Answers to Health Care 2022 questions

This month: Learn about coverage for those living outside Ohio

By Michael Pramik, Ohio Public Employees Retirement System

June 29, 2021 – As we draw nearer to 2022, and the changes that will affect OPERS Pre-Medicare retirees next year, we will periodically post questions and answers to key topics we believe will benefit our members.

This month we’re answering several questions regarding health care for out-of-state residents, the transition deposit and how the HRA works when retirees are on their spouse’s insurance.

Q: It would be great if you could address out-of-state Pre-Medicare retirees. How will the transition impact that population?

A: You can use Via Benefits to find a plan no matter what state you live in. Your state of residence has no bearing on your reimbursements, although there are enrollment restrictions for residents of Massachusetts, Rhode Island and Vermont.

Since OPERS will no longer offer a group medical and prescription plan, you may want to consider enrolling in a new medical plan this open enrollment period. Plans offered through the OPERS Pre-Medicare Connector may feature a defined network. Because of network coverage restrictions, you may want to enroll in one plan while in Ohio and a second plan while living in another state.

You can sign up for a second plan when it comes time to move during the year, since changing residences would launch a Special Enrollment Period. That allows you to enroll in a new plan, but your deductibles and other out-of-pocket expenses would start from zero. In such special situations, you’d be best served to talk it through with Via Benefits.

Q: I’ve heard OPERS is going to fund the Pre-Medicare HRAs with an initial deposit of $1,200 this year. Is that a flat amount, or will it be based on my allowance amount?

A: OPERS will provide a one-time, $1,200 transition deposit this fall for retirees who are enrolled in the OPERS Pre-Medicare group medical plan as of Dec. 1, 2021, and have opted in to the HRA. This is a flat amount and is designed to help defray up-front costs associated with enrolling in a new medical plan.            

Q: I’m an OPERS retiree, but my spouse is still working. I am covered as a dependent under the medical plan offered by his employer. Can I receive reimbursement from my HRA for the premiums we pay for his employer-sponsored plan?

A: Yes, but only if your spouse pays premiums post-taxes. Whether you or your spouse is the enrolled employee, all medical plan premiums must be post-tax in order be reimbursed from the HRA.

For more information on this transition, visit the Health Care 2022 page at opers.org. Also, plan to attend a Retiree Health Care Under 65 webinar. This webinar was updated with new information in February. If you have attended one of these sessions, you may consider attending again this year. Visit the Member Education Center at opers.org to register. All webinars are also available as Recorded Presentations to watch at your convenience.

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

    • Anita,

      To this date, legislators have not taken action on the Board-approved proposal to freeze the COLA.

  • I am a re-employed retiree and am currently have State of Ohio medical coverage. I called in and was told the monthly amount I would be eligible for would be placed in a health spending (maybe not the right words) account which I would be eligible to use when I actually do retire again. What do I need to do (and when) to ensure this happens?

    • V,

      You will need to opt into the HRA through Via Benefits during open enrollment this fall. We will be sending out much information about that process as the time draws near. Thanks for asking.

  • Michael

    I’m looking at possibly retiring next June with 39 years.
    My question is can I contact Via Benefits and open an account with them to see what kind of insurance is offered to me through them? Or do I have to go through Opers’s and actually put in for retirement before I can create an account with Via Benefits?
    Thank you
    BG

    • BG,
      You would not be able to create an account with Via Benefits until they have your file. Please send the questions you may have about this process through your OPERS online account message center so we can review your account and provide answers that are specific to your situation.
      Thanks MS

  • When I turn 65 (in 09/22) I will still be employed and covered by my employer for med insur. Do I have to go on Medicare? Will I lose my HRA? How will 65 affect an employed person (not a PERS employer)?

    • Teresa,
      In 2022 if a Medicare eligible retiree does not enroll into a medical plan with Via Benefits they will not be eligible for the HRA. A retiree is only considered re-employed if the employment is through an OPERS employer. Please send additional questions you may have about this process through your OPERS online account message center so we can provide account specific answers.
      Thanks MS

  • Can I opt into the HRA and opt out if my circumstance changes? The reason to opt out would be qualifying for a premium tax credit.

    • Tammy, A pre-Medicare retiree may Opt-Out of the HRA at any time. A pre-Medicare retiree who does not Opt-In during the initial enrollment period will not be able to Opt-In until the next Open Enrollment period unless they had a premium tax credit and then lost eligibility for that tax credit during
      the year. Thank you, OPERS

  • I read in this article where Whether you or your spouse is the enrolled employee, all medical plan premiums must be post-tax in order be reimbursed from the HRA, this is the first time I am hearing this and it basically changes everything. Seems to me that OPERS are trying every way possible to keep retirees from getting reimbursed their funds and are either changing the rules or adjusted them on the fly. How many employees pay post tax premiums? If you are going to apply something apply it fairly and across the board.

    • Lawrence,

      That question and answer refers only to the specific case in which the OPERS retiree is using his or her spouse’s medical coverage.

      • This would only effect you if you were receiving benefits from another employer correct? If you are purchasing insurance on the open market it would not be effected by tax correct?

  • My husband has been retired since 2001. After we turned 65 he has a secondary which is Humana and mine is First Health both through you. Are we now going to lose this coverage and have to find something on our own ?

    • Barbara, members and their dependents can continue to utilize Via Benefits in 2022. Any changes to your current plans will be available during open enrollment. Thank you, OPERS

  • Having read many of the customer reviews of these available marketplace companies (for the pre-65 people) 95+% of them have 1 star reviews, do not have up to date provider lists & usually require spending 8 grand before a dollar is offered by the ins. How can we even chose from these few worst of the worst companies when we cannot rely on the providers list? If we have to travel hours to get to a provider & they refuse a benefit after you go because they are no longer in the system, what do we do then? Reviews indicate they will tie you up for months refusing to respond or denying any accountability. Look at BestCompany reviews for Molina, Ambetter, Buckeye Health, etc.

  • I am currently an opers retiree, if I take a job in the private sector and take there benefit package, then something happens and i leave that job sometime next year will I still get my HRA account package? My point is if I take benefits from a private sector job and then leave that job, does it bump me out in any way of the HRA availability?

    • Tracy, A Pre-Medicare retiree from OPERS can be enrolled in a medical plan through their own employer or a spouse’s employer and submit premiums for that plan for reimbursement from their HRA as long as those premiums were paid post- tax. The employer can be either public or private. A pre-Medicare retiree who does not Opt-In during the initial enrollment period will not be able to Opt-In until the next Open Enrollment period unless they had a premium tax credit and then lost eligibility for that tax credit during the year. Thank you, OPERS

  • My husband and I receive Medical Mutual through Via Benefits; our first insurer is Medicare. Does the new arrangement mean that we will not longer be eligible for this secondary insurance?

    • Ellen,
      In 2022 the Medicare recipients will continue to use Via Benefits to enroll into a medical plan. You will need to contact Via Benefits during open enrollment to go over the plans for 2022 and determine if you would like to make changes.
      Thanks MS

    • Tammy,

      You will receive a Welcome Letter in late August. It will invite you to reach out to Via Benefits, schedule an appointment and create an online account where you can explore plan options. Enrollment appointments will occur Nov. 1–Dec. 15.

  • I am a 30-year retiree living in Florida. Because I spend part of the year in Ohio I have the only plan that was available to me as a Florida resident in order to have out of state (Florida) coverage.
    I have a Medicare supplement plan through United Healthcare which I obtain through the OPERS Medicare Connector.
    Is this considered the Medicare secondary plan that will no longer be offered?

    Susan

    • M Susan Lanning
      Please reach out to Via Benefits at 1-844-287-9945 to get additional information about the plan you are enrolled into.
      Thanks
      MS

  • i retired in 12-1-2014 i am under i am 56 years old i retired as opers i was in law enforcement with 30 years credit or 30.5 years credit. A. when do i sign up for my STIPEND VIA and where do i sign up B. How much will i receive C. What is current Status on my health care. D. Do i also have to find Vision and Dental Insurance. E. Do i have to find my own healthcare/insurance or is there a plan beingoffered .
    I have heard so much different information since it was announced we out losing our healthcare as it ischanging. Thank you brad baty

    • Bradley,
      The pre-Medicare recipients will opt into their HRA during open enrollment this fall. The open enrollment mailings will go out in September 2021. Please contact OPERS member service center through the online account message center or by calling 1-800-222-7377.
      Thanks, MS

    • Diana,
      Medicare recipients that are eligible for the HRA will continue to be eligible to be reimbursed for health care qualifying expenses from the HRA.
      Thanks, MS

  • Will the Pre-Medicare members be able to choose a provider from Health Care.gov or will we have to choose from the Via Benefit providers.

    • Lisa,
      The pre-Medicare Connector administered by Via Benefits will be able to assist in finding and enrolling in plans on their private exchange as well as all plans found on the public exchange (a.k.a. Healthcare.gov).
      Thanks MS

  • Where is a complete, understandable explanation of health care benefits for future retirees? I’m 64 and will be getting Medicare next year (not looking forward to that as I will have to pay extra for an “advantage” plan to get what I want and need).
    I had originally planned to retire from my OPERS job at 30 years of service when I will be 71 years old. I am also looking at the difference at 25 years. I also will receive some SS payments at 66.5 years old which coincides with the 25 years of service. Since I started working for an OPERS covered job, I had operated under the assumption that it would provide some health care coverage IN ADDITION to Medicare. Now it looks like this is no longer the case. I didn’t get much information from this article that explains what I can plan on or what it means for me. What’s an HRA anyway? How does it benefit me?

    • William,
      Please send your question through the online account message center so we can review you account.
      Thanks, MS

  • I am a 30 year pre-Medicare retiree and currently work part time, 20 hours per week for the city where I live in Ohio. I am not offered health care and it is not offered to other part time employees. Can you confirm that I will not be able to access my HRA for health care reimbursement? If correct this is a harsh penalty for working part time and I will be forced to quit.

    • Todd,
      In 2022 retirees that are re-employed in an OPERS position will have the option to have an accumulated HRA while re-employed and once re-employment ends the funds would be deposited into the HRA with Via Benefits. The recipient would not be able to be reimbursed for expenses that happened during the re-employment period.
      Thanks, MS

  • I have the opportunity to go on my husband’s health insurance. He will be retiring in 2 years. During this time, I understand I’ll still receive my monthly HRA? When he does retire, we will be looking for new health coverage. Can I check with via benefits then for a health plan?

    • Linda,
      Please send your account specific questions through the online account message center there we will be able to review your account and provide an account specific answer.
      Thanks, MS

    • Kurt,
      Funds in the Pre-Medicare HRA may be used to reimburse for any pot-tax eligible expenses for the recipient and eligible dependents.
      Thanks, MS

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