Individual health care market strong in Ohio

Expert says Supreme Court case not likely to disrupt current coverage

By Michael Pramik, Ohio Public Employees Retirement System

Dec. 10, 2020 – A strong individual marketplace for health care exists in Ohio, a health care policy expert recently told OPERS trustees.

John Barkett, Senior Director of Policy Affairs for Willis Towers Watson Via Benefits, provided an overview of the marketplace and other health care issues at the November Board of Trustees meeting. It was in preparation for 2022, when the OPERS group plan will terminate and our Pre-Medicare retirees will enroll in a marketplace plan.

OPERS will provide these retirees a Health Reimbursement Arrangement (HRA) in which funds will be contributed, allowing the retirees to seek reimbursement for qualified medical expenses.

Barkett said the Ohio insurance marketplace has stabilized and will strengthen next year as premiums drop and carriers expand their offerings. There are currently nine insurers in the Ohio market, compared to a U.S. average of 5.4 per state. The carriers define their territories by county, and 95 percent of Ohio residents have access to three or more carriers. Competition is increasing, which will lead to a better environment for consumers.

He said the plans must cover “Essential Health Benefits” that include hospitalization, emergency services, prescription drugs, rehabilitative services and preventive and wellness services.

Barkett also addressed the current Affordable Care Act challenge before the U.S. Supreme Court. In the case California vs. Texas, the court is deciding whether a coalition of states and citizens have standing to challenge the act, whether the individual mandate to purchase health care coverage is constitutional and whether the mandate can be severed from the rest of the act and ruled on separately.

Barkett believes the case is not likely to disrupt the individual market, meaning OPERS retirees should not face the threat of losing coverage for pre-existing conditions, or having pre-existing conditions precluded from coverage, in the future.

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

  • Need more information on what is happening to us retires in 2022 regarding health insurance Are you saying we will no longer have Via benefits services??????

  • Can you clarify what 2022 ” OPERS group plan will terminate…” means as far as VIA and the services they offer current retirees?

    • Barbara,

      The “group plan” refers to coverage for pre-Medicare retirees. Via Benefits currently serves Medicare retirees. For more information about the upcoming changes for Medicare retirees, refer to the Health Care 2022 section of the OPERS website.

    • Sylvia,

      That’s a great question. Mr. Barkett referenced only the U.S. average and the Ohio market, but your question is something that the plan administrator will be able to help answer when it comes time to select coverage.

  • If I buy out my pension will my social security still be affected by the windfall act? I had 20 years in the private sector and will have 15 years in the public sector when I retire.

  • If your under 65 and re-employed employee and decide to retire and are offered a COBRA plan by your re-employed employer. Will COBRA be Eligible for the health reimbursement

    • Your Health Reimbursement Arrangement (HRA) allowance can be used to reimburse yourself for qualified medical expenses, including monthly premiums for the health care coverage medical plan of your choice.
      This plan can be offered through the OPERS Pre-Medicare Connector, (The Affordable Care Act (ACA) health care marketplace), a non OPERS-covered employer (yours or your spouse’s), any private health care insurance carrier. We will continue to provide updates on our website under the Health Care 2022 section. Thanks MS

        • Brent,
          When a person elects COBRA coverage from any source other than OPERS, the premiums are qualified medical expenses that can be reimbursed from an HRA. Thanks MS

  • I’m trying to find information on how the new healthcare changes will effect the retired- rehired Pre- Medicare retirees especially when they are no longer a retired- rehired employee after 2022.

    • Federal rules have recently changed regarding re-employed retirees and HRAs. These changes may provide more options than currently exist. We’re evaluating options and the impact of these recent changes on those re-employed in an OPERS-covered position. We’ll share more information in the Health Care 2022 section of our website as it becomes available in the coming months.

  • Barkett said the Ohio insurance marketplace has stabilized and will strengthen next year as premiums drop and carriers expand their offerings. I disagree with this statement. I have a friend who is the spouse of a recently deceased police officer and she is being offered horrendous health insurance. It has over $10,000 in out of pocket expenses and her premiums are over $900 a month, and she has no choice but to take it. That’s affordable? I really worry for the non-medicare age retirees in OPERS in 2022.

  • Retired in 2013 with slightly less that 20 years service. I was grand fathered in as a result. The linked information states

    ” Your allowance will be reduced to between 51% and 74% based on your actual position on the allowance table effective Jan. 1, 2022.”

    Does this mean that I will lose all of the HRA benefit??

    • If you retired prior to 2015 and you had less than 20 years of service, your allowance percentage will be reduced to 51% effective Jan. 1, 2022.

  • I plan to retire effective June 1 of this year. I am pre-Medicare. Am I right that where I fall on the scale (68 %) that beginning in 2022, I will still receive the same 68 % percent only as an HRA deposit? And that will be deposited in my bank account? Or how does that work exactly?

    • On our website under the Health Care 2022 section we offer a step by step guide on how to determine your allowance percentage and additional information on the Health Reimbursement Arrangement. We will continue to update the website as additional information is released. If you would like account specific answers please send your questions through our online account message center or contact our member service center at at 800-222-7377. Thanks MS

  • Can you please tell me when will the providers/vendors that VIA Benefits will be offering pre-medicare retirees for 2022 be available for review?

    • You can research private plans as well as plans on the open market offered through 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

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