Answers to 2022 health care questions

This month: Learn about the OPERS Medicare Connector

By Michael Pramik, Ohio Public Employees Retirement System

Sept. 22, 2021 – As we draw nearer to 2022, and the changes that will affect OPERS health care 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 the OPERS Medicare Connector.

Q: What is changing for participants in the OPERS Medicare Connector in 2022?

A: Medicare-eligible retirees will continue to use Via Benefits, as they have since 2016. There are a few notable changes occurring for OPERS Medicare retirees, effective Jan. 1, 2022.

The base HRA allowance amount is changing from $450 to $350 per month. Monthly HRA deposit amounts will range from 51 percent ($178.50) to 90 percent ($315) of the base allowance amount.

In addition to a change in the base allowance amount, retirees could see a change in their allowance percentage effective Jan. 1, 2022.

If you had less than 20 years of qualified health care service credit at retirement you will have your allowance percentage reduced from the current percentage to 51 percent. If you had 20 or more years of qualified health care service credit at retirement your allowance percentage could change. If, based on your years of service credit and age at retirement, your allowance percentage is 75 percent or less but you were grandfathered at a higher percent in 2015, your allowance percentage will be reduced to your actual position on the allowance table (between 51 percent and 74 percent).

The monthly HRA administration fee will increase from $2.33 to $2.60.  The $2.60 monthly HRA administration fee will remain the same from 2022 through 2025. 

Q: Why did OPERS decide to lower the base allowance amount for Medicare retirees from $450 to $350 per month?

A: Offering health care coverage has become increasingly expensive as health care rates have risen dramatically and member demographics have shifted. To preserve the OPERS Health Care Fund for current and future retirees, OPERS took a careful look at all aspects of the health care program to identify impactful changes. Keep in mind that the HRA allowance was never intended to cover the full amount of costs that a Medicare retiree may incur.

On an annual basis, OPERS staff reviews HRA utilization with the Board of Trustees. When considering the value of the Medicare base allowance amount, OPERS staff and the Board discuss the average HRA balance and how much Medicare plans cost. On average, a Medicare retiree carries a balance in their HRA from year to year.

Even though the base allowance amount has been lowered, Medicare retirees should still have sufficient funds within their HRA to cover their supplemental Medicare plan premiums and some will have additional funds for other qualified medical expenses.

Q: Will Medicare retirees still be required to enroll in a medical plan through the OPERS Medicare Connector to receive HRA deposits?

A: Yes. Medicare-eligible retirees will continue to participate in a closed HRA. This means they must remain enrolled in a medical plan through Via Benefits to continue receiving monthly HRA deposits.

Q: Will OPERS continue to reimburse Medicare Part A premiums?

A: Yes. OPERS will reimburse retirees who don’t qualify for premium-free Medicare Part A for their premium and any penalty at 100 percent. Eligible spouses will continue to receive a 50 percent reimbursement.

For more information on this transition, visit the Health Care 2022 page at opers.org. Also, plan to attend a 2022 Open Enrollment webinar. OPERS will offer a webinar for both Pre-Medicare retirees and Medicare retirees this fall. 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

  • Is there anything I need to do to keep my same health plans in 2022? I would rather not change anything.
    Thank you.

    • Judith,
      If you are enrolled into a Medicare plan through the OPERS Medicare Connector we recommend for you to review your plan information that will be provided from your current plan administrator during open enrollment and if you need to make any changes please reach out to Via Benefits for further assistance.
      Thanks,
      Megan

  • I currently only have health insurance through my employer. I am re-employed retiree. What is the benefit to adding a Medicare connector through VIA? If I don’t start taking the HRA deposits will I lose the opportunity to do so? If I add a connector will it affect my ability to be covered by my employer?

    • Nancy,
      Please forward your questions through your online account message center or contact our member service center at 1-800-222-7377.
      Thanks, MS

  • Michael-
    Thank you, first of all, for the work you do on our behalf . . it is very much appreciated.

    I wanted to bring your attention to a situation regarding ViaBenefits as it compares to Medicare.gov. I have been researching available Part D drug plans for my wife, and have run into the same problem with ViaBenefits that I had last year.

    ViaBenefits lists 17 available Part D drug plans that we can choose from, while Medicare.gov shows 23 plans available. These are all my zip code, by the way, and none have been discontinued. When I went through this same situation last year, ViaBenefits DID sign her up for the plan we wanted to use even though it was not shown on their platform, but my point is that I wouldn’t have even known that the plan we preferred was available if I had not looked on the Medicare.gov. site.

    I never received a satisfactory answer from OPERS or ViaBenefits as to why they are not offering ALL the available plans, but I think it is imperative that retirees know that they should shop for Part D drug plans on Medicare.gov as well as ViaBenefits. They might find a plan that saves them hundreds of dollars a year that never showed up on the ViaBenefits site.

    Again, thanks for this blog site and your attention to our concerns.

    • Thanks for your excellent advice. I skip Via benefits for my part D benefits. If you have a Medicare.gov account I find that the shopping is easy and accurate. Because I use online claims, I do not see any advantage to using Via Benefits for part D sign up.

  • If I am not making any changes to my dental and vision, do I need to take any action? The form provided in the mailer says to complete “if you wish to enroll, make changes, or cancel to complete this form”. Does this mean if you are enrolling for the first time? Or do I have to enroll every year?
    It does not state that if you are already enrolled and do not wish to make changes, that no action is necessary. Please clarify, thank you!

    • Andrea,
      If you are currently enrolled in an OPERS vision and/or dental plan, you will receive your Open Enrollment information directly from OPERS. Your enrollment will continue unless you choose to cancel coverage during the Open Enrollment Period.
      Thanks,
      MS

  • I Live in the Akron area. Saw a list of places I could go in personally to discuss my choice for 2022. I prefer talking to someone in person. Not sure where I saw the list of places. I believe one was in Bath, etc.

  • I am confused by Mr Bells comment that he purchases Medicare Part D drug plan coverage from other providers not offered by VIA Benefits. I thought OPERS Retirees have to purchase from VIA Benefits to get their reimbursement or is he speaking about a spouse?

  • After calling via benefits four times and being disconnected I finally got to speak to someone to make an appt. for a call to enroll in the HRA. I explained to her I was not signing up for insurance since I am still employed part time in an OPERS position. She told me I would have to call back and ask to be transferred to someone who could do that. (apparently she could not or did not want to make the transfer). I called back, waited on hold fifteen minutes only to be disconnected again when the line rang on the other end. Do not expect much from Via Benefits.

  • I followed your instructions and scheduled an appointment with VIA Benefits for 5 today. It is now 6:30 and still on hold. I called on another phone and was told this was the third complaint they had today about the wait. Question: Given the costs to each member and OPERS why shouldn’t the service be top notch? Why isn’t there are option for them to call the member back rather than sitting on hold? If OPERS experienced this level of customer service from their vendors would they continue to use them? As a member I’m in a no win situation. Have to use them to change carriers, but can’t connect. Very sad!!

    • Bill,

      We apologize for the frustration retirees have experienced, and Via Benefits has had some technical issues with its virtual hold functionality. Watch for updates via email from OPERS. We are currently working very closely with Via Benefits and are committed to keeping you informed and providing the necessary assistance in the coming days and weeks.

  • Can someone please define ”OPERS covered position”? I am a pre 65 retiree and work PRN as needed for previous employer and not offered any health benefits. Can I continue this or must I stop after on Jan 1? Also, good luck folks in getting any assistance from VIA Benefits. There are no open slots left for a phone call appt all the way through Dec 7th. Rep said to call in and expect to sit on hold for 4 hrs.

  • Wondering if anyone has had the same experience trying to switch Part D? Received a letter from Cigna saying that they are replacing Express Scripts. If I do nothing to change plans the new premium will be $53.00, nearly $30 more than current Express Script. To change, I was directed to Via Benefits. When comparing plans on the Medicare Website, Cigna offered a low and middle of the road plan in addition to the $53.00 plan. The middle of the road was very similar in cost and coverage to my current plan. When reviewing this with the Via Benefit agent I was told Via Benefits doesn’t offer everything that is on the Medicare Website and I could take the more expensive plan or the low option, but not the middle plan.
    Basically, again we are held hostage to a more costly or less beneficial plan without other options than changing carriers and moving prescriptions to the new plan.
    Again, I feel compelled to ask as a member is this great customer service??

  • Why are the local hospitals in Columbus like Ohio Health, Ohio State and Mount Carmel not in network with almost all of the plans listed in Via Benefits for pre-medicare retirees?

    • Valerie,
      Via Benefits does not determine the contract between a carrier and a provider. A contract to become an in-network provider is determined between the provider and the insurance carrier. Remember that with an open HRA model, you may enroll in any health care plan through any method. This means you may choose to enroll through the OPERS Pre-Medicare Connector, Healthcare.gov, through an insurance broker, or even directly with an insurance company.
      Thanks, MS

  • Do pre medicare individuals need to disclose that they are opting out of opers HRA on the ACA application.
    My concern is will be penalized if I disclose this information. If that’s the case wouldn’t it be better if OPERS offered no HRA?? I tried calling via benefits help line, to no avail.

    • Tony,
      We apologize for the frustration retirees have experienced. Please know both OPERS and Via Benefits are working together to remedy this situation as efficiently as possible. Please reach out to Via Benefits with questions about completing the ACA application. As retirees are served and Via Benefits builds efficiencies into their process, we anticipate on-hold times improving and appointments running closer to their scheduled times. In particular, if you don’t already have a scheduled appointment, please consider waiting until the end of November or into December to call Via Benefits, as hold times are expected to decrease by that time.
      Thanks, MS

  • I talked with ViaBenefits yesterday because I was looking for pricing of Medicare Plan G from Medical Mutual. I currently have Plan F from Medical Mutual. They informed me that they do not have a contract with Medical Mutual and if I wanted to change to Plan G with them I would have to go through Medical Mutual. That would in turn cause me to lose my reimbursement from OPERS. Medical Mutual is an OHIO company and as such it should be an option. I like to keep my money as close to my community as possible. OPERS should pressure ViaBenefits to contract with Medical Mutual and keep as much money as possible in Ohio.

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