How ‘non-qualifiers’ can gain Connector coverage
The Ohio Public Employees Retirement System has released the latest health care chat with OPERS Health Care Director Marianne Steger.
This month Steger details how OPERS retirees who do not qualify for premium-free Medicare Part A coverage can secure coverage through the OPERS Medicare Connector. She also addresses member questions about our health care coverage with OPERS’ Michael Pramik.
You can click here to watch the video, which we’ve posted on our YouTube channel.
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 still completely confused. However, I did follow through with applying for Social Security for the medical side. I received a letter indicating they will be sending my Medicare Card, indicating my eligibility for the program.
Would a surviving spouse still qualify for the 50% Medicare Part A premium coverage after 2018? Would a surviving spouse get reimbursed for the 50% Part A premium after 2018?
Pat,
Yes, surviving spouses of non-qualifiers for Part A will continue to receive reimbursement for the Part A premium after 2018.
–Ohio PERS
I can hear the initial music, but not the individuals talking.
what to do?
Bob,
Turn up the volume? Sounds crazy, but we’ve never heard of anyone being able to hear only the intro music and nothing else! Also, that introductory music rolls for about 10 seconds, then the actual interview begins.
–Ohio PERS
It was mentioned in the video about people that are under 65 may also be on Medicare. It was stated that they would also be allowed to use the connecter. Will they only be allowed to pick a Medicare advantage plan? If so then when they turn 65 will they be given the opportunity to switch to a medigap plan under the 6 month rule and not be subject to underwriting
Janet,
We’ve shared information with OneExchange about individuals who are under 65 but eligible for Medicare. Your best source of information is to speak directly with OneExchange about your coverage options. We encourage you to schedule an appointment with OneExchange at medicare.oneexchange.com/opers.
Your 2016 open enrollment statement will tell you whether or not you are eligible for the Connector.
–Ohio PERS
My wife and I are both non-qualifiers. We have already scheduled our telephone call with OneExchange for October, 2015. However, it appears from this month’s video that we may be premature with that call. Should we cancel that call and reschedule for sometime between April and June, 2016?
James,
Yes, it would be helpful to follow the protocol as outlined in the video.
–Ohio PERS
I am single and one of the retirees who never paid into medicare. I went to an informational meeting yesterday evening in Findlay, OH and I did find it interesting but, of course, it wasn’t directed at my group! After the meeting I did ask the man there about the Part A requirement and was surprised that I had to write a check for that! I have been following the information and am aware that the law was changed to pay this part for us but I am still confused. Is this a one time payment I have to make or do I have to write the check every month? What is the cost of Part A? Are you providing informational meetings for the 5 or 6000 of us as you have with the rest of the retirees? I am very concerned about the financial end of this. Life happened backwards for me and I was given two young boys 14 years ago and I adopted them a few years later. Because my only income is my OPERS retirement, they qualify for Medicaid and reduced lunches at school. I still have to feed them and have all the increased cost that go with a family and I accepted that responsibility. One of my sons will graduate in 2016 but I’ll still have the other one. With only 1 son, he probably won’t qualify for medicaid and I’ll have to pay out of pocket to insure him. I know my situation is unique but I am very worried about it. Any increase in cost for anything in our household means something else has to be reduced or eliminated. I’m just very concerned.
Kathy,
We will reimburse you for your Medicare Part A premium, which you will have to pay monthly through the Social Security Administration. We are planning educational meetings for the first quarter of 2016. We recently sent a letter to this group to indicate how you would be affected. You’ll receive several more communications as we draw closer to your enrollment.
–Ohio PERS
The initial letter explaining all this arrived today. Thank you again OPERS. I am curious about one detail, though. Will the new HRA become effective for us in July, or may we use it for medical expenses retroactive to January 1st, 2016?
John,
The HRA will be available for the initial plan premiums only that you may pay prior to July 1 of next year. All other medical expenses must be incurred on or after that date to be eligible for reimbursement.
–Ohio PERS
Will we have to pay taxes on the part A reimbursement ?
No. That reimbursement is not taxable.
–Ohio PERS
You had mentioned about people under 65 whom are on Medicare can use the conecter. My question is will they only be able to pick an advantage plan? Also when they turn 65 will they be able to change to a medigap plan and have the 6 month grace and will not be subject to underwriting?
Janet,
Both Medicare Advantage plans and Medigap plans will be available. There might be scenarios in which participants will be subject to medical underwriting in the future. One could be switching from a Medicare Advantage to a Medigap plan. It’s important that you plan ahead and go over this scenario with the OneExchange licensed benefit advisor during your enrollment call if that’s something you might consider.
–Ohio PERS
The end of the video again mentioned anticipated plan changes in response to the Cadillac tax, implying you’ll be doing things to avoid paying it. Let’s say the current benefits are $2000 over the threshold for the tax, how is it better for the retiree to have the benefit reduced by $2000 (to avoid paying any tax) than reduce the benefit to $1425 over the threshold (net reduction $575) and paying $575 tax?
David,
Our goal is to avoid paying any kind of tax on the plans we offer.
–Ohio PERS
We have received the Open Enrollment Guide and my wife’s (age 62) monthly cost rose from $212.86 this year to $473.41 for 2016. How do we verify this is correct and how do we deal with this very large increase? Will TW help her find alternative coverage for 2016?
Bruce,
Allowances are transitioning to zero for all spouses starting in 2016 until they will have a zero allowance in 2018. The first year of the allowance reduction is in 2016 and this has resulted in the large premium increase that you have experienced. If by TW you mean Towers Watson, the Connector is only for those who are eligible for Medicare Parts A and B.
You might want to research options available at HealthCare.gov.
–Ohio PERS
I am not eligible for premium-free Medicare Part A. I am 70 years old with 35 quarters. I have not received any information explaining how I will be affected. I have managed to gather info from other sources on your website and I believe I understand it thoroughly but would like to have something in writing with my name on it. Thanks very much.
Cherri,
We will be conducting educational sessions during the first quarter of 2016 for those “non-qualifiers.” Plus, we are planning other communication directly to you and others who did not qualify for premium-free Medicare Part A coverage.
–Ohio PERS
If understand this correctly, my brother will be put on a Humana interim Policy until June, 2016.
That said, a letter from ProMedica hospitals in Toledo, OH has put us on notice on an after Jan. 1st, services rendered by a ProMedica facility won’t be payable. It is nearly certain, services will be rendered after Jan. 1st, 2016, but before he goes to the marketplace for a different carrier. He is on Medicaid, but Jobs and Family Services has indicated Humana will be primary. HELP!!!!!!!!!!!!!!! I have called your “help” number, but have not received the promised return call.
Penny,
We suggest your brother contacts either/both OneExchange at 944-287-9945, or our Member Services department at 800-222-7377 to discuss your options, as they are not clear here. Sorry about the fact that you didn’t get a return call earlier.
–Ohio PERS
To my relief, the Humana interim policy, according to ProMedica will continue to pay for any services.
Why I got the letter remains a mystery. Nonetheless, it is comforting to know these facilities will remain payable.
We are in need of some IMMEDIATE HELP!! My mother in law was a state employee who began in the 1970’s. She had to go on hospice last week, and we just found out she does not have Medicare Part A. Since she did not have the option to pay into MCE, does OPERS cover her hospice care in our home?! I would call OPERS to ask but the wait time is four hours on hold!!!
Tracy,
Yes, OPERS will cover in-home hospice care in this situation.
–Ohio PERS
My mom is not eligible for premium free Medicare A, so at the risk of sounding redundant to the above entries, I want to see if I understand her next steps. She will be automatically enrolled into a temporary OPERS sponsored policy thru June 2016. In the meantime she is to go to the Social Security and apply for Medicare A, then she is to make an appt to speak with One Exchange and during the eventual phone call she will shop for her new insurance plan, for which she will receive monies from OPERS monthly towards her new premium. I just want to make sure I don’t have something wrong with the end of December looming.
Heather,
You’ve got it — that’s how it will work.
–Ohio PERS
The Medicare letter arrived today. It states that enrollment will be effective in July, and that a new Medicare A and B card will be mailed shortly. According to your information, we will need to send you a copy of the new card/letter of acceptance and a copy of the *paid* bill once we have that. The question is: How do we obtain a copy of the *paid* bill to send you? How do we indicate proof of our remittance? Or, do you simply need a copy of the Medicare invoice? Thanks for clearing up this matter!
John,
Send in a copy of the Medicare bill and proof of payment. You should receive the bill soon if you haven’t already.
–Ohio PERS
The monthly allocation has arrived for my plan, which begins July 1. The nifty calendar, which has a note in the deposit date (and already a note for July 1 showing the service charge), is very clever.
I have two questions, though.
First, will the additional $300 be added to our accounts at some point?
Secondly, please scrutinize this section from the OneExchange Dashboard:
Frequently Asked Questions
Health Care Flexible Spending Account (FSA)
*Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.
I have a health care FSA. If I’m contributing throughout the year, how much will my FSA cover for a claim in the beginning of the year?
With a health care FSA, your full election amount is available on the first day of the plan year. This means that you can use your entire election on day one of the plan year.
Example: You elect to contribute $1,200 for the plan year. In January, you have contributed $100. ($100 x 12 months = $1,200) In that same month, you receive health care services that cost you $1,000. At this point, you haven’t submitted any other claims. This means, you’ll receive the full amount of the claim from your FSA. You don’t have to wait until you actually contribute this amount to your health care FSA.
I understand that some members have been “overpaid” and then had to send OneExchange a check. I will be having some dental work performed in three weeks and wonder if I should submit the entire bill or wait. The explanation above seems to indicate that we will receive the entire claim at once, but you have indicated to others that it is necessary for the allocation to “catch up” with the claim. Which is true?
Thanks!
John,
Call OneExchange at 844-287-9945. They can help you with your issue about the flexible spending account.
–Ohio PERS
Michael,
It is now July and I do not see the $300 additional deposit. Are we eligible (you did not answer that query in my previous comment)?
The preparation for a “Fax Cover Sheet” on the OneExchange site is confusing. One must complete the File a Spending Account Claim, check off the signature box, press the Fax button, and then find in sheets in the “My Dashboard” and then “My Documents.” Unfortunately, I just discovered that in addition to the Fax sheet being created I inadvertently sent some practice claims electronically too!
Thank you for reaching out. For retirees that do not have premium-free Medicare Part A, the $300 additional yearly deposit will arrive over the next few weeks.
(The deposit could not occur until after the plan effective date of July 1st)
Heather,
The $300 arrived last week and OneExchange is supposed to reimburse the faxed dental claim Monday, less than one week after the dental visit!
I realize several members have had problems with OneExchange, but fortunately I have not. Thank you for this HRA program.