List of Connector insurers taking shape

Beginning in January Ohio Public Employees Retirement System retirees 65 and over may access health care coverage through the OPERS Medicare Connector administered by OneExchange.

Several of our retirees have asked us what types of coverage will be available or, more specifically, which insurance carriers the Connector will make available to them. They’ve also asked us whether OPERS will assist OneExchange in offering specific choices.

While OPERS will annually review the roster of insurance carriers, OneExchange is responsible for building it. The list will include national and Ohio carriers such as Humana, United Healthcare, Aetna/Coventry, Cigna, BlueCross BlueShield, Wellcare, Medical Mutual (Ohio) and Medigold (Ohio).

The Connector will be for retirees enrolled in Medicare Parts A and B. They will choose a Medigap plan or a Medicare Advantage plan and a prescription drug plan on the individual health care market.

Participants can search an OPERS-specific OneExchange website beginning in mid-July for more information. (There will be a link to this site on opers.org.) The actual plans, including pricing, will be available in early October after rates for them have been determined. Medicare Advantage and Part D plans are renewed annually and can change each year. Medicare supplement rates can change at any point during the year, and Towers Watson is always evaluating and expanding available options.

Keep in mind that some insurance carriers and/or insurance plans may not be on the roster because they don’t meet OneExchange’s technical requirements or quality standards.

Meanwhile, some insurance carriers’ business model precludes participation in public or private exchanges. As individual insurance carriers plan which region in which to participate, they consider the location’s population size, competition from other carriers and other factors.

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.

Michael Pramik

Communication Strategist

  • This information may be clear to you, but it is quite unclear to me. I’m retiring at the end if the year and need to get this coveragein place before Jan 1st. What do I need to do to get the coverage I need to supplement Medicare, is my question?

    • Jan,

      You will work one-on-one this fall with a representative from OneExchange to choose a health care plan that will work for you. They will contact you by phone later this summer to set up a phone session during which you’ll choose coverage. We will provide a monthly allowance in the form of reimbursing some or all of your costs.

      –Ohio PERS

    • Dora,

      We plan to post a blog on Thursday providing some details about 2016 health care coverage for those under 65.

      –Ohio PERS

  • I am so confused and scared I will pick the wrong ins I like one on one talking in person

  • What is the process of taking my money from the HRA account to pay for my medical bill ( each time I receive one) and how long will take?

  • What is happening with those of us retirees who only get Part B? Has OPERS/the state of Ohio decided how they are going to cover us in future?

  • Do we have to sit at home all summer and throughout the day waiting for the Connector to call to set up the appointment? Not all of us have cell phones, and we need to leave home at times to go to the store, doctor, etc. What happens when the representative from OneExchange calls and we are not home to answer the phone? Please advise.

    • Robert,

      Beginning July 13, you can call OneExchange to set up your enrollment appointment. The number is 1-844-287-9945.

      –Ohio PERS

  • What about my spouse, who is under 65 and not yet eligible for Medicare? I am very concerned about insurance and cost for her. We of course have been aware of this due to your excellent information. It’s just disconcerting.

    • Paul,

      We just posted a blog on the under-65 plan for 2016. Please return to perspective.opers.org for that information.

      –Ohio PERS

  • why do we not know cost of age brackets I have asked this question for over one year. what about people over 75

    • CG,

      We will not have 2016 rates to share until Medicare determines them. But we can say that the allowance decisions for those on the Connector were made with older retirees in mind.

      –Ohio PERS

      • Hi. You should definitely check this out for yourself, but while doing research on Medicare.gov (call 1-800-medicare — please do your own research for your own edification (-: ) I learned that there is one medigap plan f which offers “community based pricing” (I think that is the phrase, again — look for yourself, please (-: ). Your question to Medicare might be something like, “will community based pricing ensure that I, a 75-year old will get the same rate as a 65-year-old? Or, you might phrase it: which program(s) offer me — a 75-year-old the same rate as a 65-year-old? And also does this guarantee that unless there is an across-the-board increase in medical insurance, my costs won’t go up as I age?

        Good luck.

        • Ja, as you may have seen my posts. Medigap will increase with age. I am 81 and have been on it for 20 years. I am sure the rep from the connector, will advise you as my agent does, of the best prices for your age.

    • Just learned that Community Based pricing is not all it is supposed to be. The company I had in mind doesn’t raise the rate, but takes away a discount when you turn 70!! LOL!! If that isn’t a rate increase, I don’t know what the definition of “isn’t” is…..

      Instead of hypothetically paying 170.00 at age 66 when I turn 70, I might possibly be paying 3% more. Based on the base rate, which is 211.00 so….at age 70, it might be (barring any across-the-board increases at the (I believe) State level…..$176. Still affordable for good coverage.

      I can only guess at what this will cost starting at age 75. I am sorry.

      Perhaps call a plan which looks good by getting the telephone number from — maybe the One Exchange person when you call to make your apt?

      • Ja, as you may have seen my posts. Medigap will increase with age. I am 81 and have been on it for 20 years. I am sure the rep from the connector, will advise you as my agent does, of the best prices for your age. I am presently paying $224 per mo.

  • As a “very” old 79 year old, I tend to panic at changing from the good Humana program, and next year having to drive outside my community rather than to my doctors at the Falls Family Practice in Cuyahoga Falls, a group of physicians near where I live, that have been just great. I can’t drive much so must find care givers nearby. Would our current provider Humana have knowledge if the present plan and doctors’ team would be available in Cuyahoga Falls with our new health care program. The list of providers in the book you sent seems to list various plans in several states but not in Summit County.

    • Shirley,

      That’s a question that only Humana can answer. Please make sure to ask it when you work with your Connector administrator representative.

      –Ohio PERS

  • My primary Dr. Is only par impacting in bs/bc connector. I am going to be in Florida 6 months starting in November how will there be enough time to choose a plan and find a new Dr. This is very confusing. I have Humana now and am eligible for VA services, but humans doesn’t recognize the VA. Please explain further Thanks. I need this decided before leaving Ohio.

  • I read the blog for Under 65, does this include those Disabled and under 65? I’m on the Housing Voucher program and I have to return my renewal application in the next few days, how do I get verification of my deductibles? Can someone email me what they will be? My medical expenses are considered since I am on disability with OPERS.

    • Cassandra,

      Your request goes beyond the scope of the blog. Please call us at 800-222-7377, and we can help you.

      –Ohio PERS

  • Being part of a group plan for supplemental insurance lowers our current costs. Will the insurance coverage we choose in this new plan be based on individual pricing or as part of a “new group – OneExchange”? Are we losing the benefit of being part of a group?

    • Brenda,

      It will be based on regional pricing, a larger group than we are as a system.

      –Ohio PERS

  • I have recently read about Aetna purchasing Humana. How will that affect those of us who are retired and have Humana Medicare Advantage and wanted to keep it when we go on the connector?

    • Ronald,

      For now, it remains the same. The acquisition is scheduled to close upon regulatory approval in the second half of 2016. Beyond that, we can’t say, just to ask the Connector administrator this fall what Humana is offering via the Connector.

      –Ohio PERS

  • I don’t turn 65 till may 2016,currently on disability since 1997,what do I do till I can get on Medicare.

    • J,

      You will “age into” Medicare coverage during the calendar year, so you would be in our coverage until then. It would benefit you to sign up for Medicare as early as you can, which is three months before you become eligible.

      –Ohio PERS

  • Clarification needed:
    Starting in 2016 are Medicare retirees expected to pay the full monthly amount for our Insurance and medication plan. Which could be $400 to $600.00 per month. We’re also to pay the monthly Medicare Insurance ($102.00). We can expect to receive a one time amount of $300.00 only if, we sign up for the Connector? So, will there be an additional charge for signing up for supplemental Insurance?

    • D.H.,

      Beginning in 2016, the OPERS Medicare Connector will be available for those retirees who are enrolled in Medicare Parts A and B. OPERS will provide a monthly amount into an account upon which the participant can draw to be reimbursed for health care costs. They include the premiums that you will pay for Medicare.

      Please refer to http://www.opers.org for more information about the Connector.

      –Ohio PERS

    • D.H I am 81 years old and only pay $ 224.00 for plan F. You won’t pay any where near $400 unless you are on Dialysis.

  • PERS always claimed to be self insured. I don’t understand how doing the billing and paper work costs PERS what they claim. If they are self insured, why does Humana get so much money just to do the paperwork? If this is true no wonder they are going broke. Maybe PERS should hire new administrators and save our health care. Also why can they afford to pay for part A but not part B which costs a lot less? Maybe part A is for the people who make the most money?

  • Is it a REQUIREMENT that BOTH the Medigap plan AND the drug plan be purchased through OneExchange/Towers or can only one of the two be purchased through them with the other plan purchased at a better deal elsewhere, and yet still qualify for the reimbursement money?

    Thanks.

  • It is 8:33, July 13, 2015 and welcome to OneExchange and the process of communicating with them. I called at 8 sharp and have now been on hold for 33 minutes.

    At 8:14 I left my house and drove to get a repair estimate on my car. Returned. Still on hold!

    Wanted to get this call over with.

    I will say they knew we were coming.

  • Waited an hour then got a good employee who answered all my questions. But — too long!! There are 2 one exchange call centers. The one I was transferred to has about a 100 call taker capacity and they arrive — the new people coming to work — every half hour.

  • I am inquiring for my dad. He is in the re-employed retired category. He is over 65 and will most likely retire before January however he is not sure at this time.

    Where can he find more info on the Group re-employed retiree plan? Will the information include premiums?

    Also, what is the 0$ premium plan mentioned in the video?

    • Susan,

      All of this information will be presented in the open enrollment mailing your dad will receive in September. This information includes a personalized statement on 2016 costs. That is, if he is retired an is in our plan.

      There are some Medicare Advantage plans with zero-dollar premiums. However, if your father is re-employed his first obligation would be to take his employer’s health care coverage if it’s offered.

      –Ohio PERS

  • I am currently taking a new somewhat experimental specialty drug that costs $9,700 a month. It will not be in any formularies, I imagine. I am doing very well on it. How can I find out how much individual drug plans will pay for this drug? Do I have to contact them each individually?

    • Susan,

      OneExchange will help you find the best drug plan. That’s the reason they are asking our members for a list of drugs they take when the members register. Be aware, though, that you’ll have to wait until Oct. 5 to find the best plan because that’s when Medicare certifies the rates and plans for 2016.

      –Ohio PERS

  • I am a surviving spouse and over 65. Am I correct that I will not be eligible for any health care reimbursement after 2016? If that is correct, why would I go through the One Exchange for supplemental health care? Can you briefly explain? Thank you.

    • Joanne,

      You will be eligible for reimbursement in 2017, but in 2018 your health care coverage allowance will be reduced to zero.

      –Ohio PERS

  • I am a 63 yr old re-employed retiree. I need to know the estimate of my cost to participate in the re-employed retiree plan. Your “Re-employment and Health Care Coverage Fact Sheet” says to sign in to my OPERS online. I did, but now where do I find my info? I cannot find my info online! Please help.

    • Cheryl,

      Log into your online account and use the health care calculator under “Tools and Resources.” If you estimate costs for 2016 it should ask you whether or not you are a re-employed retiree. We will have additional information in a health care bulletin we’re mailing out in early August, and you will see your coverage costs in the open enrollment kits being mailed in September.

      –Ohio PERS

      –Ohio PERS

  • How will the Connector help retirees choose appropriate plans in light of the coming mergers of Anthem buying Cigna and Aetna buying Humana? With the major insurance companies dwindling down to 3 or 4, it makes sense that premiums for members will rise significantly. Is OPERS going to communicate these mergers to members?

    • Ginny,

      It’s too early to tell how these recently announced deals will affect the health care landscape. They both face regulatory hurdles, and neither is expected to be completed until next year.

      –Ohio PERS

  • At an appropriate time could you add a blog post or discuss the following in a video: What are the ramifications of choosing a basic Medicare supplement or advantage plan and changing to a higher benefit supplement or advantage plan after a few years.

    Thanks

    • Jim,

      Thanks for the question. We’ll try to address it in our next video, due out this month.

      –Ohio PERS

    • Whether you can afford to use a n Advantage plan is pretty much a risk taker on your part. I have had Medigaps For 20 years, because I could not afford the risk of 20 % costs for major medical problems. In these 20 years i have had several surgery’s, and several Emergency Room visits. As you Know surgery run into the thousands. I have only paid out of pocket once. I paid $44 for a medicine while in the hospital because it was a med that Medicare did not pay for. Believe me, you will; have peace of mind with this program. You can thank OPERS for putting this program together, and saving your Medical Coverage.

  • Like other retirees, we are concerned about choosing the right Medicare supplemental policy. Will the premiums for the supplemental and Part D (prescriptions) be deducted from the PERS pension? We’ve heard good reports about AARP’s Medicare supplement policy. If it turns out they’re not on the “approved” list, can we purchase directly?

    • Marilyn,

      If you secure insurance through the Connector, you first pay the premium then apply for a reimbursement through your Health Reimbursement Arrangement. There is more information about this account on our website.

      If you participate in the Connector, you must purchase your plan through the Connector in order to receive a reimbursement.

      –Ohio PERS

      • Marilyn, my experience with ARRP for the past 20 Years on Medigap, they have always been the highest.

  • What will be the monthly charge for the Connector to do it’s work…. Will it be added back to me, in the reimbursement

    • Rose,

      Yes. Nearly all current retirees will receive about $337 monthly in their reimbursement accounts.

      –Ohio PERS

  • Can you please provide me with a link to the various plans available along with the pricing?
    Also formulary for the various Part D plans.
    Also, list of doctors and services that are in a health plan’s network

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