OPERS offers aid in choosing pharmacy plans
Medical care is just one part of the equation that OPERS Medicare Connector participants need to think about for 2016. Prescription drug plans also are in play, and we have suggestions that might help.
A new, two-page flier offers tips to help you reduce drug costs if you’re using the Connector for your coverage next year. We recommend carefully reviewing your drug choices with the OneExchange licensed benefit advisor during your enrollment call.
Here are a few suggestions for keeping pharmacy costs as low as you can:
- Know your options: Prescription drugs are commonly categorized into buckets or tiers. These tiers start with less expensive to more expensive generic options and then move into preferred and non-preferred brand name drugs before topping out with the more costly specialty medications.
- Start saving for higher out-of-pocket expenses: Beginning next year, OPERS Medicare participants taking specialty drugs covered under Medicare Part D may experience higher monthly out-of-pocket expenses during the year. The out-of-pocket costs will drop significantly in subsequent months if you reach the annual maximum.
- Consider different medication: Switch from a specialty medication to a traditional drug, or switch to a lower-cost specialty drug.
For more information, refer to www.medicare.oneexchange.com/opers, or call 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.
Is it just me or is everyone else (OPERS member-wise) feeling overwhelmed by the amount of printed materials, reminders and other items being sent related to our health care? I barely have time to read, research and understand one thing before tackling the next batch which often says the same thing in previous mailings. Being informed is nice, and necessary, but all of this is overwhelming considering the sheer volume.
I absolutely agree with you, Kay. In addition, I have called and talked several times with “benefit advisers” at One Exchange. They are inadequately trained. Do not know the answers to questions. My husband and I know more about Medicare and medical insurance than some of the “advisers” do. I feel sorry for other retirees who may not have as much understanding. They are going to choose something essentially just to have “something”.
At least one of the screening questions asked on the One Exchange site prior to gaining entry to medical plans is confusing or perhaps poorly worded.
Ben is right, this is not going to be cheaper than our prior plans through OPERS, absolutely not.
My father and I will be signing up for my mother, who is in assisted living and memory care. We are overwhelmed by the entire process. Our call is scheduled for Wednesday. If we choose the wrong coverage, we fear losing everything we have, between her current needs, her future needs for skilled nursing, and what will be covered by the new insurance plan.
I have very little faith that someone in a cubicle somewhere understands what we need. If they can do it in a phone call, why have we been buried in brochures and booklets and connector kits enough to fill a rainforest!? After 5 hospitalizations and two rehab facilities, we moved my mother back to Ohio from FL and haven’t had much time to consult with anyone who knows about this. I have watched the videos online, because we missed the deadlines for, well for everything in person. I can’t plan my days as it is, between caring for both of them and arranging for their care. Did I mention I’m disabled?
This is the most frightening experience I’ve faced regarding my mother’s care. We always knew where we stood with Humana and what to expect under different scenarios, such as out of network costs. After reading the blogs and comments, I feel in my gut that there is nothing good about this entire process. It’s just going to cost us more money that we don’t have. After another day of useless research on the one exchange website and another call to an ‘expert’ who read her responses off a printed card in her cubicle, I’m hopped up on caffeine and ready to punch something!
JR,
We’re sorry you’re experiencing all this angst. We realize that for some choosing a plan can be challenging because of the many choices. Realize that you have until the end of December to choose a plan. That means you can change the first choice that you make.
OPERS created a wide-ranging communication strategy (all the brochures you’ve received) because some people respond better to information presented that way. We want to make sure that all participants are happy with the choices that they make.
The details of the plan you choose should be communicated clearly, just like the Humana plan was. Please let us know if we can help after you select a plan. You can call us at 800-222-737, or continue to reach out to OneExchange after you select a plan.
–Ohio PERS
I thought we had to choose a plan by Dec 7 and that if we wanted to change after that, we had til Dec 31???????
Polly,
That’s only if you are not currently enrolled in our coverage.
–Ohio PERS
You might want to call OSHIIP-the Ohio Senior Health Insurance Information Program @ 1-800-686-1578 for help. You want to talk to one of the reps, not the customer service person who may answer the phone. They’ve been helpful to me and others who are going through this process. I was told that one person called who had been guided to a prescription plan by a One Exchange advisor that didn’t cover ANY of her medications. Many OE advisors are good, my later ones were fine, but some are not as knowledgeable. OSHIIP can help you!
Day late dealt with connector yesterday. Not as easy as described. Felt rushed. Very few answers.
I have had a horrible experience with the connector . I have called opers to return my call
I am having a problem of trying to find a prescription plan that I can afford for my wife. She is on fifteen medicines due to her copd and glucose. All the prescription plans want $11,000 out of pocket to cover her medication. We can not afford it and right now I don’t know what we will do in January.
I am told you CAN go outside the exchange to get an Rx plan. Best option is Medicare.gov
compare plans and enroll in the one that covers your meds at lowest cost. Really helps if you have a trusted agent – it doesn’t cost anything more.
Contact the insurance company directly for drug pricing prior to signup. Medicare.gov and OneExchange information is not consistently accurate.
I agree. My wife is on a tier 5 specialty drug and we’ll be in and out of the coverage gap in 1 month. I was told by the agents at OneExchange that we can obtain a Prescription Drug Plan on our own (at Medicare.gov, for example) and we will still receive our full HRA allowance. Check into that.
All this was to be cheaper and better according to OPERS I think not. You can thank Obama and the democrats for the unaffordable act that’s creating this mess.
My experience with the connector has been terrible. My scheduled apt on Oct 6th was a disaster. Woman I spoke to did not know the information . I needed to make a selection. She acknowledged that the info was confusing not only to me but she said she was confused also I did not need to hear that I ended my call to her not having selected a policy. Called the next day and I thought selected a policy. Three weeks later I rec’d a message from the connector stating that I needed to re do my application. When I asked whyI did not get an answer Finally after insisting that I wanted an answer and after talking to 4 people I was told that the person I spoke to on Oct 7 was not licensed to sell ins in Ohio. Really Why did this happen This process is confusing enough for us and then we get to talk with people who it appears do not know what they are doing. Very disappointed in what OPERS said would be relatively easy It has been any thing but that. Betty O grady
I agree it was a terrible experience hope I am registered don’t know no one from opers will call me or answer my emails very upset
to me it is a case of people sitting behind a desk who has paid medical. they do not know the older you get the more meds cost I would not recommend any one to start out working under OPERS. I think this is wrong they take away PART B Reimbursement. from some and pay for part A for others. almost all drugs are at least tier 2. they tell you. you can buy good coverage for $30.00 you can but you still have a high cost on your meds.
cg,
OPERS is required by Ohio law to provide Medicare Part A equivalent coverage to about 6,500 of our members who did not qualify for premium-free Medicare Part A coverage during their working careers.
–Ohio PERS
It makes no sense to pay for Part A for those who never contributed to Medicare and then penalize those who worked under Social Security and PERS with an offset in their benefits.
Suzy,
We are required by Ohio law to provide health care coverage to those public employees in our system who did not qualify for premium-free Medicare Part A coverage during their working careers.
–Ohio PERS
DO we still have dental and vision and how much will it be
Kay,
Yes, that’s still an option. That information is in the open enrollment kit for 2016.
–Oho PERS
What do I pay for it if I keep the same plans I have do they still take it out of my retirement ? Also I just got my prescription plan from silver script the information your connector plan gave me was totally opposite of what they said I am very confused I sure hope I picked the right plan also I would like a call to be sure I puckednthe correct plan because the connector to.d me my prescriptions would be 3 dollars it is not true according to the plan I just spoke to them . Please have someone that knows the correct answer call me thanks what an ordeal this has been not a good one either
Kay,
Here is a link to details about our dental and vision coverage for 2016.
–Ohio PERS
The vision coverage is only worthwhile if you need prescription glasses. We dropped it, but we kept the dental coverage. Retirees were to notify OPERS on whether or not we wished to keep the same vision and dental coverage by October 31. I ended up emailing OPERS because I could not get through to OPERS by telephone. I am sorry for those retirees who do not have email access.
Betty, I also had my sign-up call on Oct 6. I did not have problems with the agents ( I talked with 4) but with the phone service! We even had our phone lines checked as we thught it was on our end. The first agent called me back while I was talking to #4 and finishing the enrollment and told my husband that they were having phone line problems. I later found out that the agents would not realize the problem until someone let them know about it. Sorry you had a bad time. Liz
My wife and I completed our 2 1/2 hour enrollment call with OneExchange on Oct. 21. I would rate the experience as just OK. I began looking at options on their site as soon as prices were available in the 1st week of October. We had no problems reviewing the Medigap plans available, but the Part D Prescription site was a challenge. The OneExchange site notated some of our prescriptions as “unavailable” or “not covered” (even though the “not covered” drugs were inexpensive generics) so it was not possible to compare plans, and the information about gap coverage was from 2013. So I called OneExchange 4 different times to answer questions I had and even called the Providers I was interested in. Their advice was to go to Medicare.gov to look at the plan information on that site. There I found all the same plans as listed on OneExchange with all the prescriptions prices I needed and up to date information on the coverage gap.
My Part D plan will cost me $18.40/month, and all my tier 1 and tier 2 drugs will cost me nothing ($0) for the entire year. I think that’s a pretty good deal. My wife’s plan, on the other hand, because she is on a tier 5 specialty drug, will cost us over $5000/yr., including her premium. So, between premiums for the Medigap plans and Part D plans, as well as our anticipated drug costs, our expenses will be about $9000/yr. We’ll be receiving about $8000 in our HRA for 2016, so we’ll need to budget another $1000 out for the difference. All in all, having to spend $1000 a year to cover all our health care needs is more than reasonable. The next few years, as the HRA gets reduced, will be much less manageable. Let’s hope somebody does something about the skyrocketing cost of medical care in this country before we’re all forced to decide between eating or seeing a doctor.
Why did you not set this up as a Retirement Medical Account instead of an account that only I qualify. It would be nice to be able to use those funds for my spouse (under 65) to offset some of her medical cost.
Paul,
The Health Reimbursement Arrangement allows us to provide a tax-free allowance to participants. That’s a major reason that we chose this method.
–Ohio PERS
My husband takes Atorvastatin (Lipitor). While searching on One Exchange for a prescription drug plan they all tell us they do not cover this drug. However, when searching Medicare they give me the names of 23 Medicare Part D plans in Ohio that cover Lipitor. We have our One Exchange call coming up next week and we are very confused at this point. Is this a common problem with the plans we find on One Exchange?
Ruth,
The plans that OneExchange offers vary by region. OneExchange has criteria that the plans must meet. For instance, they must be able to process payments electronically. For more information, talk to your licensed benefit advisor.
–Ohio PERS
If OPERS retirees are pursuing a Medigap program, it is important to know that there is one available through AARP. It isn’t listed as one of the available programs on the One Exchange site. However, one of the benefit advisers I spoke with told me about the AARP program through United Healthcare. We are not members of AARP, we dropped it because we did not agree with the politics of the organization. However, I will join if this is the best and cheapest way for us to have the coverage we want.
I was absolutely stunned to learn that, while this offer is not on the One Exchange site, it is available to OPERS retirees. How does OPERS justify this option when they cannot list it as an option on One Exchange?
Madeline,
We do not list options with OneExchange. OneExchange is responsible for the coverage options that they list. Please contact OneExchange at 844-287-9945.
–Ohio PERS
I just got off of the phone with the one exchange I had questions about my insurance H R A I am so totally confused and no one will call he from opers I am so upset
Kay,
We are taking nearly 15,000 calls a week now that the Connector plan selection has begun. We thank you for your patience in receiving a return call.
–Ohio PERS
Is Poof of Credible Coverage required when we sign up for medical and prescription drug coverage via OneExchange?
Braid,
No. We are ending our current plan, so for your initial sign up that’s not necessary.
–Ohio PERS
I too have had extremely trying times with One Exchange. I have questions which I need answered in order to make as intelligent choice of plan. It seems the advisors just want to sign you up. I have tried to research information on the computer but if you don’t understand it is hard to get much out of it. I am frightened about what the future holds insurance wise. I understand costs are higher for elderly people but these are some of the people who need assistance the most. Cost is a hugh factor due to perscriptions and out of pocket expenses medically. If you are extremely poor or wealthy you need not worry but woe to the average and elderly people. I also see the president is already talking about increases and we can’t afford what is being offered now.
I still don’t know witch Insurance Companies we have to choose under OPERS. Is there a list? I thought I just trust the counciler. But from what I read some of them are not vert knowlegible.
Hilda,
You can find which policies are available in your area when you go to the OneExchange OPERS portal. It helps if you create an online account.
–Ohio PERS
Beware there are no generic’s For Insulin that diabetic’s require. Thank You Obama
Do I need to call and let you know I want vision and dental
Kay,
Only if you don’t have it now. If you currently use our coverage and want to continue it in 2016, there is no need to contact us.
–Ohio PERS
I have been on hold so far for 30 minutes for my “appointment” at One Exchange. They are playing music so I guess I am still on hold. Even after that , they need to hook me up with someone licensed in my state. Looks like a very long disorganized process. Wow! this very minute the music got replaced by a busy signal so apparently disconnected. Now what do I do? Also I used my other phone and found out that their phones are not working. What a mess!!!! They seem poorly organized. Where is the “keep your place in line and we will call you back”? Then I tried to call OPERS. After pushing a bunch of buttons it would take two hours for them to talk to me! This whole thing looks like a big mess!!! They could have spent less money on “rah-rah” trainings and emails and given me a bigger healthcare budget. Or give me money to find my own advisor. Not happy. And we all know Towers Watson does not care. They just want to make money the cheapest way possible.
WHEN PERSONS ARE ADMINISTERED INFUSION DRUGS AND OPERS STATES THAT MEDICARE WILL PICK UP THE COST, WHAT HAPPENS TO THE 20% MEDICARE DOES NOT COVER. WILL OUR INSURANCE COMPANY THAT WE SELECT PICK UP THIS DIFFERENCE OR DOES IT COME OUT OF OUR POCKET?
Ruth,
We suggest you discuss this issue with a OneExchange benefit advisor. There may be different coverage for Part D and Part B.
–Ohio PERS
I read all the material, used the calendar, and watched all the videos provided by OPERS. I completed my profile and compared medigap plans on line prior to my appointment. The prescription plan comparisons were not available for review at the time of my appointment so I was depending on the advisor to make a recommendation.
One of the prescription drugs on my profile was prescription strength Vitamin D. My first advisor did not tell me that Vitamin D is not covered by any of the Medicare Prescription Drug Plans offered by OneExchange. The first advisor told me that one of my medications (I have only 3, one of which is not covered) was a Tier 3 on one plan and Tier 2 on another plan which greatly affected out of pocket expenses. When I talked to another advisor today to clarify some issues she told me that Vitamin D was not covered on any of the plans and the drug I was told previously was a Tier 2 drug for Humana was actually a Tier 3 thus activating the $360 deductible that is not applied to Tier 1 and Tier 2. She helped me select another plan she told me was not eligible for 90 day mail pharmacy that later turned out to be eligible for mail pharmacy for Tier 1 drugs only. She checked with her supervisor twice during our conversation. Both the supervisor and the advisor said the PDP were individual plans, and not group plans, explaining the discrepancy between the higher prices for drugs compared to drug prices with the Humana Medicare Advantage Plan. I am grateful for the allowance we are getting but had hoped there would be enough remaining to help pay for unexpected expenses. I am a little disappointed with the expertise provided by OneExchange.
I quit my re-employed job this month because of all the in and out rules of re-employment. My question relates to drug coverage. My dependent spouse chose a Medicare Advantage plan without drug coverage on the Connector site based on OPERS Nov 11, 2015 letter stating, “…you will be automatically enrolled in the self-insured prescription drug plan offered by OPERS effective January 1, 2016.” 1) Does this letter apply to all Medicare retirees or just to re-employed retirees? If it applies only to re-employed retirees, we will have to choose from Connector plans with Rx coverage. 2) If it applies to all Medicare retirees, will we be automatically enrolled when we choose a plan w/o Rx coverage on the Connector?
Tom,
This applies to re-employed retirees. If your spouse chooses to stay with her Medicare Advantage plan, she will need to purchase a Part D plan or select a Medicare Advantage plan which includes Rx coverage. She can be on the Humana Interim plan through OPERS, which includes Rx coverage as long as you are enrolled.
–Ohio PERS
Would like information on setting up second account for the NRA and how soon this needs to be done. I have not received my Getting Reimbursed Guide as yet. Thank you.
Judy,
OneExchange will send you an HRA packet after you have selected your coverage. It contains the Getting Reimbursed Guide. You can read it now online at the OneExchange/OPERS portal.
–Ohio PERS
–Ohio PERS
Why did you pay one exchange. I was to call at 2:00 o’ clock Nov. 19, I called and called they did not answer the telephone. I was trying the hard of hearing number. called other number, called and called finally some one answered. I could not hear everything. Thank goodness my daughter in law had come over to help me. I went with plan F. ALSO A DRUG PLAN, THROUGH HUMANA . then I received a e-mail saying I do not need more than one Medicare Supplement policy. Why would the person who suppose to have helped me not said anything. I’m keeping things the way the are. too much headache.
My experience is that it took three tries to get everything right-disconnected the first try (was on hold an hour), second try person steered me to wrong health plan and finally the third person was great, very knowledgeable. All told I spent about 4 hours.
Now I just need to figure out where in my budget that I can come up another $600 a month when I hit the donut hole in March.
Dear OPERS Members — Is anyone hearing or helping with your complaints/issues regarding OneExchange? Who, outside of OPERS, do we contact about how this is being handled? I have not yet retired, but I dread the day when I am faced with these issues.
Cheryl,
Thanks for your note. We are looking at every comment that comes to us, and we are working closely with OneExchange to provide the best service for members going forward.
–Ohio PERS
I am not feeling confident in One Exchange’s ability to help determine what is my best plan. They are under a lot of pressure to get all the people signed up. I have talked with several licensed benefit advisors and they had difficulty answering my questions. I have spent hours trying to research information and attending meetings to make the best decisions. A one on one meeting through opers should have been offered to individual since health care went from group to individual. Not a phone meeting. OPERS claimed a benefit of One Exchange was the knowledge of the many options they could offer the individual on health care instead of the opers group plan. I only received one option from One Exchange. I had to bring up the discussion of the donut hole or it never would have been discussed. The phone system does not work well for people with hearing loss.
I agree
My first call to the connector program, I dealt with a benefit advisor who talked like he was in a fog, and I reluctantly feel he may have been under the influence of something… My second call resulted in a little better response but did not resolve my questions and had to do my own homework before i made a choice.
I still have hesitations about the drug plan, and my change my benefit advisors choice.
I seriously doubt that we are dealing with “trained licensed advisors”.
Carolyn,
Ohio Revised Code Section 145.325 was enacted on Dec. 14, 1967, and required that OPERS provide equivalent Medicare Part A coverage to those members who did not qualify for Medicare.
Recently, our members who did not qualify on their own for premium-free Medicare Part A coverage asked us to consider allowing them to join the OPERS Medicare Connector. It made sense, financially, for us to do this. So Ohio law (ORC Section 145.584) was amended on March 23 to allow it to happen.
–Ohio PERS
I am looking for Information for 2017.I did not get any benefit from 2016 plan ,only high premiums and high deductibles witch I did not meet and can not afford.Can you give me a list of what is available for 1917?
Thank you for reaching out. CMS will release 2017 plan costs by CMS early October and can be accessed online at medicare.oneexchange.com/opers. You will want to call OneExchange to schedule an appointment to discuss available plan options and costs at 1-844-287-9945. You will receive your OPERS Open Enrollment materials early October which includes a personal allowance statement. This statement will show your monthly HRA amount which can be used towards reimbursement of premium costs such as medical, prescription drug, vision and dental, as well as Medicare Parts A and B. Other eligible expenses include qualified out-of pocket medical expenses as allowed by the IRS and medical deductibles. A list of full eligible expenses can be found at http://www.irs.gov, under publication 502.
If you have any questions about this account, OneExchange would be happy to assist you.
Thanks,
Ohio PERS