Health care open enrollment dates set for 2017

Open enrollment presents a time for retirees of the Ohio Public Employees Retirement System to adjust their health care coverage. This year, our open enrollment will be held Oct. 15-Dec. 7 for both Medicare and non-Medicare retirees.

We recently mailed the OPERS fall newsletter, which includes a health care bulletin previewing what is to come for 2017 medical, prescription, vision and dental plans. Here are a few of the highlights and details:

Medicare

  • If you’re happy with your current plan selections through OneExchange, there’s no need to take action. Current plans will automatically carry over into 2017.
  • If you’d like to explore different plan options, call OneExchange (844-287-9945) from Oct. 15-Dec. 7. Be sure to read the health care bulletin in the fall newsletter, which should arrive soon, for details about automatic or recurring reimbursement arrangements.
  • Eligible plan participants will still receive open enrollment materials from OPERS for optional vision and dental coverage.
  • Participants will receive 2017 plan information from their current carriers.

Non-Medicare

  • If you’d like to continue your current coverage, there’s no need to take action. Current plans will automatically carry over into 2017.
  • If you’d like to adjust optional vision and/or dental coverage, or add or drop a dependent for 2017, contact OPERS from Oct. 15-Dec. 7.
  • Co-insurance and copays are not changing for either the OPERS Retiree Medical Mutual PPO Plan or the Medical Mutual Interim Plan.
  • We’ve added a lower-cost tier to the prescription drug plan, specifically for biosimilar/generic specialty medications.

Non-Medicare premiums will rise in 2017 because of the continued reduction in the allowance amount, and because of overall plan increases. The health care bulletin includes helpful resources available to plan participants in the face of these higher premiums.

The annual OPERS Enrollment Guide is mailing at the end of September and will include a personalized cost statement to help you with your planning needs. Watch your mailboxes and as always, if you have any questions, OPERS is here to help. You can contact us at 800-222-7377.

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

  • Will we be getting a packet showing Medicare supplement options? And will we get a packet for non-medicare eligible spouses? Thanks.

    • OneExchange will be sending information about the enrollment period and a newsletter will mail this fall. If you are interested in researching available plans, visit medicare.oneexchange.com. CMS will release the 2017 plan rates in early October. Any Medicare questions pertaining to medical/pharmacy plan options should be directed to OneExchange.

      OPERS open enrollment materials will arrive to households in early October and will include a personalized cost statement, including non-Medicare plan information, if applicable.

      -Ohio PERS

  • I’m somewhat prepared for the sticker shock of insurance premium increases for 2017 due to ObamaCare.

    And when the ObamaCare, Cadillac tax hits PERS in a couple years we ALL will suffer zero financial help from OPERS.

    Tom

        • Scott, The OPERS Open Enrollment materials are mailing at the end of the month, your household should receive it in early October. Included in the packet of information is a personalized allowance statement. This will provide a clear picture and help you determine your next steps based on your budgetary needs. The recently mailed Health Care Bulletin contains a list of helpful resources if you are seeking more information.

          I hope this helps.

          -Ohio PERS

    • I guess you haven’t been reading OPERS comments about the Cadillac tax. They won’t be paying it. The Cadillac tax taxes group insurance plans that are deemed too generous by the powers that be. OPERS is reducing insurance benefits for non-medicare retirees in preparation of the Cadillac tax so they can avoid paying it.

      • Indeed! But in the meantime, OPERS continues to suffer those of us that elect to return to work with a public employer. This is punitive and there seems no changes for 2017 in taking away benefits from those that fall into this category. This rebuff of members is untenable. It is extremely unlikely the Cadillac Tax will ever go into effect. Obamacare may even go the way of the dinosaur. Get real OPERS!

    • The OPERS education team will be holding optional seminars around the state to help non-Medicare retirees learn about their health care coverage for 2017. The health care bulletin lists locations, dates and times. If you have not received your bulletin, it should arrive soon. It is also available online at opers.org.

      For questions pertaining to Medicare plans, please call OneExchange at 1-844-287-9945. A Licensed Benefit Advisor will be able to address any concerns you may have.

      -Ohio PERS

  • Right now, I’m satisfied with my medical MediGap and drug coverage, but I have a couple of areas of concern should I want to change either.

    First, if I decide to change medical plans to another MediGap plan will their still be guaranteed acceptance, or will I have to qualify after medical evaluations? Second, can I change Part D drug plans freely to get a better premium or drugs covered and have guaranteed acceptance? Please don’t send me to the OneExchange phone lines. Thanks.

    • When changing going from one Medigap plan to another Medigap plan, medical underwriting may apply. Medical underwriting does not apply between Medicare Part D prescription drug plans.

      Thanks,
      -Ohio PERS

      • Medicare is very rule-driven. According to their rules for medigap plans, you cannot change from one medigap plan to another (from a Plan F to a Plan G for example) or from one insurance company to another at guaranteed issue pricing. You would be subject to underwriting based on your health and likely much higher premiums if you try to make either one of those changes. For all intents and purposes, you are stuck with the medigap plan you currently have. You can change from a medigap plan to an advantage plan during open enrollment, however, but you would be subject to underwriting if you tried to change back to a medigap plan from an advantage plan.

  • Is it required for spouses who will get less than 30% in 2017 and 0% in 2018 allowance for health premium to use the one exchange connector in order for the retiree to submit spousal reimbursement using the retiree’s HRA?

    • The retiree’s allowance can be used to reimburse a spouse’s qualified medical expense even after the spouse is no longer receiving an allowance. Whatever expenses are left over in the HRA can be used towards a spouse’s qualified expense regardless of if the spouse selected a plan through the Medicare Connector.

      Thanks,
      -Ohio PERS

  • Once again OPERS has done a disservice to its re-employed retirees in the 2016 Q3 Open Enrollment Bulletin. Nowhere in bulletin is an explanation of the 2017 premium cost for non-medicare re-employed retirees. We “Meet Henry” on page 6 but nobody who reflects the non-medicare re-employed retirees. Come on, OPERS. What happened to transparency? You could do MUCH better than this (if you wanted to).

    • Anita,

      You can go online now and use the Health Care calculator under “Tools and Resources” to find out what your premium will look like in 2017. We did not have space in the newsletter to include an example of every scenario.

      –Ohio PERS

    • Kimberly,

      We recommend that you double-check your pay stub to make sure there are no contributions being taken out for OPERS. If you can’t find that contribution amount, then call us at 800-222-7377, and we can help you. It’s possible that you are not an OPERS member because zoos often hire seasonal help through employment agencies.

      –Ohio PERS

  • From the last Benefit Change Notice Statement that I received from OPERS it is apparent that when I receive my monthly net benefit that part of that net benefit is a Medicare Reimbursement of $31.81/month.
    That leaves me paying approximately $89.99/month in order to have Medicare (it would have been $121.80, had it not been for the $31.81/month Medicare Reimbursement that OPERS affords me).
    Then additionally my wife has to pay $122.00/month so that she can be enrolled in Medicare.
    So my question is, is that $211.99/month that my wife and I pay to Medicare in order to be enrolled in Medicare eligible for an HRA claim?
    If so, what do I have to do to make the claim?

    • Great question, thank you for reaching out. Medicare Part A and B premiums are considered eligible expenses under the HRA guidelines (for a complete list, visit the IRS webpage., under publication 502.

      Your next steps are to submit a claim by filling out a Recurring HRA Claim form, found here one for you and one your spouse. You would list the entire Med B premium amount ($121.80) for your wife and the $89.99 for you. Be sure to read the instructions as to what documents you must submit along with the form as you will need to include proof from Social Security for each of you showing the premium amount and effective date of the Medicare Part B. You will then send this information to OneExchange. If you have any questions about this process, please contact OneExchange at 1-844-287-9945.

      -Ohio PERS

  • Extremely happy with my Medicare Plan F, through AARP.

    But what about our prescription plans?

    Was cautioned last year to not just arbitrarily keep the same prescription plan. If you addressed that, I didn’t see it. Have been happy with Aetna Prescription coverage, but it might not be the same plan in 2017 as it was in 2016. Please advise me what to do and if you addressed this, I apologize. I didn’t see it. JA

    • Great question. The Open Enrollment materials mailing at the end of the month includes direction for what steps to take if you are happy with your current coverage or wish to explore other options through OneExchange. In short, if you are happy with your coverage, you do not need to take action as your 2016 coverage will automatically continue. If you’d like to explore other options, you may call OneExchange. You may also contact your carrier to learn about possible plan changes for the upcoming year. Additionally, CMS will publish the 2017 rates at the beginning of October, check out medicare.oneexchange.com/opers for more details.

      There are other important pieces of information included in your Open Enrollment guide pertaining to the reimbursement process; please be sure to read the document cover to cover.

      Thanks,
      -Ohio PERS

    • The plans may change the drugs that they cover or how they cover them. The other thing that may change is the medications that you take. Medicare.gov, https://www.medicare.gov/find-a-plan/questions/home.aspx, has the best tool for finding the best drug plan for you.

      If you get your health care plan through One Exchange you are eligible for an HRA and can purchase your drug plan from any provider. Not just the ones available through One Exchange. One Exchange has contracts with all of the providers that they manage. You may be able to get a better deal through One Exchange. Do your research and call One Exchange for their advice and to cancel your current plan.

      If you are prescribed a brand name medication, regularly check with your doctor or pharmacist to see if a generic has become available.

  • I will be eligible for Medicare in April. If I stay with my current coverage with the State of Ohio, but decide to go with somebody else for a supplement after I’m on Medicare, must I wait until open enrollment to leave the state’s coverage? If so, I assume I can keep the state’s coverage, along with a possible other supplement, and drop one at the next open enrollment. Thanks.

    • Thank you for reaching out. It sounds like you may have a couple of moving parts. I would recommend calling OPERS at 1-800-222-7377 and we can walk you through some options/point you in the right direction.

      Thanks
      -Ohio PERS

    • Thank you for your question. I assume you are referring to your Health Reimbursement Arrangement (HRA)? If so, each time there is a reimbursement issued, you receive an Explanation of Payment (EOP) which displays your HRA balance. You can also manage your HRA balance through your online OneExchange account.

      Thanks,
      -Ohio PERS

    • Money in your HRA account can only be sent to you as a reimbursement for medical expenses (IRS rules). The balance carries over month to month and year to year (even when you die). That includes negative balances. If you spend more than you have in your account, it will be paid to you when funds become available.

      One Exchange manages the money, but they do not hold the money. HRA money stays on deposit in the health care fund at OPERS until it is sent to retirees.

  • Ive misplaced my Sept. Newsletter. Can you send me another one? Want to get the new changes for 2017 . Howdo I go about getting one plz.

    • Thank you for reaching out. Did you know you can access the most recent copy, as well as archived editions online? The latest edition is located at opers.org. The web also archives previous versions dating back to Spring 2006. If you are unable to access the bulletin online, you may call OPERS (1-800-222-7377) to request a new one be sent to you. Additionally, your personalized Open Enrollment Guide will mail at the end of the month containing more detailed information.

      Thanks,
      -Ohio PERS

  • What is a payflex card? It is referred to on the Onexchange site, but I can’t figure out what it is or how to get one.Is it a service that Opers retirees are entitled to use?

    • PayFlex – a subcontractor of OneExchange – serves as the administrator of the OPERS Health Reimbursement Arrangement. Like many businesses, they offer different options to meet client needs, one option may be a PayFlex debit card. The debit card is not available under the OPERS agreement.

      Thanks for reaching out,
      -Ohio PERS

      • Is this something that might change in the future? I’ve asked many others with HSA/FSA plans, and they have all expressed shock over the fact that this is not available to me.

        I would think that Mastercard or Visa would make this a very easy option for you to add, and the cost of offering this would be covered by the money you would save on having to manually process these online requests.

        • As previously mentioned, the debit card is not available under the OPERS agreement, however we will keep looking into ways to make the reimbursement process as smooth as possible, revisiting all opportunities as it gets closer to contract renewals. In the meantime, we welcome any feedback and suggestions.

          Thanks for reaching out,
          -Ohio PERS

          Thanks for reaching out,
          -Ohio PERS

  • I understand if I return to work even if part-time my insurance premium will increase. How much on average will this increase be and if it’s a seasonal position will the increase go away when I’m no longer employed for the year?

    • James, great questions as re-employment and OPERS health care follow different rules. If you haven’t already, check out the re-employment section at opers.org. It includes further direction on what to do in certain scenarios. If you have further questions, please don’t hesitate to call OPERS and we can walk you through your personal situation.

      Enjoy your day,
      -Ohio PERS

  • I am a retiree whose spouse is not of Medicare age, he is 61. We haven’t received our cost for health care in 2017 yet but from what I’ve read it will increase substantially and of course in 2018 we will be charged the full amount. I’m looking for anyone in the same situation who may have some good options for health care coverage for a spouse who is not eligible for a medicare supplement.

    • Thanks for your comments. 2017 Open Enrollment Guides should reach mailboxes mid October. It will include a personalized allowance statement with cost details for both you and your spouse. Also included is a list of resources should you seek other alternatives. Opers.org will also have a dedicated page speaking to this topic, accessible from the open enrollment page. Those should be implemented this week.

      -Ohio PERS

    • Paula, i am in the same boat as you are. My wife is only 60. My wife’s premiums for health and dental will be about 800.00 dollars per month. You can go to the OPERS website and do a estimate. Unfortunately i don’t think there is any other good options. Obamacare is not the same as what we have now. My wife doesn’t work and we rely on my OPERS retirement and little SS check, and i can’t get a subsidy for her. I think OPERS meant well by saying Obamacare was a option for the spouse but even with the high premium i don’t think you can beat Medical Mutual coverage.

  • OPER’s is currently making changes to our retiree insurance coverage in preparation of the cadillac tax. If for some reason this tax is delayed further into the future or removed from the affordable care act will OPER rolling back their changes.

  • RE: If you’re happy with your current plan selections through OneExchange, there’s no need to take action. Current plans will automatically carry over into 2017.

    I would suggest that everyone still review the 2017 options on the Towers Watson Website. My current plan changed their formulary tiers which would increase my RX costs an additional $1,000 per year.

    Question: Are the Humana Part D drug plans still offered? They do not show up on the Towers Watson Website for 2017.

    • OneExchange does offer a Humana Medicare D plan on their roster. You will need to contact OneExchange (1-844-287-9945) for details.

      -Ohio PERS

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