Open enrollment draws near
Packets will begin mailing in late September for 2021 health care coverage
By Michael Pramik, Ohio Public Employees Retirement System
Sept. 15, 2020 – Open enrollment time is almost upon us for participants in 2021 health care coverage through OPERS.
This year’s open enrollment season will run from Oct. 15-Dec. 7. The changes will take effect on Jan. 1. Packets of information explaining coverage options and other details will begin arriving in late September.
As open enrollment nears, we encourage participants to think about your health care needs and to be prepared to make choices best for you and your family. A few items to be aware of:
Pre-Medicare
Next year will be the final year for the OPERS pre-Medicare group plan. In 2022, OPERS will switch to a Health Reimbursement Arrangement model, in which participants will receive a monthly allowance that can be used for reimbursement of plan premiums and other qualified medical expenses. Beginning early next year, watch for information on the transition process.
Meanwhile, if you’re not yet eligible for Medicare next year, you may be eligible to enroll in the OPERS Retiree Health Plan, administered by Medical Mutual. It’s a network/PPO plan.
If you’re not yet eligible for Medicare and are re-employed, consider the Pre-Medicare Re-Employed Plan, also administered by Medical Mutual.
Premiums will not increase for 2021, so the monthly cost for participants in the pre-Medicare group plan will remain the same as this year. Premiums for OPERS dental and vision care will be slightly reduced in 2021.
There will be some plan changes:
- The prescription drug out-of-pocket maximum is increasing by $400, from $2,400 to $2,800. The increase aligns us with the Affordable Care Act guideline for overall maximum allowable out-of-pocket expenses, which is $8,550 for 2021.
- The medical out-of-pocket maximum is staying the same as in 2020.
- There will be additional preventive drugs covered at 100 percent. They include medications used to prevent breast cancer and HIV in high-risk patients.
- The three-day hospital stay requirement before being admitted to a skilled nursing facility is being removed.
If you’re making no changes, your coverage will automatically continue in 2021, and you need take no action during the open enrollment period.
If you’re enrolling, making changes or canceling coverage, you must complete and return your open enrollment form or contact OPERS between Oct. 15 and Dec. 7. You can cancel medical coverage or adjust dental and/or vision coverage by calling us at 800-222-7377.
OPERS Medicare Connector
The HRA base monthly allowance will remain at $450 for 2021. Your monthly allowance amount, which is a percentage of the base amount, will remain unchanged.
Review your current medical and prescription drug plan. Look for changes in premiums, plan design and prescription drug formulary. If your health conditions, medication or medical providers have changed in the last year, consider if your current plan will meet your needs next year.
OPERS will continue to offer vision and dental coverage. Refer to the open enrollment packet for more information.
In 2021, premiums for the OPERS vision and dental plans will be automatically reimbursed monthly from your HRA with no additional forms to complete or receipts to provide. This is a convenience that retirees have requested. However, if you do not wish to have these premiums automatically reimbursed monthly from your HRA, you can opt-out by using the form within your open enrollment packet.
Also, If you currently receive automatic reimbursement for your individual Medicare plan through Via Benefits and do not change plans for 2021, automatic reimbursement will continue. If you change medical plan carriers, automatic reimbursement will not carry over to a different plan. Talk with Via Benefits about whether automatic reimbursement is an option for the new plan that you are considering.
Recurring premium claim forms for Medicare Part B premiums must still be resubmitted each year.
If you’re making no changes, your coverage will automatically continue in 2021 and you need take no action during the open enrollment period.
If you are enrolling, making changes or canceling coverage, contact Via Benefits between Oct. 15 and Dec. 7.
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.
I am thankful that the premiums for pre-Medicare retirees are not increasing!
As a beneficiary of a retired deceased spouse, are there any changes regarding dental and visions benefits? Thank you,
Judith,
There are no plan design changes for either the dental or vision programs next year.
I understand the challenges of trying to maintain a pension plan while still trying to balance some type of healthcare for the participants. What I never understood is how you can reimburse or provide a monthly supplement for those needing the OPERS health plan but for those who have selected to be a participant on their spouses insurance (not OPERS) there is no consideration for some type of payment. Did you not consider that the reason to not select your plan may have been based on how the benefit may compliment their personal needs but their still may be costs associated to get that plan? Why do you not provide some type of financial benefit to the pre-Medicare participants who have selected a plan outside of your offering.
Pam,
OPERS doesn’t currently have the ability to offer financial support the way you suggested. But as part of the recent health care changes that will be effective in 2022, pre-Medicare retirees may be able to seek reimbursement for premiums from other plans in the manner you’re requesting. For more information, see the Health Care 2022 section of the OPERS website.
I retired at age 51 with 30 years of service. I am now 72. This should put me in the “65 and over” column of the “Health Care Allowance Percentage” table. Correct?
To determine your allowance percentage using the allowance table provided on our website you would use your age when you first enrolled in the OPERS Health Care Program and your qualifying years of service at retirement (Partial years are not rounded up to the next year.) Please forward additional account specific questions through your online account message center or contact us at 800-222-7377.
I agree with you Mr. Beck
Have not received open enrollment paperwork yet. Any idea when it will arrive? I just read that it should be arriving in late September.
The open enrollment packets are available through the members online account under the Document History tab, or if the packet is not received by 10/21/2020 you can request a duplicate be mailed by contacting us through the online account message center or by calling 800-222-7377.
How can I find out which insurance is accepted by OSU
If you have questions about your coverage through OPERS please send your question through your online account message center or contact us by phone at 800-222-7377.
Medical mutual is dropping OSU ?
Medical Mutual has assured us that the SuperMed Network, which our pre-Medicare group plan uses, will continue to be covered next year. We did confirm that OSU will be excluded from Medical Mutual’s Medicare Advantage network effective Jan. 1. For further information, contact Via Benefits at 844-287-9945.
Clarification please – for 2022 and the reimbursement it talks about being currently enrolled and also currently eligible. If I am currently eligible being in Group A, but I am not currently enrolled (I was enrolled in 2019) and not planning to enroll in health care thru opers in 2021 am I still eligible for the reimbursement. I am currently covered in private sector health care which is why I’m not enrolled in OPERS health care. Do I need to enroll for 2021 to get the HRA in 2022? or will I be eligible if do not re-enroll
Please forward your inquiry through our online message center, there we will be able to review your account specific information and respond to your question. If you do not already have an online account, you may register from the upper right-hand corner of OPERS website. Once you have logged in, click on my account tab, select message center from the drop-down menu, then click add new at the bottom of the page to submit your question or you can contact OPERS at 1-800-222-7377. Thanks MS
I can’t seem to find out how to do that using my phone. I can log in but I see no way of contacting thru that manner. Do I have to use a computer
Once you are logged into the online account go to the My Account tab then select Message Center from the drop-down. If you are not able to access it through your phone try and login through a computer or contact us at 800-222-7377. Thanks MS
Do you still offer the service of help to find the best health insurance for me?
We offer the Medicare Connector that is administrated by Via Benefits for Medicare recipients. Via Benefits phone number is 844-287-9945. Thanks MS
I’m 58, how old to be eligible
Curtis,
Here’s a link to a pension and health care eligibility chart that’s on our website.
I think folks should know that when researching Part D Prescription Drug Plans on the Via Benefits site, not all the available plans are shown. When I checked Medicare.gov for available Ohio plans for PDP, they showed 30 plans available for me, however, Via Benefits shows only 21 available. I contacted Via Benefits about this and was told that not all the plans available to us are listed on their site. This is especially troubling because, in my case, the Anthem plan I wanted with the lowest total cost was not listed as an option by Via Benefits. If I had not checked the Medicare.gov site, I would have had to choose a plan that would have cost me hundreds of dollars more.
Via Benefits did confirm that I can choose the plan I found on Medicare.gov even though it is not listed on their platform, and that I will still receive my HRA monthly stipend.
The bottom line here is to do your plan research on Medicare.gov first before your call to Via Benefits. I don’t want to imply that Via Benefits is doing something underhanded, but I feel this practice is certainly not in the best interests of OPERS retirees.
I cancelled my health plans for 2020, and I’m going back to the open enrollment for coverage for 2021. Am I allowed to just request coverage or something else is required to be enrolled
Curtis,
You’ll have to provide proof of creditable coverage in another health care plan and documentation from your plan administrator or employer confirming your cancellation. Here’s information from our website on health care enrollment. If you have further questions, contact us at 800-222-7377.