How drug coverage will work with the Connector

Participants in the OPERS Medicare Connector will have to make decisions on prescription drug coverage in addition to medical insurance.

A new video, featuring OPERS Pharmacy Benefits and Policy Manager Brian Lehman, covers many topics related to this coverage. It includes an introduction by OPERS Health Care Director Marianne Steger.

You can also find it on our YouTube channel.

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

80 thoughts on “How drug coverage will work with the Connector

    • October 19, 2015 at 9:20 am
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      I had my appointment for health care on the 9th of Oct. It went very well, I was very pleased with the representative my husband and and I talked to. She was extremely helpful although it was a little long there were no problems at all and we are very pleased with our coverage. Kudos to O.P.E.R.S. for getting ONE EXCHANGE.

      Reply
  • October 1, 2015 at 8:07 pm
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    This kind of talk is very much needed as I go through the health care changes. I will not join the connector until July 1, 2016, and I hope that videos and OPERS talks continue on a regular basis through the end of 2015 and continuing on in 2016. Right now I have a working computer and having internet access is important. I hope OPERS can also include such informative information and tips in other forms like those mailed to recipients.

    Reply
    • October 2, 2015 at 7:19 am
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      Gilbert,

      Thanks for the note. We intend to continue recording videos and producing other communication that will help our members understand the Connector.

      –Ohio PERS

      Reply
  • October 1, 2015 at 8:12 pm
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    I hope OPERS continues its policy of making videos and written information available to those with pensions and healthcare. I will not join the Connector until July 1, 2016, and I hope the policy continues through 2016 and on. Most people will join the Connector January 1, of 2016, and I will be among those few bringing up the rear. Do not forget about those of us joining the Connector at the end.

    Reply
  • October 2, 2015 at 11:18 am
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    Hello,

    I use the health plan but am on disability. Not eligible for Medicare
    due to only being 55 years old.
    It appears to me and please correct me if I am wrong. But it seems
    that state coverage is “federalizing”. This is the impression I
    received. I know that disability changed recently to only 2 years;
    Then one goes on Medicare. If not meeting certain requirements
    I was in the disability plan prior to this change so I should not
    expect to go on the Federal Plan until I reach 67 or 68? I was
    born in 1960. It gets a little confusing to me at times.
    But I know OPERS changed the disability rules.
    Could you please clarify? Thanks so much.

    Reply
    • October 6, 2015 at 1:56 pm
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      Rebecca,

      Here is general disability health care information as relayed in our 2015 Health Care Guide:

      Members receiving a disability benefit that became effective prior to Jan. 1, 2014, will have continued access to the OPERS health care plan based on the annual review and approval of their disabled status. Members receiving a disability benefit that is effective on or after Jan. 1, 2014, will have access to health care coverage for the first five years of their disability based on their continued eligibility and receipt of a disability benefit during that time.

      Health care coverage for disability recipients will continue past the first five years only if: 1) the recipient meets age and service retirement requirements or, 2) the recipient enrolled in Medicare, due to a disability, prior to the end of the five years and prior to reaching age 65.

      A previous disability retirement based on a different condition will not qualify a new disability benefit application for an exception to the five-year rule.”

      Please contact us at 800-222-7377 for more information.

      –Ohio PERS

      Reply
  • October 5, 2015 at 12:45 pm
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    I have an appointment to call One Exchange on Wednesday. I am physically ill over this.Even though I have been to a seminar and have read the material sent in the mail I am so fearful I will make wrong choices. I should be on a beach enjoying my retirement instead of agonizing over these health care choices. I do not understand why I can not speak to a representative in person. Why must this be done over the phone? I understand the company is based out of state, but you think they could have sent representatives to Ohio to help us through this process. I dread making that phone call on Wednesday.

    Reply
    • October 6, 2015 at 1:02 pm
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      Patricia,

      The Centers for Medicare and Medicaid Services is very strict about face-to-face enrollments and encourages telephonic enrollments so that the dialogue can be recorded.

      –Ohio PERS

      Reply
      • October 6, 2015 at 3:44 pm
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        It is what it is I guess. They could record me while I sat in front of them if they wanted to. I would feel much more comfortable talking face to face. An hour on the phone will be a trial for me. Then there is my husband, who is hard of hearing, so it will probably be two hours on the phone.
        Sigh.

        Reply
    • October 15, 2015 at 1:30 pm
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      I agree with you. I also was informed by mail that one of my doctors will no longer accept payments and I must either choose a new MD or pay myself to remain with the doc that has treated me for over 20 years.

      Reply
  • October 7, 2015 at 1:09 pm
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    My husband and I spent more than 90 minutes speaking with a One Exchange “expert”. While she was very nice and apparently plugged our information into her software, she could not answer many of our questions. We spent the last 20 min or so speaking with her supervisor. One big stumbling block was our inability to see the drug formularies for the various plans. They had the information and happily looked up our current meds and told us what they would cost. The amount was staggering. They were not able to make comparisons within an individual formulary or between other plans. We were told that we would have access to the information on Oct 5. Today is October 7 and the web site still tells us to “check back soon.” In spite of not being able to calculate the true cost of our insurance, we were pressured to make a decision anyway. We did not and asked to schedule a phone call. We were told they couldn’t do that as they were set up to handle only incoming calls. The phone number is the one we were given with our planning materials from OPERS. Getting through on that number took over 10 minutes of redialing due to a busy signal. We were told we could call back anytime but that things would get even busier. This change is not what I expected when I worked 30 yrs under OPERS and the process is nothing like what was promised.

    Reply
    • October 8, 2015 at 5:25 am
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      I am still working but have been reviewing these comments on the Connector / One Exchange. I dread the day I have to go through this. Without a doubt, OPERS did not consider our retirees who are disabled, hard of hearing, etc. My heart goes out to those folks who are having problems. It is indeed a scary situation! Best of luck to you,

      Reply
    • October 11, 2015 at 9:19 am
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      I have only spoken with one representive at OneExchange who was actually competent. Before the 2016 plan offerings were available, we could go on line to see and compare plans. They were outdated, but at least you could get an idea of the differences in drug costs, when you might hit the donut hole, and what the total annual expenditures would be for each health plan, I learned a lot by studying those so I would be better prepared when the 2016 plans became available for review and comparison. Well, to my surprise, we will not be able to see and compare visually any of the plans. I can’t even see the doctor and drug lists I put in many weeks ago at the urging of OPERS. OPERS is shelling out our money for a truly inferior (cheapest bid) “service.”

      Reply
    • October 12, 2015 at 8:06 pm
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      I HAVE RUN INTO THE SAME PROBLEM WE WHERE SOLD SOMETHING THAT WASN’T TRUE AND THE DRUG COST STILL ARE NOT UP ON THE SITE

      Reply
  • October 7, 2015 at 6:06 pm
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    Well I’m signed up! The advocate was very helpful, knowledgeable and above all, patient. There was not a question I asked that she didn’t know the answer to. She deserves a raise for putting up with me and my husband, LOL!!!! This process took over 3 hours to sign up both my husband and myself. I’m glad it is over!. Most of the time was spent answering our questions. I think things would have been smoother if you had the prescription drug tiers or Formulary, with drug prices visible for each plan, available on the web site so I could have compared actual prices before speaking to the advocate.. As it was, my advocate had to relay information she could see and I could not. I still feel a bit shaky about the prescription plan. But I know I can change those plans if I need to. Although that will probably entail another looong phone call. I just hope I made the right choices.

    Reply
    • October 12, 2015 at 9:10 am
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      I went into the companies. Often it’s still 2015 but you can get an idea.

      Reply
  • October 7, 2015 at 8:36 pm
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    these drug plans are a joke we have been sold down the river it is only good if you don’t use the drugs they are almost as much as medical coverage

    Reply
  • October 10, 2015 at 10:35 pm
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    The group coverage we had was an excellent policy, which covered my specialty prescriptions. I am disabled and on special medications. The new so called more “affordable coverage” will cost me more than $7000.00 dollars in 2016 to get my medications. OPERS definitely not telling the truth about the health insurance being better or cheaper for the retired member. I will not be able to afford my medications. It’s a horrible plan.

    Reply
    • October 13, 2015 at 8:47 am
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      Catherine,

      We covered this topic in a recent video. (The discussion about specialty drugs begins at about 5:30.) We encourage members taking specialty drugs to consult with their physicians to make sure they are the most affordable and effective drugs they can be taking and if they’re receiving the drug from the most-affordable source.

      –Ohio PERS

      Reply
      • October 14, 2015 at 7:00 am
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        Catherine, you and I are in the 25% of retirees that OPERS has decided to ignore and sacrifice. I would love to see them produce a “feel good ” video for those of us who require a Tier 3 Formulary drug with no lower cost alternative. When you hit the “donut hole” in month 2 or 3, you are one of the retirees that has been sacrificed to save money. What OPERS has spent on mailings, videos, childish calendars and other cute stuff to makes think they care would have paid for decent drug coverage.

        Reply
      • October 18, 2015 at 11:25 am
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        Multiple sclerosis drugs are expensive. The new oral medication is being used because it is the last resort for me to try and slow down the progressition. There are no cheap generic alternatives sir. The newest drugs are the newest research to help patients who are progressing and they are our best defense. Hope u r never in this spot.

        Reply
        • October 20, 2015 at 7:23 am
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          Catherine,

          Thanks for your reply. Our Health Care department suggests talking with your physician to seek other ways of obtaining the medication, such as from their office. Is that a possibility?

          –Ohio PERS

          Reply
    • November 10, 2015 at 7:55 pm
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      This prob won’t help you, Catherine, because of the specialty drugs you need but I discovered, when I called some of the companies about their formularies, that each can put drugs on different tiers. E.G. I have one that some have on tier 2 and cost about $15/month and others have on tier 4 and costs $100 or more a month. So anyone who has some like this might want to check differen rx plans.

      Reply
      • November 12, 2015 at 10:51 pm
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        this is why people need a GOOD agent who can help them to get into a plan that DOES save them $….doesn’t sound like there is good advise happening here

        Reply
        • November 13, 2015 at 7:57 pm
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          I asked the pharmacist’s for explanation of their plans. They are not allowed to advise you, but have the best info.

          Reply
          • November 23, 2015 at 3:13 pm
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            Dorothea, the pharmacist cannot recommend because they are not licensed agents and may be a conflict of interest. I am an agent and there are many reputable MEDICARE specialist agents that could definitely help you. You need advice & guidance.

          • November 23, 2015 at 3:42 pm
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            Thanks Rhoda !

  • October 11, 2015 at 8:22 am
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    Every step of the way, OPERS has glossed over the real facts, especially regarding the Part D changes. What you don’t say is that we are losing all payments “from other sources” that limit the current impact of the donut hole. I am one of the 25% of retirees who must take a specialty drug for which there is no generic alternative. Whereas my current plan has protections and benefits that limit my out of pocket cost for this drug to $460.00 annually, I will now have to pay $4850.00 in 2016. That cost will rise every year until 2020, when I will pay 25% instead of the full cost in the donut hole. Guess what — 25% of a month’s supply of the drug I can’t survive without is about $500.00.

    Never, in any discussion or publication, has OPERS come right out and said, “you currently have a great plan that is protecting you from the donut hole and we are taking that away forever.” The contribution OPERS is going to make to my HSA every month will not even cover my annual drug expenses much less pay for my medical insurance premium. Instead, we heard comments about how we may be able to find a plan that “helps us control or reduce our prescription drug costs.”

    Thanks for letting us slowly figure this out on our own.

    By my estimate, my annual costs for hospitalization, doctor visits, tests, treatments and drugs is shooting up from about $1700/annually maximum to $7,350/annually and increasing every year while your contribution decreases every year.

    Your presentations and publications have been very misleading.

    Reply
    • October 18, 2015 at 11:34 am
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      Absolutely true.

      Reply
  • October 11, 2015 at 11:49 am
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    I take, on a regular basis about 15 medications. With Express Scripts, my 3 month cost with 3 exceptions has never exceeded $10. I was told Silver Script was the best choice for me – and my out of pocket costs increased from $260 per 3 months, currently, to $1355 per 3 months with Silver Script. And when I reach the doughnut hole the cost for my insulin (Lantus injectable) alone increases to $4665 for 3 months. Yes that’s right – she repeated it three times. I outraged. It’s bad enough that OPERS changed the rules in the middle of the game but too say it will be less expensive??? The numbers speak for themselves!!

    Reply
    • October 13, 2015 at 12:14 pm
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      I an having the same problem with my husbands meds. At this rate I will have to sell the house just to pay for prescription medication. I can’t seem to find anything affordable offered in those plans available. When I questioned the high price the advocate told me it was because we were changing to an individual plan from of a group plan. Now,
      I distinctly remember the representative from PERS stating the individual plans would be LESS expensive. This is so disheartening.

      Reply
    • November 4, 2015 at 4:24 pm
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      Under our current plan, all diabetic testing supplies and insulin were covered in full. Now you have to pay for them, thousands of dollars. This is insane.

      Reply
  • October 11, 2015 at 2:18 pm
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    Please clarify…When an individual becomes enrolled in medical coverage through The Connector does their current build up of any earnings in their Aetna Health Reimbursement Account remain where its at for future use or not? As rumors take place I have heard any remaining funds will be transferred from an individuals Aetna Health Reimbursement Account and go into ones new Health Reimbursement Arrangement (HRA) funds thus closing out ones Aetna Health Reimbursement Account.

    Reply
    • October 13, 2015 at 9:11 am
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      Dennis,

      The funds we deposit into the HRA will not be commingled with any money you might have in your Retiree Medical Account. We may consider this in the future, but for now they are separate.

      –Ohio PERS

      Reply
  • October 14, 2015 at 11:09 am
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    I hate what you’ve done to us old retired people. It is bad enough to worry about our health and fixed income, now we have to worry about how to stay alive using the new insurance options provided. My husband worked many years and retired from the State. He now has cancer and the days ahead look very unstable. At this time to worry about coverage is a crime. No other insurance company would cover my husband in his condition. We will be forced to use your insurance with poor benefits. The State of Ohio is ignoring all the good senior citizens who were dedicated employees and retired thinking they would be taken care of in their retirement. How are we suppose to survive?

    Reply
  • October 14, 2015 at 2:34 pm
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    Well, it looks like my e-mail statements, questions, and comments of a year or two ago are all coming to fruition. We will now pay for those covered by the ACA who could not afford or didn’t want insurance. But not to fear, we will soon be among them and the Feds can help pay for our policies. Sorry if I sound too upset, but from what I have read here, and what I have been told by persons that I retired with who have already had their time with the “Connector”, I am upset!

    Reply
    • October 17, 2015 at 7:36 pm
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      I’m sorry. OPERS retirees have an excellent retirement plan.
      Better than most in dollars. Plus they made more on average than
      private companies with strict 40 hour work weeks.
      I do get tired of the whining. State employees retire extremely
      well. You have a higher limited income than most plus whatever
      You salted away. I do get tired of the whining. I’m sorry
      Join the rest of the world. Ohio pays for your retirement. Most
      people do not make comparable retirements. Include double
      Dippers and I have no pity. I’m sorry. I was one as well. I know
      the workers and the work. Much less rigorous than private
      industry. There needs to be a balance. Why should there be
      Any different retirement for anyone?? Simple because we were
      lucky to work for a state government. I’m
      sorry but I had to go on disability. I don’t get a full retirement.
      Which is a very good retirement. And the benefits were incredible.
      No whining. Just like Federal employees. What makes anyone
      different than a private employee?????
      Thanks
      Be grateful.

      Reply
      • November 10, 2015 at 11:59 am
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        What I am really tired of is people who disparage state employees(active or retired) because those who disparage lump us in with the sometimes less than honest politicians they see bloviating on TV. Yes the retirement benefits at least up until now have been very generous. However, I can assure you that holding the position I held upon retirement(after approx 34 years) I was getting paid significantly less than someone in the private sector with similar duties. I accepted a smaller but adequate salary for years knowing the retirement benefits I would receive would help even the playing field. If people who did NOT choose to enter government employment want to ‘blame’ their career decisions on others please first look in the mirror.

        Reply
      • November 12, 2015 at 7:25 pm
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        What makes us different was that we were required to put 10 percent of our salary into a retirement fund. I worked 20 years in the private sector and 20 years in the public sector. For the 20 years that I worked in the private sector I put 10 percent into a personal retirement plan. My private retirement plan yields as much as my pension. The difference is having the freedom to not save for your retirement. Far too many people in the private sector choose to not save for their retirement.

        Reply
  • October 15, 2015 at 7:49 am
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    I’m the spouse of a retiree, when comparing Plans on One Exchange website, there is not enough information to make a decision. Most provider lists are missing. And there aren’t any drug list showing where the drug is to determine drug costs. I actually went to the providers webpages hoping to find more detail. I called our physicians office to see which plans they will accept. They indicated they will not know whether the providers keep them or drop them from their plans until Jan. 2016. Robert and I both had a phone call from Humana evaluating our physicians within the last couple of weeks. If Humana or any provider decides to drop a doctor, they do it. We have great doctors, we gave them great reviews; and we want to keep them. If we cannot be assured our doctors are not on a new plan, and they aren’t, then what are we going to do in Jan. 2016 when they get dropped by the new provider?

    Reply
    • October 15, 2015 at 1:09 pm
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      Paulette,

      If you choose a Medigap plan, there typically are no network restrictions.

      If you select a Medicare Advantage plan, there are two major options. One is a Preferred Provider Organization, in which you pay less if you stay within a network but can go outside the network if you choose at a higher cost. The other main type of Advantage plan is a Health Maintenance Organization, in which you pretty much have to stick to the network of doctors.

      Given your concern about your doctor being dropped at the last minute, you should consider both types if you are selecting an Advantage plan. In either case, you will be able to change plans during next year’s Medicare Annual Election Period if you don’t like your choice of plans for 2016.

      –Ohio PERS

      Reply
      • October 22, 2015 at 6:24 pm
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        If she chooses a Medicare Supplement will she be underwritten????

        Reply
        • October 23, 2015 at 12:54 pm
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          Rhonda,

          When someone goes from an Advantage plan to a supplement plan there is the possibility of underwriting.

          –Ohio PERS

          Reply
          • October 24, 2015 at 8:43 am
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            Very important – what if someone already has a Medicare Supplement (outside of OPERS) and now being offered help paying for healthcare through OPERS, she completed information for a Med Sup through OPERS – that then will be underwritten and there is a possibility of her being declined due to existing health conditions? I understand to get the monthly subsidy from OPERS she has to enroll though them. Does she also have to get her Rx through OPERS to keep the subsidy?

          • November 13, 2015 at 12:28 pm
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            Rhonda,

            You do not have to get your drug plans through the Connector to retain your HRA allowance. We are canceling our sponsored health plans, so you will not need to go through underwriting if you choose a plan through the Connector.

            –Ohio PERS

          • November 6, 2015 at 9:24 am
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            Mr Pramik,
            I have not received an answer as to if someone ALREADY has a Medicare Supplement and completed an application for another through OPERS, that too will be underwritten then? Can she stay in her existing Med Sup and receive the help paying for it??????

          • November 10, 2015 at 2:40 pm
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            Rhonda,

            Only plans selected through OneExchange will allow the retiree to receive their HRA dollars. Those retirees who are already enrolled in an individual Medicare supplement plan should call OneExchange, as there are ways to re-enroll and potentially avoid medical underwriting. This is a conversation you definitely should have with OneExchange.

            –Ohio PERS

  • October 15, 2015 at 1:44 pm
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    I know I’m echoing everyone’s sentiments here, but just finished enrolling with One Exchange. The prescription drug plan is HORRIBLE! I will be paying 300% MORE for the prescriptions I need!! How can OPERS possibly justify this? I had heard about seniors having to choose between eating and taking necessary meds, but I NEVER thought that would be something I’d have to face since OPERS was supposedly looking out for us. What a joke that has turned out to be ! Thanks, OPERS!

    Reply
    • October 23, 2015 at 6:35 pm
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      Well I just got the prescription drug plan in the mail today. OMG!!!! I don’t know what we are going to do. The out of pocket cost for the drugs are are just unbelievable. And I was told the was the most affordable plan for us. There is no way we can afford this. Under the old plan our cot was no where near this. What is going on? I am soooo disheartened. I just don’t know what we are going to do.

      Reply
  • October 21, 2015 at 2:47 pm
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    I agree with all the comments made. I made my call to One Exchange. It took one and half hours and it was very stressful and difficult to understand the questions that the person taking my application was asking.. The drug plans are terrible. I take 3 prescriptions and 1 for Restasis which is eye drops. They are telling me the Restasis is $15,000 per year. That is just not possible! That price would put me in the donut hole immediately. I cannot afford this. The videos I watched and the OPERS seminars were very misleading. I am so stressed about all of this and I may never be able to get my prescribed eye drops which I need to have healthy eyesight. This is all so wrong.

    Reply
    • October 27, 2015 at 8:53 pm
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      Anyone who is on Medicare needs to be looking at Medicare.gov for their prescription plan. Unless you are signing up for the Humana Advantage plan. If you are signing up or enrolled in a supplement which takes a separate Rx plan you are able to go outside of the Insurance Connection for Rx.
      Be sure to ask to be absolutely certain, but that is what I have been told…you CAN go outside companies. I highly recommend having an agent guide you to be sure you save the most on your meds. There is no additional cost for an agent to help you.

      Reply
      • November 5, 2015 at 3:28 pm
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        Rhonda, did you get confirmation on that ?

        Reply
        • November 14, 2015 at 12:37 am
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          Yes, I did receive a message, which should show in the postings from Ohio PERS, that you can go outside of the Connector to get Rx coverage and still get the allowance. By using Medicare.gov you can put in your Rx’s and compare the plans to see which will save you the most $—all depends on what Rx’s you have. Everyone is different of course. I do recommend having a good agent who is knowledgeable about Medicare Health plans to help you.

          Reply
  • October 22, 2015 at 9:23 am
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    I know I had previously read about “the doughnut hole” but cannot find it. Where can I find information about the doughnut hole

    Reply
    • February 10, 2016 at 11:31 pm
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      Fred,
      You can go to http://www.Insure-care.com and look for a link in center of home page about Prescription Drug plans. If you click on that it takes you to a page that you select a link for information about the drug plans. It explains very well how the ‘Donut Hole’ works.

      Reply
  • October 24, 2015 at 9:03 am
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    The video doesn’t give full disclosure about the donut hole…… when you reach donut hole, I did not hear specifics, only when you get out of it how much coverage you’ll have. Not clear at all.

    Reply
      • November 9, 2015 at 12:40 pm
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        I know all about the donut hole. Your company has not answered my specific questions. Nor have you told or answered your retirees. CAN they enroll in a Part D prescription plan through any Pt D provider (company) or do they HAVE to go through your company’s prescription programs???????
        Lack of information to people is NOT helping them.

        Reply
        • November 24, 2015 at 1:29 pm
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          Rhonda,

          A prescription plan purchased outside of the Connector is a reimbursable expense.

          –Ohio PERS

          Reply
  • October 26, 2015 at 10:46 am
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    I agonized over doing One Exchange even though I attended meetings, kept up with everything mailed to me and asked questions during my on going treatment from my Oncologist. My appointment started badly as I was on hold over 20 minutes when I thought the idea of the appointment was to get right to my “benefits advisor” without any waiting.(Hint: use the same phone as the number they have for you as I used a landline because I didn’t want my battery to out. Bad idea!) I was also on-line with their website so I could follow what was being recommended.
    2 hours and forty five minutes is how long it took and what I think I purchased was totally different than what I thought would fit my needs. I was physically and emotionally drained by this experience!
    Have your Medicare card, checkbook, credit cards, and if you need help have that person or persons with you because if your experience is like mine, my worst fears happened.
    The real test will be come 1/1/2016 and the coverage kicks in as the peace of mind I’ve had with Humana Advantage stops and what I’ve chosen starts(I hope.)

    Reply
  • November 5, 2015 at 2:47 am
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    I just discovered this site and find the comments very interesting! Why did they stop with Oct 12? It’s now Nov 5 and I wonder what’s going on now! I have my phone appt this Saturday and am in no way ready to make a decision. I feel sick to my stomach! At this point I can’t get past worrying about paying the premiums. The information I received clearly said that we have to pay the premiums first and THEN get reimbursed. If I get a medigap plan with rx plan, it looks like my premiums may well be from $250-300. I DON’T HAVE that much extra each month to pay the premiums and wait to be reimbursed! And I doubt that many do! I don’t understand why they couldn’t have set it up so that once we’re signed up for a plan and OPERS knows what our monthly premium will be, that amount couldn’t be direct deposited into our bank account so we would have it to pay the premium when due. WHAT are we supposed to do!!

    I also agree that regardless of what we were told, I don’t see these plans costing less than the coverage we have now would be….and why couldn’t OPERS have contracted with a different advantage plan for all of us, to replace the Humana plan, that would have cost less. Everyone who is not on Medicare is still on Medical Mutual, right? They have new Advantage plans, wouldn’t a group plan with one of those have been better?

    All but one of my doctors is an OSU dr and I go to OSU/Wexner hospitals. They finally, after a month or more, sent memos to patients telling us of the 6 plans they would accept, one Aetna and FIVE Medical Mutual plans. And from what we could find out, the Aetna SM plan is a group plan…does that mean that you have to belong to a particular group to use it? And forget trying to contact anyone at OSU hosp to get more information.

    Reply
    • November 10, 2015 at 2:47 pm
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      Polly,

      We appreciate your concern. Unfortunately, the only way we can provide the HRA dollars on a tax-free basis is through a reimbursement mechanism. Retirees are encouraged to file their first reimbursement requests manually as that is the fastest way to get their money back and then sign up for auto reimbursement.

      Retirees can pay with a credit card if that helps them financially and should be able to receive the reimbursement prior to the due date of that credit card.

      A group plan would not have been more affordable. Most retirees would be paying $200 more a month than they are now. Through the OPERS Medicare connector most retirees will have money left over in their HRA to pay for out-of-pocket medical expenses. The individual Medicare marketplace is simply more affordable than group Medicare plans.

      Regarding any individual provider, make sure when you sign up for Medicare Advantage plan that your doctors are in their network. If you want to avoid any network restrictions, select a Medigap plan.

      –Ohio PERS

      Reply
  • November 5, 2015 at 3:05 pm
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    Everyone is blaming the wrong thing. It’s the drug companies.
    It’s the number one import of the US. No one can afford these
    drugs. But people want excellent returns on their stocks.
    Why doesn’t anyone focus on these drug companies and the
    outrageous profits. Supposedly R&D. My Mom has taken restasis
    for 10 years. It was in shot form. I recall it was $2,000 a shot.
    Supposedly experimental 10 years ago. She had wet macular
    Degeneration. Until we start focusing on the causes. I’m sure
    there are many taken profits off drugs. Remember the old big Pharma
    companies buying doctors with gifts and trips. Why doesn’t
    anyone monitor big Pharma. Only the rich will be allowed to
    be healthy and live. It’s disgusting. What about countries like
    Germany who are way ahead of the US in Heath care.
    Sorry. The government needs to step in here.
    Time magazine did an entire issue on Big Pharma. These people
    are mainly messengers. Go after the initial cause here.
    Break up the monopolies. Pfizer Merck. Etc.
    Then the feeders like Express Scripts. Since when have drugstores
    started taking coupons for drugs. Why isn’t anyone really looking
    into the problem?

    Reply
  • November 5, 2015 at 3:34 pm
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    Michael, does this make sense ? In 2015, once you and your plan have spent $2,960 on covered drugs (the combined amount plus your deductible), you’re in the coverage gap. In 2016, once you and your plan have spent $3,310 on covered drugs, you’re in the coverage gap. You would think the deduct would be part of the doughnut hole, not penalize you in reaching the hole.

    Reply
    • November 24, 2015 at 1:21 pm
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      Dorothea,

      You have the amounts correct. For more information about the donut hole, you really need to ask Medicare: 1-800-MEDICARE

      –Ohio PERS

      Reply
    • November 24, 2015 at 10:22 pm
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      Some Part D drug plans have NO deductible. Some have RX coverage through the donut hole. I would be glad to help but they won’t show my contact information. Find a Medicare insurance specialist.

      Reply
  • November 5, 2015 at 5:31 pm
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    I have been trying to understand all of these changes and help my husband make the best decisions. One question we have been unable to find the answer to – what exactly is eligible for reimbursement from the reimbursement, specifically can we apply for reimbursement for the out-of- pocket prescription drug costs? It may not seem like much, but these days every little bit helps.

    Reply
  • November 7, 2015 at 3:12 pm
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    I thought it was very impersonal and rehearsed. I am disappointed

    Reply
  • November 10, 2015 at 4:48 pm
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    My husband is a OPERS member, he had his phone call with one exchange today. I went to every meeting and watched every video offered by OPERS to understand the changes with our healthcare. After he and I spent two hrs on the phone with one exchange we both felt that OPERS could have done a much better job representing their members. This process was not at all easy to go through. It was very confusing and stressful. I am hoping we made the right decisions. I don’t know how an elderly member with out someone to help them will be able to make the right choices! This process is nothing like OPERS represented to their members! Shame on them!!

    Reply
  • November 11, 2015 at 10:34 am
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    We have had our discussion with OneExchange and nit went rather well. The person we talked to was friendly and very helpful. It took about three hours for the two of us due to problems on their end with computers, for which the person kept apologizing. That being said all the glossy literature we received and all the glib presenters on You Tube will not change the fact that this change (especially the drug coverage) is a disaster for we retirees. Not only is it a disaster next year it will be even more so the following years as the supplement of OPERS decreases and the cost of medical care (especially drugs) goes up even though the donut hole closes slowly. I have to wonder is anyone from OPERS, including the board, is paying any attention to the comments from the members regarding the difficult times ahead caused by this change in insurance coverage.

    Reply
  • November 12, 2015 at 2:20 pm
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    I have selected Humana Walmart Medicare ” D ” ..Spoke with pharmacist and several of my prescriptions fall in with their low cost $ 4 & $ 10 list. They do not report them as part of your Medicare ” D ” I don’t know if this is nationwide or not.

    Reply
  • December 11, 2015 at 9:42 pm
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    I am a retiree from OSU hospitals and worked for 30 years as a critical care nurse. One of the reasons that I continued my employment was the benefits I would have on retirement. The last three years I have kept abreast on the changes that where to occur with mine and my dependents health care. But nothing prepared me for the cost of my prescription drugs. As a diabetic enrolled in the wellness program, I have stabilized my diabetic values to the best they have been in years and the plan cost me very little out of pocket. I was prepared that I was going to need to pay more for my drugs but I wasn’t prepared that I would be in the donut hole in three months. I am taking generics on all oral meds but there are no generics for the various insulins that I take. There was only ONE Rx plan that covered my drugs and with that my yearly out of pocket will be $4982.00 and that is just the prescription drugs not counting in the over the counter meds that I take. My husband found NO drug plan on the connector that covered all his meds. He also has generics for all his meds that are generic but many of his also has no generic. His out of pocket yearly is $12,800.00 plus $6000.00/year for the drugs that are not in the plans formulary. These drug costs will be 33% of our yearly retirement. income. These costs do not include the premium costs. HOW CAN ANYONE PREPARE FOR THIS…………I am sure that I am not the only one facing this issue.. I would be happy to discuss my experience. Thank You, Marion S

    Reply
    • December 15, 2015 at 1:08 pm
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      Marion,

      Thank you for responding. We are forwarding your comment to our pharmacy benefits manager.

      –Ohio PERS

      Reply
      • January 26, 2016 at 3:16 pm
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        Michael, Is someone going to contact me about my drug concerns Marion Speer

        Reply
        • February 5, 2016 at 10:51 am
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          Marion,

          We forwarded your original comment. If you’d like to talk with an OPERS representative about health care, call us at 800-222-7377.

          –Ohio PERS

          Reply
          • February 8, 2016 at 1:14 pm
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            I called the number that you provided me. The service rep does not deal with pharmacy benefits and could not offer any assistance except to listen to my cost concerns for mine and my husbands medications. She indicated that she would pass my concerns along like you said you did. She then told me to call One Exchange. I would like to see OPERS be my advocate and address the fact that pharmacy plans chosen do not meet the needs for some retirees .

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