliminated in 2022, the trustees voted to implement new rules for re-employed retirees effective Jan. 1, 2022.
Current re-employed retiree coverage:
When current retirees become re-employed in an OPERS-contributing position, their health care coverage changes. OPERS requires all re-employed retirees to choose coverage offered by the employer if it’s available to them. If employer coverage isn’t available, re-employed retirees may enroll in a separate, OPERS group plan that closely aligns with our current plan for retirees. Retirees pay a premium which is offset by the OPERS-provided allowance. For Medicare retirees, the allowance replaces the HRA during the re-employment period. Participants are subject to new deductibles and co-insurance.
There is one difference specific to Medicare re-employed retirees. They can stay enrolled in their Medicare medical plan through Via Benefits with no monthly HRA deposits (vs. enrolling in their employer coverage or enrolling in the OPERS group plan if employer coverage isn’t available). No matter which option they choose, federal regulations require their HRAs are frozen, and expenses incurred during re-employment are not eligible for reimbursement; however, expenses incurred outside of re-employment can continue to be reimbursed.
Re-employed retiree coverage beginning in 2022:
All re-employed retirees will be able to retain their private-market plans. The monthly HRA deposits will continue to accumulate during re-employment. However, because of federal rules, re-employed retirees will not be able to access the accumulated money while they’re re-employed. It will become available once they terminate their re-employment and can be used to seek reimbursement for any expenses incurred outside of re-employment.
Similar to today, re-employed retirees will continue to be have access to their HRA balance during re-employment to seek reimbursement for expenses incurred outside of re-employment.
Mr Pramik – in the second last paragraph you indicated
all re-employed retirees will be able to retain their private
market plans – the HRA deposits will continue to accumulate during re-employment However you will not be able to access it until they terminate employment
My question: are you referring to All MEDICARE re-employed retirees or ALL re-employeed retiress – because
Pre-Medicare re-employed retirees do not currently get an
HRA allowance?
Bonnie,
Yes, I was referring to the way that, today, all Medicare re-employed retirees can use their HRAs only for expenses incurred outside of re-employment. You’re correct that pre-Medicare retirees are still in a group plan.
Beginning in 2022, all re-employed retirees will receive allowances deposited into their HRAs during their re-employment, but they will be able to use those funds only for expenses incurred outside of re-employment.
You’ve indicated, “OPERS will partner with a service provider to help pre-Medicare participants find the best plan for their needs, in a manner similar to the OPERS Medicare Connector”. Who at OPERS will be deciding to “partner with” and will those being affected by this decision (pre-Medicare retirees) have any input on this selection?
The OPERS Board will make the final decision.
I found one line in the January, 2020 board report almost laughable, namely. “The overall goal was to design a flexible, but predictable, health care program that can provide access to coverage based on available funding. “…. The health care side of the retirement system has been anything BUT predictable. Don’t get me wrong , I get the need for the changes, but since I retired in 2006, the number of changes has been almost mind boggling to say the least.
We understand you are weary of all the changes but we believe we have put a structure in place to extend the life of the Health Care Fund for current and future retirees.
Julie, OPERS
2022 is going to be a rough year financially for many retirees. In addition to freezing COLAs for two years, OPERS is reducing the the health care allowance. Worse yet, grandfathering is eliminated effective that year for retirees (many of whom had to retiree earlier, with fewer years, due to circumstances beyond their control). So not only is the allowance reduced for them, so is the allowance percentage, which, for some, could be as much as 24%, meaning that the allowance such retirees will receive will not cover much of all the premiums for Medicare Part B, a Medigap policy, prescription coverage, and dental and vision coverage. (It is true that Medicare Advantage policies have lower premiums, but they often have high deductibles and many co-pays.) Thus, these retirees will be faced with paying more of their income for health care, thereby reducing funds available for other living expenses like groceries and utilities. So sad.
Our objective is to continue offering access to health care, in some form, to all eligible retirees. To accomplish this, we needed to implement changes to extend the solvency of the Health Care Fund. Without the changes, the Health Care Fund will be out of money in 11 years.
Julie, OPERS
Who is being grandfathered out?
Linda,
OPERS provides an allowance for all retiree health care participants based on their years of service and age when first enrolling in OPERS health care. Here’s how your grandfathering status could change:
• If you retired and enrolled prior to 2015 and had 20 or more years of service, your allowance percentage will not change.
• If you retired and enrolled prior to 2015 and had at least 10, but not 20 years of service, you were “grandfathered” at an allowance percentage of 75%. Your allowance percentage will be reduced to between 51% and 74% depending on your age and years of service when you first enrolled in the OPERS health care plan. You can find the allowance percentage chart here at opers.org/healthcare/allowance.
Julie, OPERS
Retired at age 48 with 30 years of service. What coverage will I have if any?
You can find 2022 allowance percentages and amounts here: https://www.opers.org/healthcare/health-care-2022/index.shtml
From: https://perspective.opers.org/index.php/2014/12/12/legislature-oks-measures-for-members-retirees/
“The OPERS Board of Trustees this summer (2014?) recommended that OPERS staff pursue changing the section of Ohio Revised Code that defines how the system provides insurance to retirees over 65 but who did not qualify for premium-free Medicare Part A hospitalization coverage throughout their careers.”
“Under the new plan, OPERS will reimburse 100 percent of the retirees’ Medicare Part A premium as well as any applicable surcharges when the retiree enrolls in Medicare Part A and selects a plan through the Connector. Enrolling in Medicare Part A makes these retirees eligible to select health coverage through the Connector and receive an applicable allowance.”
I have read a few posts on OPERS Facebook page stating the OPERS will provide this “in 2022.” What about after?!
Thank You.
The Medicare A reimbursement remains unchanged by the new health care program that begins in 2022.
They are also supposed to pay 50% of a spouse’s (if they don’t get it free) Medicare A premium to the retiree.
The Medicare A reimbursement policy remains unchanged for retirees and their spouses in 2022. OPERS will reimburse retirees who don’t qualify for premium-free Medicare Part A for their premium and any penalty at 100%. Eligible spouses will continue to receive a 50% reimbursement.
Julie, OPERS
1) Where does the $1200 figure used to calculate what dollar amount will be allowed for pre Medicare retirees.
2) What effect do the reduced benefits higher deductibles and increased premiums have on the healthcare fund.
Jim,
The allowance charts for Pre-Medicare and Medicare retirees can be found at https://www.opers.org/healthcare/health-care-2022/index.shtml.
On the impact of the health care changes, the new plan maintains access to the health care program for all eligible pre-Medicare (under 65) and Medicare (over 65) retirees. The changes are estimated to extend the Health Care Fund from 11 years to approximately 18.75 years.
Julie, OPERS
I have a few questions on Pre-Medicare . I am re-employed working a PERS PART-TIME job, with no benefits, and have been working the same job for nine years now. Will I be able to keep my PART-TIME OPERS job and still receive the monthly allowance?
Also, how would the HRA work? What bank will it be set up with? Will there ever be a chance that someone would be denied reimbursement? If so, what for? Also since the HRA is non taxable we would not be able to write that off of our taxes for medical expenses like we can now correct? Just the amount that we pay in addition to the allowance?
We will be communicating extensively with retirees over the next two years until the changes go into effect on Jan. 1, 2022. We encourage you to read your mail, refer to our website, blog and social media sites for more information, and take advantage of the extensive offerings made available by the OPERS education team. More information regarding re-employed retirees will be available in the coming months.
On the Health Reimbursement Arrangement, HRA, you will receive a monthly allowance based on your years of service and your age when you first enroll in OPERS health care. You can use it to be reimbursed for qualified medical expenses, as determined by the IRS.
Julie, OPERS
My question(s) are based on information I received yesterday with probably one of your brightest customer service reps. I complimented him to his supervisor. He was that good, patient with my questions and empathetic with my pension woes.
Item 1. I retired at 60 with 20 years in Opers. I am at the 51% of base so will now get about $179 per month in my HRA from OPERS. I also have the worst of two worlds — as a victim of WEP, the government keeps 2/3 of my social security earnings.
The customer service rep yesterday told me that to enable OPERS retirees without enough quarters to get them Medicare part A (I don’t think this applies to part B — but I am hoping you will correct me if I am wrong) OPERS pays the (this was his estimate, not mine) $400+ or so to (Social Security? Medicare? Who? ) get them part A “so that they can use the connector.” If these (I thought it was only the 30-year employees who received this perk, but he said if I hadn’t had enough quarters for social security and Medicare, I would also receive it free thanks to OPERS.)
The more I think about this — it doesn’t sound correct. Please tell me what IS correct then because I do remember when the VIA Benefits connector was first introduced in the early years of this past decade there was something on a blog which addressed this. Needless to say, the employees who did NOT have SS & Medicare were quite happy.
If it IS true — I will just say that I am saving you $400+ or so a month by my choice to look ahead and see that in order to get Medicare, I had to have enough quarters. I learned this from my parents, also OPERS retirees. My Mom had previous employment in the private sector and while my dad was still working, he earned his quarters by working at a local S & L on Fridays.
Why are the thirty year and/or other employees getting a $400+ or so perk while I am being smacked down to a measly $179 or so a month contribution in my HRA? I made a choice to work in the private sector before I had my OPERS position. I am saving OPERS money while enduring the worst of both worlds — a WEP “penalty” and a penalty for retiring under the 20-year rule back in the good old days — and now being penalized for that, too. Why am I less worthy?
Item 2: What exactly — very definitively now — is OPERS/OP&F/STRS/SERS doing to get a more equitable treatment for those of us who contributed (I have verification from SS — correspondence they used to send out) to SS to earn Medicare coverage? Do you have lobbyists? What?
All of us made what we saw as the best choices based on the information we had at the time we began public or private employment and retired from OPERS jobs. Is it incorrect for me to feel penalized then while I see “the others” who didn’t know they needed outside employment for SS & Medicare as getting rewarded to the tune of — is it really this amount — $400+ or so a month gratis OPERS?
Again — hope I am wrong.
If I am wrong, I humbly apologize. I am not trying to arm-wrestle with you, but I would like clarification and I sure as heck hope I am wrong.
If you delete this, please answer me privately. As a former news reporter, I believe the retirees have a right to know. But if you choose not to — I would like to know for my own edification.
Thank you for what you do.
First, on the Medicare A reimbursement: Retirees receiving a reimbursement of the Medicare Part A premium from OPERS prior to Jan. 1, 2022 will continue to receive this reimbursement. This affects those retirees over 65 who worked in a job prior to when Medicare A was deducted from paychecks. Retirees are required to enroll in Medicare at 65 and we will reimburse them for the Medicare part A cost and penalty.
2 — Allowances: The allowance percentage is based on your years of service and age when you first enroll in OPERS health care. The longer you work, the higher your percentage.
3 — Windfall Elimination Provision (WEP) and the Government Offset Provision (GPO): We continue to advocate reform of both provisions.
Julie, OPERS
In prior years it was necessary to submit proof of the cost of Medicare Part A to OPERS to obtain reimbursement each month included with the benefit payment. What action needs to be taken by the retiree now (12/21) to continue this reimbursement?
Arlene,
The Medicare A certification letter started being mailed on 12/8/2021 to all members that are required to complete the certification.
Thanks, MS
JA: You said you are 60 with 20 years of service. I don’t know why you expect to get same allowance as someone with 30 years of service? It does not make any sense.
I worked in other jobs previous to my 20 years in my OPERS employment and retired under the rules in effect at the time. Therefore I earned enough to get part A on my own; but am now being penalized by WEP because I have this very lucrative OPERS pension — while those who worked 30 years in OPERS so didn’t earn their own Part A are getting their Part A paid by OPERS and I am getting the worst of both worlds. Losing 2/3 of my SS and being forced to accept a cut in my “grandfather rate.” That’s why.
I retired at the end of 2005 with 32 1/2 years of service at age 61. What is the amount I will be getting for my health care benefit?
You can find 2022 allowance percentages and amounts here: https://www.opers.org/healthcare/health-care-2022/index.shtml
Possibly you’ve already answered this. The chart regarding health care allowance pertaining to years of service. Would this be the same chart used to calculate OPERS Law Enforcement? Being that we paid more into our pensions you would assume this would be factored in!
The health care allowance chart applies to all OPERS retirees, including law enforcement.
Julie GP
YOU didn’t answer the question. Should Sharon use the 32 aos or the 33 aos? The IRS accountants would round up to 33. What would your actuaries round up to? And anyhow, in these days of super computers and algorithms, why round at all? Use the exact (or nearly exact) number.
In the example you reference, Sharon would use the percentage associated with 32 years of service on the allowance chart. In order to obtain the percentage associated with 33 years of service, she would need 33 years of service, not 32 1/2.
Julie
you keep talking about the CHART how DO WE FIND IT??? I’ve LOOKED ON BOTH OPERS AND Pers pages and get BLANKS!!
Elizabeth,
You can find 2022 allowance percentages and amounts here: https://www.opers.org/healthcare/health-care-2022/index.shtml
Julie
Does the allowance percentage increase with age or does it stay at the amount it is when first eligible and enrolled in health care?
Your allowance amount is based on your years of service at retirement and your age when you first enroll in OPERS health care. The percentage does not change.
Julie, OPERS
I had to retire on disability from OPERS quite early. As a result, my budget is extremely tight (low-income per federal guidelines but not currently low enough for Medicare help). I am in a panic that I will not be able to afford healthcare in the future. I am now on Medicare and a Medicare supplement. I seem to have no options but to see what happens.
I retired in 2017 with 34.75 years of service, at the age of 61. I was a grandfathered employee, and did not pay into Medicare, and did not earn Medicare credits. Since I had credits from other jobs, I got an OPERS part-time job and earned the remaining credits I needed. However, will OPERS continue to pay Medicare A for grandfathered employees without 40 credits?
The Board voted to continue the current Med A reimbursement program.
Why is it that the people with the least pension will get the least reimbursement. Because I stayed home and cared for my children and didn’t start to working until I was forty I will be getting a lot less pension and reimbursement. And because of WEP/GPO I am cheated out of my husband’s widow’s SSR funds. I didn’t know of this until I was ready to retire. Because of this I live below the poverty level. I will not be able to afford the health insurance any longer. And now am at the age when I need it the most.
So much for being taken care of in my senior years.
Allowances are based on your years of service and age when you first enroll in OPERS health care. Those who worked the longest received the largest allowance.
Had we not made changes to the Health Care Fund, it would have run out of money in 11 years. The changes maintain access to health care for current and future retirees.
Julie, OPERS
Will your retirement group (A, B, C) remain the same? For example: I am in group A now, Pre- Medicare, will that remain under grandfathering? Or will everyone be reevaluated?
Your group remains the same.
I will be retiring in 2021 with 31 years service, but I was injured on duty and missed time while on workers comp. I purchased the service time back, but it did not count towards medical care. This gives me 31 years service, but only 30 years 11 months towards medical. Do I need to work that extra month or will I still receive medical coverage? I see everything you say in the e-mail states 30 years for medical, but my year end statement says I’m a month short?
Please call us at 1-800-222-7377 or schedule an appointment with a Counselor through your online account to discuss your options.
What happens to my surplus funds saved in my hrs over the years?
Dale,
Your unused Health Reimbursement Arrangement (HRA) allowance will roll over each year. You may use your account for expenses until it is depleted. If you pass away, your authorized representative can submit claims for qualified expenses incurred prior to death for up to two years. After two years, the balance will be forfeited.
Julie, OPERS
Are eligible dependent’s monthly health care premiums considered “qualified medical expenses” and capable of being reimbursed from the retiree’s HRA account? For example, retiree’s monthly allowance is $876 & marketplace health care premium for retiree, spouse & child is $700. Does this scenario fall under the “qualified medical expenses” definition? Also, does the unused portion ($176) compound in the HRA account monthly or is it lost?
Thomas,
Your Health Reimbursement Arrangement (HRA) allowance can be used for qualifying medical expenses, as determined by the IRS. Pre-Medicare participants will be able to use their HRA dollars to pay for premiums for the health care plan of their choosing for themselves and their dependents. You can choose a plan through the health care marketplace, a spouse’s employer or any private insurance carrier. The unused portion will roll over but does not draw interest.
Julie, OPERS
Does OPERS look at different health providers? My wife is retired through the State of Ohio and her insurance cost are lower with better coverage? Has OPERS looked at Aultcare as a health care provider?
Larry,
To answer your question, yes, we chose our pre-Medicare vendor and health care plan through an extensive competitive bid process. Beginning Jan. 1, 2022 OPERS will no longer offer a group plan for pre-Medicare retirees. Instead, you will be given a Health Reimbursement Arrangement (HRA) allowance based on your years of service and your age when you first enroll in OPERS health care. You can use your allowance to reimburse the cost of your health care coverage for your spouse, dependents and other eligible medical expenses. You can select a plan that best fits your needs from a provider of your choice.
Julie, OPERS
Julie: The 2022 pre-medicare monthly allowance chart ranges from $612 to $1080 from top to bottom. However, in parentheses at the very top it says “($1200 base allowance)”. I do not understand the discrepancy. What does the $1200 mean v. the $612/$1080? Thank you.
Mark,
The $1,200 is the base allowance for pre-Medicare retirees beginning Jan. 1, 2022. You will receive a percentage between 51% ($612)-90% ($1080) of that amount based on your years of service and your age when you first enroll in OPERS health care. For example, if you had 32 years of service and first enrolled in OPERS heath care at age 54, you would receive a 75% allowance or $900 a month.
To see how the changes will impact you, go to https://www.opers.org/healthcare/health-care-2022/index.shtml
Julie, OPERS
According to the chart….I will have a stipend of 852.00/month towards purchasing a medical plan in the open market. What about the 300 plus I’m currently paying for my current medical plan? Will I get the 852.00 + what I’m currently contributing ? Or does the 852.00 I qualify for include my current medical contribution ?
Also- If I go out and find a job that provides medical insurance…do I still get the stipend ?
John,
The $852 allowance and your current $300 premium are not tied together. Your pension check will go up because you will no longer pay your health care insurance premium through OPERS. Instead, as a pre-Medicare retiree, you will receive a monthly allowance in a separate HRA account that you can use for eligible medical expenses, including the health care plan of your choice. This plan can be offered through the healthcare marketplace, an employer (you or your spouse’s) or any private health care insurance carrier.
Julie, OPERS
Actually it’s a hit because the premiums paid now are pre tax, but unless you get some type of reimbursement from a HSA you will be paying any additional premiums to purchase with taxed funds. In addition to the freeze of COLA. No I don’t anticipate it’ll be MORE, actually LESS.
My husband and I both will OPERS retirees in 2023 and will be enrolling in healthcare. We will both be eligible to receive a health care allowance from OPERS. When we pay our healthcare premium, how will the process work so that we are reimbursed from our allowances (ex. 50% premium paid from my husband’s allowance and 50% of the premium paid from my allowance.)
Once you retire you will each have a pension and a monthly allowance in a separate HRA account. (You may have different allowance amounts depending on your years of service and age when enrolling in OPERS health care.) You will submit medical expenses for reimbursement, and anything left over can be rolled over from year-to-year.
Julie, OPERS
For pre and post 65 retirees, OPERS offers dental and vision at the full premium cost to the retiree. Does OPERS plan to continue this option or will the retire have to look for these benefit elsewhere also?
Mark,
OPERS will continue to offer optional group dental and vision plans. Anyone receiving an OPERS benefit can enroll in these plans, regardless of their eligibility for other parts of the health care program. Eligible dependents can also be enrolled. Participants will pay the full premium cost, which is the way the OPERS vision and dental plans are administered today.
Julie, OPERS
I retired in November 2018 at age 51 with 32 years in OPERS. I am re-employed with a non-Opers part time job and I am currently on my wife’s health care plan through her job. Will I be Eligible for the Health care reimbursement in 2022 if I still have the part time job? Thank you.
More information regarding re-employed retirees will be available in the coming months.
My retirement check is $500 less than last month. I have received no notifications from OPERS about a change in my benefits. HELP PLEASE.
Please call us at 1-800-222-7377 and a member of our staff will help you sort it out.
Julie, OPERS
If I retire at age 63 with 25 years in OPERS, will I still be eligible for the Health Saving Account when I turn 65 and have Medicare coverage?
Yes. Any retiree currently eligible to participate in the health care program will continue to be eligible after Jan. 1, 2022. If you retire after Jan. 1, 2022, you will eligible for an HRA allowance once you are Medicare-eligible (typically age 65) and have at least 20 years of service credit.
Once you become eligible for Medicare, you’ll enroll in a plan through the OPERS Medicare Connector. For more information about that process, go to https://www.opers.org/healthcare/plan-options/ViaBenefits/index.shtml.
If you are considering a retirement date between now and when the changes become effective in 2022, we strongly encourage you to attend an OPERS educational seminar as well as schedule a meeting with an OPERS retirement counselor to evaluate your options.
Julie, OPERS
I retired from county board of elections in May 2019. I’ve been asked to return to assist with Presidential primary as of February 19th. Estimated time of employment is 6 weeks. How is this going to effect my current healthcare?
Jennifer,
If an OPERS retiree works as an election worker and makes more than $600, the retiree may experience a change in eligibility for OPERS-sponsored health care coverage.
For more information on how re-employment may impact your health care, refer to our PERSpective blog posting on this subject, “OPERS’ rules for election workers,” which contains additional resources that can help you. https://perspective.opers.org/index.php/2017/10/24/opers-rules-for-election-workers/.
We encourage you to call us at 1-800-222-7377 to discuss the impact re-employment may have on your health care.
Julie, OPERS
If I retire on December 31, 2020, will I still qualify for the current medical, dental & vision plans? It seems that the new policy takes effect in 2022, not 2021, as I had understood. How about if I retire June 30, 2021? Right now, my decision is based on whether or not I can still be covered under the existing plans. Thank you!
David,
The changes will go into effect on Jan. 1, 2022. If you are considering a retirement date between now and when the changes become effective in 2022, we strongly encourage you to attend an OPERS educational seminar as well as schedule a meeting with an OPERS retirement counselor to evaluate your individual options.
In general, current health care coverage will continue through 2021. Please be aware your effective retirement date is always the first day of the month following your last date of employment. Retiring in December 2021 would have an effective retirement date of Jan. 1, 2022.
Julie, OPERS
I see that working for a board of elections over $600 dollars may change things. What about working for the US Census?
The key is whether you are working for an OPERS employer.
Your health care benefit will not be impacted if you will be working for a private or non-OPERS employer. The U.S. Census is a federal program, not a state program, and not an OPERS employer.
Julie, OPERS
On February 18th, your answer to “Linda” stated that “If you retired and enrolled prior to 2015 and had 20 or more years of service, your allowance percentage will not change”. I retired December 1st 2013, enrolled at that time, with 23.7 years of service. My allowance percentage at this time is 75%. Will it stay that way or will it be reduced in 2022?
Eileen,
Your allowance percentage is determined by your years of service at retirement and your age when you first enrolled in OPERS health care. To see how the health care changes may impact you, including allowance percentage and allowance amount charts, go to https://www.opers.org/healthcare/health-care-2022/index.shtml.
Julie, OPERS
Where can I find the rational/justification/discussion for not providing an allowance/reimbursement for minor dependents of premedicare age retirees? I was told originally OPERS would be following the Federal Guidelines. I asked repeatedly before the Board meeting if the issue was on the table for discussion and was told no. Not only was it on the table but a vote took place to not offer the allowance. No major news media outlet was issued that info not any correspondence I received reflected that information. Where is this information in detail located?
Deneen,
The Board discussed discontinuing allowances for dependents at the November 2019 meeting. A copy of the presentation can be found at https://www.opers.org/about/board/packets/2019/agenda-2019-11.pdf. (The child allowance discussion begins on p. 59.)
As you note, there will be no allowance for dependents as of Jan. 1, 2022. However, you can use your own HRA dollars to be reimbursed for qualified medical expenses for an eligible dependent. Counseling will be available to help evaluate your options as well as identify any financial assistance available.
To answer your question, since OPERS will be providing funding and not a group plan beginning in 2022, the dependent coverage requirement in the Affordable Care Act does not apply.
Julie, OPERS
It seems that Towers Watson is being sold to a company called Aon. Since TW handles the reimbursement program, has TW reached out to OPERS to explain why they were selling and how it may affect the operations of the reimbursements?
Mike,
We expect the same commitment and service we have experienced to date. Until the transaction is finalized, expected in the first half of 2021, Willis Towers Watson and Aon must act as separate and independent companies. That means Willis Towers Watson won’t begin interacting with Aon or sharing client information at this time, and there will be no changes to our current relationship.
Please stay tuned. We will share more information if anything changes.
Julie, OPERS
Question regarding TeleMedicine coverage. I currently have Medical Mutual “Pre-Medicare” through OPERS. I am scheduled for a followup Medical Appt with my physician this week. Due to the current Health Care Crisis–Coronavirus Pandemic, my physician requested a “Telephone Appointment” to limit in person exposure. On 3/17/2020 I contacted Medical Mutual. I was told TeleMedicine in NOT a covered benefit under my current health care plan, that they would deny payment and I would be responsible for the for the bill. The Medical Mutual Rep advised me to contact OPERS. I spoke with a representative at OPERS and was told Telephone Visits are indeed covered under “Medical Home.” Please clarify whether TeleMedicine is a covered benefit. Please note, if “TeleMedicine” is not currently a covered benefit it would be prudent given the current crisis to add this as an approved service. Thank you in advance.
Diane,
We cover telemedicine visits if they are a scheduled visit with your primary care physician. The co-pay will be the same as a regular office visit. You can find telemedicine mentioned in your Medical Mutual Plan on p. 3 (footnote) and on p. 14 (definition). Please call us at 1-800-222-7377 if you have any other questions.
Julie, OPERS
Julie,
Thank you for your timely response. This appt was with a specialist, not my PCP. A representative from Medical Mutual called me 3/19/20 and said that Specialist Provider Telemedicine appts would be covered at this time. Thanks again. Diane Ailor
So happy it worked out!
Be safe,
Julie, OPERS
I think I know the answer to this but I keep hoping there is some loophole I am missing! I am retiring at age 62 in July. I have been with the state for 15 years, having not started until I was 46. I am on the Combined Retirement Plan. From what I understand, there is no scenario in which I would get anything for any amount of health care, correct? Even some prorated amount? It seems unfair for people who start with the state later in life to not even get a small piece of the amount of healthcare, especially because I have been paying into it. From what I now understand, if I was on the “Member-Directed” retirement plan, I would have gotten some amount of an HSA, which I did not know about at the time of my selection 15 years ago.
To be eligible for OPERS health care program, you must be a minimum age 60 and and have 20 years of qualifying service. Eligibility requirements are not prorated. For more information go to the Health Care page on the OPERS website at opers.org.
Julie, OPERS
What is the change in health care eligibility between now and 1/1/22 for Group B? My understanding is that the current requirements are 32 years of qualifying service at any age or 31 years at 52. Am I correct about the current requirements? What is the change in eligibility effective 1/1/22? As I read it, there is no change but you are advertising it so heavily, I’m afraid I’m missing something.
David,
The eligibility criteria for active members beginning in 2022 is spelled out on our website. Go to this page and click on “Active Members” to see the criteria.
–Ohio PERS
If the ACA is repealed, and that is no longer an option for pre-Medicare retirees, how can we get an idea of what health insurance plans may cost through the Connector starting 2022 and will having a pre-existing condition effect the ability to get insurance through the Connector. Even a rough estimate would be helpful for budgeting purposes.
Jack,
While we can’t speculate on something that might nor might not happen, we did have an expert in this area speak at the November Board of Trustees meeting. John Barkett, Senior Director of Policy Affairs for Willis Towers Watson, said the ACA case before the Supreme Court is not likely to disrupt the individual health care market.
Well. It looks like the Supreme Court is going to get rid of Obamacare soon.
So Where am I going to find an affordable Health Plan in 2022 if all the rules fly out the window? There will be NO Marketplace
Ed,
While we can’t speculate on something that might nor might not happen, we did have an expert in this area speak at the November Board of Trustees meeting. John Barkett, Senior Director of Policy Affairs for Willis Towers Watson, said the ACA case before the Supreme Court is not likely to disrupt the individual health care market.
What is the plan if the ACA is overturned for retirees with preexisting conditions????
Susan,
While we can’t speculate on something that might nor might not happen, we did have an expert in this area speak at the November Board of Trustees meeting. John Barkett, Senior Director of Policy Affairs for Willis Towers Watson, said the ACA case before the Supreme Court is not likely to disrupt the individual health care market.
AT age 67 and 26 years of service is my health care benefits grandfathered through pers
Please forward your question through the online message center so we can review your account and provide you with an account specific answer. If you do not already have an online account, you may register from the upper right-hand corner of OPERS website. Once you have logged in, click on my account tab, select message center from the drop-down menu, then click add new at the bottom of the page to submit your question or you can contact OPERS at 1-800-222-7377. Thanks MS
I had to retire many years ago on a PERS disability pension with less than current minimum years. At age 70 will I have all my security swept away? I am scared.
Please send you questions through the online account message center so we can review your account and provide an account specific answer. If you do not have access to an online account please contact us at 800-222-7377 for further assistance. Thanks, MS
If the affordable care act is overturned, how will retirees with pre-existing conditions get health care? I took early retirement and have successfully purchased my health care insurance through the health care market. I have to be honest it was a very difficult.
Susan,
While we can’t speculate on something that might nor might not happen, we did have an expert in this area speak at the November Board of Trustees meeting. John Barkett, Senior Director of Policy Affairs for Willis Towers Watson, said the ACA case before the Supreme Court is not likely to disrupt the individual health care market.
I retired in 2016 at 48 with 30 years of service. I am currently on OPERS insurance. I have the option to go on my husbands insurance effective Jan 1, 2021. Can I opt out of the OPERS insurance for the year of 2021 and then still be eligible for the HRA effective 2022? If so, will I be reimbursed for the amount we are paying through his employer for my part, and what happens to the difference with the HRA amount and the premium through his employer?
The pre-Medicare population is not required to be enrolled in our pre-Medicare medical plan in 2021 to have access to the Health Reimbursement Arrangement in 2022. The allowance provided by OPERS that will be deposited into the Health Reimbursement Arrangement (HRA) can be used to be reimbursed for health care qualifying expenses like medical plan premiums. We encourage all OPERS members and retirees to read their mail, refer to our website, blog and social media sites for more information, and take advantage of the extensive offerings made available by the OPERS education team. Visit the Member Education Center for seminars, dates and locations.
Are we getting a raise in2021, and how do we figure 2021 HRA allowance
pd, We’re not sure if you’re talking about an increase in the HRA amount or your pension.
The pension cost-of-living adjustment will be 0.5 percent in 2021. As for the HRA allowance, it’s not changing in 2021. We have instructions on how to calculate your health care allowance on our website.
I retired in 2012 will this new health care plan effect me also
Monica,
To find out how you are specifically impacted by the changes please send your questions through the member online account message center there we will be able to review your account and provide account specific answers. Thanks MS
When will the plan options be available to look at with Via Benefits?
Terri,
You can research private plans as well as plans on the open market offered through Healthcare.gov. Information on plans offered through the OPERS Pre-Medicare Connector will be available as we get closer to the 2022 open enrollment period. Thanks MS
Hello, In a 03/25/21 OPERS email titled “Health Care 2022 Pre-Medicare Update” under a question titled “Q: What is a Health Reimbursement Arrangement?” it states “[HRA] Expenses are determined eligible for reimbursement based on IRS guidelines.”
1. So, WHAT ARE those guidelines? (In plain English please)
2. What and who determines if a reimbursement is eligible?
3. Please provide A LIST of what are eligible expenses?
If you can’t answer these questions, why?
David,
The reimbursement guidelines are determined by the Internal Revenue Service. On IRS.gov you can review the IRS publication 502 that provides additional information about the medical and dental expenses. Thanks MS
What if the HRA deposit amount ends up exceeding the maximum allowable HSA contributions?
Doug,
The retiree HRA offered by OPERS does not have any contribution or maximum balance limits. Thanks MS
It was relayed in one of your webinars that if you have/use an HRA you are not eligible for subsidies through ACA. Could you explain that? Where can I find that info through the IRS? Also, could you still have the HRA but not use it to pay for ACA plan? Would my HRA just accumulate ? If I opt for the subsidies am I forfeiting the HRA for ever? Members really need health insurance clarification earlier to make an educated decision.
Good Afternoon,
Retirees who receive a premium tax credit by enrolling in a plan through Healthcare.gov will not be eligible for the HRA. An individual cannot receive both the HRA and a premium tax credit. If a member elects to take the premium tax credit offered through HealthCare.gov they will not be eligible for for the HRA provided by OPERS while receiving the premium tax credit. Thanks MS
I’m looking through IRS Publication 502 and the parigraph titled “Whose Medical Expenses Can You Include?” It says, “You can generally include medical expenses you pay for yourself, as well as those you pay for someone who was your spouse or your dependent either when the services were provided or when you paid for them.”
Do I read this correctly that if my wife has her own health insurance, I could pay for, and then seek reimbursement for, her qualifying expenses?
David,
A spouse is considered a health care qualifying dependent, the spouses medical premiums would be considered a qualifying expense. Thanks MS
Thank you for your response.
Could you please tell me where ( the IRS or any other government agency) it states you cannot have an HRA and receive a premium tax credit if you get an insurance policy through Healthcare.gov? Anything I could find states that you cannot USE funds from an HRA and get these subsidies.
TMB,
We plan to address that question in a blog this week.
Tom,
The Medicare tax is not withheld from OPERS pension benefits. If you have additional account specific questions please send the questions through the online message center so we can review the account and provide account specific answers.
Thanks MS
Can you define, “Vendor of your Choice” regarding Pre-Medicare insurance? Would I be able to apply my monthly reimbursement to my wife’s private company insurance?
Curt,
You would, but only if your spouse’s insurance premiums are paid on a post-tax basis. If they’re deducted from her pay before taxes are paid, the HRA dollars are not eligible to be used because they’re provided on a pre-tax basis. There’s an example of this situation on page 5 of our latest Pre-Medicare retiree newsletter.
I am eligible to retire at unreduced rate on 10-01-2021. I am only 52 years old and in PERS/LE. Since I can retire prior to 01-01-2022 am I eligible for the percentage based healthcare funding?
Brian,
Please send your questions about health care eligibility through your online account message center so we can review your account and provide an account specific answer.
Thanks, MS