Tips for the Connector enrollment call
Enrollment appointments begin Oct. 5 for participants in the OPERS Medicare Connector.
We’d like to offer a few pointers for how to make the most of the enrollment calls with OneExchange as participants choose their health care coverage on the individual Medicare market:
- There are enough appointments: OneExchange is able to schedule new appointments as needed, monitoring demand on a daily, weekly and monthly basis. (We have heard feedback from some retirees who are concerned that there might not be enough appointments for all Connector participants. That’s not the case.)
- You don’t need an appointment: Any Medicare-eligible OPERS retiree or spouse can call OneExhange from 8 a.m.-9 p.m. Oct. 5 through Dec. 31 to enroll. An appointment is not necessary. OneExchange has confirmed that on-hold times will be 10 minutes or less.
- Humana is available through OneExchange: However, participants will not be able to enroll in the same Humana plan that’s currently offered through OPERS, because individual Medicare Advantage plans are different than group Medicare Advantage plans. There will be plenty of Humana options for participants to choose from. If it’s important that you retain your current physicians, make sure you tell that to the OneExchange licensed benefit advisor so you can assure your providers are on that network.
- Married couples should team up: OPERS and OneExchange encourage married couples to sign up for only one enrollment call and to make that call together. This will be a more efficient experience for couples to discuss plans, costs and other details. Also if you want to make sure your OPERS HRA allowance will cover the entire premium for both you and your spouse, tell your benefit advisor. They will be able to find you the best options for your budget.
- It could take more than one call: Plan selection is not mandatory on the first call, even if it’s a scheduled call. You can phone again if necessary to finish the enrollment process.
- The enrollment call takes time: During the enrollment call the licensed benefit advisor will confirm your medications, physicians and personal information. These details are important to ensure that you enroll in coverage that best suits you. Participants also will have to listen to a recorded disclaimer for each plan in which they enroll. While these are somewhat lengthy, it is a federal regulation for OneExchange to play them. Please be patient. The disclaimers are there for your protection. And the disclaimers will be mailed to you by the insurance plan you select.
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.
Thanks for the helpful tips. My initial experience with the One Exchange representative was thorough, concise and professional. The rep gave some of the same tips you noted.
Our experience so far has not been good. On hold for at least 20 minutes, then our consultant could not answer all our questions. She did not have complete info about the plan in which we were most interested. We were advised to get the info ourselves and callback, although she would make a note and try to research the plan when/if she had time. Made a comment that since we had such a good HRA deal, why wouldn’t we just get a Medigap plan automatically as there would be enough in the HRA to pay for it! We are snowbirds, back in Ohio in summer and need a portable plan. There is a good one for that in our area, but she didn’t know/have access to any details about the portability (called a “Passport feature” in a United Healthcare Advantage plan).
A Medicare Supplement is ideal for ‘snow birds’ You don’t have to worry about a network of Drs. You can go anywhere, see any provider as long as they accept Medicare.
I have received 5 calls from the one exchange staff and my response has always been the same. Please hold off until my wife and I can actually see all of the available plans online and do our own comparison. What I dislike most about this process is that for reasonably intelligent people, providing all of the plans side bye side with an opportunity for participants to make an initial set of decisions would be preferable to spending time with a consultant going over my private and personal medical conditions. AFTER we have reviewed all of the plans, we could then contact the one exchange folks with any questions we may have. Basing your decision to select health care and prescription coverage on what your CURRENT conditions and prescription needs are is dangerous unless you can see a year into the future to know what medical conditions you may encounter. Also, I hope it is clear when the plans are provided, WHICH PLANS WILL ALLOW AUTOMATIC PREMIUM REIMBURSEMENT THE MONTH FOLLOWING THE MONTH OF PAYMENT, so that the participant doesn’t get stuck in a process of constantly requesting reimbursement from a private company to whose benefit it is to hold your money and receive interest on it.
Thomas,
Thanks for your comments. In response to basing your plan on your current condition, our health care director has said to consider choosing a plan “for your 85-year-old body.”
–Ohio PERS
I also thought that I wanted to see all the plans on paper before selecting. It is much more important to have all YOUR information ready when you talk to the One Exchange rep. And knowing what you want covered. Also, do you want to pay a slightly higher premium up front and no co-pays later? The rep will ask you all those types of questions and then select 2-3 plans that meet those needs, including the cost you want to pay. Believe me, it is very daunting to try to review all the plans that are out there. I did the research and didn’t even see the plan that our rep had suggested. So, I was glad I wasn’t resistant to talking to them before I thought we were “ready.” Then surprised myself by staying on the line and selecting the plan during the same call.
If you hear what they have to say and are still not ready, you can call back later. They will at least have your information and you won’t have to start over.
THE PROBLEM WITH THE HEALTH DIRECTOR ALL SHE TALKED ABOUT WAS THE MEDICAL PLANS AND VERY LITTLE ON THE PRESCRIPTION PROGRAM. THE SHOCK TO RETIREES IS THEIR DRUG COST CAN GO UP $2000.. WHEN THEY ARE IN THE DONUT hOLE?
Wiam,
We have just released a video on prescription drug coverage via the Connector. The answer is that you enter the donut hole next year after paying $3,310 and leave the donut hole (and enter catastrophic coverage) at $4,850.
–Ohio PERS
I understand we are to get a packet so we can have our information ready when we make the call. When do we get the packet ?
Ben,
You should have received an enrollment guide from OneExchange in September. Call us at 800-222-7377 if you did not receive it.
–Ohio PERS
I won’t be 65 til Aug 2016. When do I start this? Do I contact now, if not, when?
Sharon,
We will begin contacting you about the Connector six months before you turn 65, and that’s when you should start planning to contact OneExchange. You can sign up for Medicare beginning three months before you turn 65, and coverage can start as soon as the first day of your birthday month.
–Ohio PERS
Hello, I totally agree with Mr. Quade — review all of the plans and then speak with the consultant. That only makes sense.
Mr. Pramik, I was surprised to see your reply to Mr. Quade about choosing a plan “for your 85-year-old-body”.
C. Holly,
Our Connector participants are free to access the OneExchange OPERS portal to review plans before the enrollment call. Just realize that you won’t be able to view 2016 rates until Oct. 5.
The comment about planning for the future is so that members won’t be surprised if they choose one type of plan today and wish to upgrade to a different plan in the future when they might be subject to medical underwriting.
–Ohio PERS
C. Holly. There isn’t much to review. Plans are all the same. The only choice will be the premium and of course reimbursement ! I am 81 years old and pay $224 a month for Plan ” F ”
I have had a Medigap Policy for 20 years. In that 20 years I have paid $43 that was not paid by Medicare. Relax, it is so simple you will be shocked. This handling by OPERS has been the greatest handling of any program I have ever witnessed. You will probably wonder what I have witnessed etc? I worked for NASA and The USAF and have been in private business. I have Stents,had surgeries, stress tests, which are expensive and a lot of medical problems and used my Medigap policy quite extensively.
Thanks for your reply, Mr. Langhals; it was reassuring. I’m still working, but I tend to get quite concerned over health care coverage for retirees.
Thank you for your reply Mr. Langhals. Reassuring. I will be making the decisions for my soon to be 99 yr old mother. I have been quite anxious about which health care and prescription plans offered. The cost of both will be a big factor for her.
Holly….thanks for coming to my defense, but I understood what Michael was eluding to in having one exchange reps being cognizant of the process of developing more complex medical issues as we age. I am actually a year away from medicare myself. I do still have one question Michael…. when we have the plans laid out for us on October 5th or 15th, will we know which plans will allow for the reimbursement of the insurance premiums the month following the month of payment? Thanks….Tom
Thomas,
The OneExchange advisor will be able to indicate whether a carrier does auto-reimbursement; however you might have to contact the carriers for exact timing of the reimbursement.
–Ohio PERS
The offered plans on the One Exchange website are very limited. Our only choice is Humana (not good in my area) or Priority Health. No BC/BS or Aetna plan options. Not much choice.
I have to totally agree with Mr. Quade. We should be able to visually compare the plans and then get in touch with OE to find out if we made the right choice.
My beef is with the equipment that OE uses to talk to us. They use headsets to communicate with us and they don’t realize that they are not always adequate for the purpose. I agree that the operator needs two hands at the computer at the same time she is talking to us but there must be another way. (I have been out of the office for 20 years and not familiar with new equipment.) I am near totally deaf (even though I have hearing aids.) and my wife is not much better. She takes the calls on speaker phone and relays them to me. I can’t be sure that she relays them word for word. To me the OE operator’s words just echo in the phone. If there can’t be some type of accommodation here it appears that there may be others, as well as we, that will not have insurance come January 1, 2016. I would do internet if OE doesn’t ask a bunch of personal questions like they did today. But that is verboten.
I am not changing anything; do I need to sign up to the connector; I have been retired 9 years and have had health insurance, etc. thru Humana. I will keep my appt. for my husband and me the 9th.
Kay,
The current Humana plan is ending at the end of this year. So yes, you have to sign up for a new plan through the Connector if you wish to continue coverage (assuming you are enrolled in Medicare Parts A and B).
–Ohio PERS
I notice that Oneexchange Connector offers Dental and vision plans. However, we just completed open enrollment for just the dental and vision plans from OPERS for 2016. Will vision and dental continue to be supplied to Medicare Part A & B members by OPERS, or do we have to choose vision and dental from the connector? Thanks.
Daniel,
We will continue to offer that coverage; you also can choose dental and vision coverage on certain plans through the Connector.
–Ohio PERS
I can’t find the plans on line. I’m not that great with a computer. Could you post the site so when I click on it it will go directly to the right site. When I enter the the address Medicare.OneExchange.com/OPERS all sorts of sites pop up.
Patricia,
Here is the link to the OneExchange OPERS portal.
–Ohio PERS
Thank you.
After talking to the One Exchange they can always answer the question. nothing on website for prescriptions yet do to the Obama Center for Medicare lack of posting drug cost.
I DON’T REMEMBER SIGNING ANYTHING GIVING THE PENSION BOARD PERMISSION TO GIVE ONE EXCHANGE MY BANK ACCOUNT NUMBER. I THINK IT WOULD BE BETTER TO OPEN AN BANK ACCOUNT FOR HRA AND HAVE THE PAYMENTS FOR THE PREMIUMS. WE HAVE NO IDEA HOW GOOD THE ONE EXCHANGE WEBSITE IS.
William,
You certainly can open a separate bank account for the HRA. OneExchange can tell you how to do that, and we will be sending our an HRA instruction kit to participants after they choose a health care plan.
–Ohio PERS
How do you comment on the Facebook site itself?
Patricia,
You can make a post directly to another post that was made to the site, or you can ask us a question or make a comment through the message center at the top of the page.
–Ohio PERS
Thank you Michael Pramik for the direct link. Unfortunately before I asked for the link ( out of frustration) I mistakenly signed into a Medicare Advantage site that was not One Exchange. Now
I am getting calls from every health insurance company in northwest Ohio. So fellow Opers people be careful who you sign into. Although most of you are probably much more computer savvy than I, LOL.
What can we do if we are dissatisfied with the health plan we choose?
Carolyn,
You will have until Dec. 31 to call OneExchange and select a new plan that will be effective on Jan. 1.
–Ohio PERS
Despite having all information available and having filled in my profile and all info, as well as choosing possible plan, we were on phone for 3 hours only to find when talking to enrollment specialist that benefit advisor gave us wrong plan (we were told we could choose our docs but plan chosen by specialist didn’t reflect that plus medicare effective date was entered incorrectly plus we were give incorrect info about a drug which at first we were told wasn’t available under any Rx plans and that there is no generic (but we found it in fact was the generic I am taking. After 3 hrs our phone battery was dying. Now we have to take another 3 hours to do it all over again – time we don’t have right now. I am very disappointed to receive all this incorrect info. Can I rely on the next person to provide us accurate info? I am skeptical now. If I hadnt picked up on inconsistency in summary info given us by enrollment person, we would be in a plan totally impropef for our needs.
I have contacted One Exchange numerous times for not only myself but for my mother who is also a retiree. In the numerous phone calls I have made to One Exchange, my experience has always been professional, courteous and most helpful. The educational materials and seminars for the run up to this change provided by OPERS have also been informative and most helpful and the hiring of One Exchange to guide us through the plan choices is a life saver. Knowing that One Exchange is there to help beyond the initial enrollment in our health care needs, is very comforting. Lastly, OPERS giving us a tax free allowance on a monthly basis to offset the cost of purchasing our health care is a blessing. Thanks
OPERS for a wonderful job in navigating thru a very difficult situation for the benefit of all retirees.
Wow, what disappointment for plan selections ! Everything by OPERS has been excellent up until now.
why is the rma allowance so high ($300 to $350) what if i see a specialist every 3 months.
Teresa,
The allowance is the amount we will deposit into the HRA for you. If you have leftover funds, they carry over to the next month.
–Ohio PERS
According to Tower the carry over fund will be deleted July 1st, 2017. Then it starts over at Jan. 1st. amount !
Dorothea,
That is not true. The money in your HRA will continue to grow if you don’t use it. It will roll over to the next year, and you will never lose any additional money that you have built up in your HRA.
The annual $300 deposit will be placed into your account for three years, in January of 2016, 2017 and 2018. The monthly HRA deposit will go into the account within two weeks of your signing up for a medical plan.
–Ohio PERS
Ruth,
It carries over to the next month.
–Ohio PERS
I am a snowbird…6 months in OH and 6 months in FL but my residency is in FL. I am so disappointed by the lack of choice I have for a Medigap plan…a total of 6! (If I lived in OH, I’d have 29 choices!) Five out of those six Medigap plans are either a Plan F or Plan C. In doing some research, I have learned that both Plan C and F will no longer be offered in 2020. I would be grandfathered in but no new retirees would be added resulting in a strong possibility that the premiums would take a big jump. I attended two Connector seminars and Plan F was being pushed as the “Cadillac ” policy to get. Why was there no mention of the plan being dropped in 2020?
I have been a staunch supporter of OPERS and their pro-active approach with rising healthcare costs but I feel like I’ve been duped.
I signed up for a plan F. I sure hope they are not discontinued!!!!
I attended a seminar and the speaker said if you have Tricare “it is a no brainer”.
When I called in to register she had no idea what that meant and offered me two
options, kinda the same as everyone else. I was confused and going to call back.
I don’t know what is smarter – a high deductible with the F plan or the regular? Any
ideas?
Depends whether you can afford up front deductibles. I can not so, I wanted all my bases covered.
I just finished enrollment with a Medigap Plan And Drug Plan. The whole experience was pleasant, professional and simple. Do plan for sometime, as the need on their part to read all the disclaimers etc. Great job by all involved!
Is the post correct that Medigap Plans C and F will not be available after 2020? Where is that information?
Don,
The Medicare Access and CHIP Reauthorization Act of 2015 prohibits people who become eligible for Medicare after Jan. 1, 2020, from purchasing a Medigap Plan F or Plan C. All who enroll in a Plan F or Plan C prior to that date will be able to keep their plan.
It’s too soon to tell whether premiums will increase if younger participants are barred from purchasing these plans. But some are of the opinion that might be the case.
If you select a Medigap plan today and wish to change plans in the future, you will be able to enroll in a Medicare Advantage plan during the annual open enrollment that takes place each fall. You also may be able to switch into a different Medigap plan, although whether or not such a plan will be available on a guaranteed issue basis will depend on the state where you live and insurance carrier issuing the plan.
-Ohio PERS
Thank you for your answer. Please clarify your last statement. If one changes from one to another Medigap plan in the future, is the guaranteed issue dependent on state regs AND insurance carrier? If yes, what is the policy for Ohio residents?
Many thanks.
Don,
Anyone can apply at any time for a Medigap plan. However, they’ll most likely go through underwriting. Some states have a “birthday rule,” which allows participants to make changes during the month of their birthdate. Ohio does not have this rule.
You should discuss your questions and your current situation with OneExchange. They have a database of information on what to do for each carrier in these situations.
–Ohio PERS
I evaluated “G” to start. If you take the $147 Medicare B Deduct and divide by 12, not that bad. Plus the premium is a little less than ” F “.
That is not very reassuring!
You can thank congress they just passed the bill overwhelmingly.
Doc Fix” also calls for changes to Medicare Supplement plans, which can be sold year-round and under less regulation compared to Medicare Advantage plans. Per the reform, Medicare Supplements can no longer cover the Part B deductible.
When I called to make my OneExchange phone appointment, I was told I had to decide during this call. No information could be mailed. I just watched a video in which a participant stated that you could request information on choices discussed emailed or mailed to you. Which is correct?
Thank you
Nancy,
You do not have to choose a plan on the first call. You can call back as many times as you’d like.
–Ohio PERS
I was just looking at the choices. I didn’t know the answers to some of the questions and there seemed to be no way to looks up our doctors. I would be so much better able to manage this with a paper booklet that I could cross off plans when I eliminate the ones I don’t want. It’s all very complicated and frustrating.
I was not able to view and print the AARP Plans described to me on the call made to the connector or from the website.
The connector said they could not mail me any of their information about “quotes” they had given me.
including AARP
Trying to gather readable info for my 80 plus year old Mom.
This is ridiculous.
I have completed my initial call with OneExchange. I did not get clarification as to certain Plan F offerings regarding price ratings(i.e. how premiums are formulated) Most plans state they are Attained Age rated , others say nothing. Looking at Medicare.gov I found an Issue-Age rated plan available in Ohio. This plan is not offered through One Exchange.
Questions:
1. Why is this plan not available through OneExchange?
2.Can they add this plan in their offerings?
3. Will we lose our HSA if we buy outside of OneExchange and deal direct with a plan provider?
4. Who do I contact in management. Your staff says OneExchange makes the decisions and decides what plans they offer.
5. OPERS contracted with OneExchange and pays for their services but lets them decide what we are to choose from?
Don,
OneExchange contracts with more than 100 medical insurance carriers. They do not contract with every carrier, and we can’t say why they do not contract with any one particular carrier. You can ask them that question at 844-287-9945.
In order to receive an allowance through the HRA, you do have to choose coverage through OneExchange.
–Ohio PERS
I have received conflicting information from One Exchange and the insurance co recommended to us as to whether the premiuns increase with age. The One Exchange rep didnt know about this but checked and told us, although there was no rating assigned , that our health premiums would NOT increase based on age. The insurance co rep too didnt know about “issue age rated” model but checked with someone and told me that all their plans (including Plan F) that the premiums would increase as we age. So I called OPERS and was told to call One Exchange back . So I did and they said to rely on what insurance co told me. This means, since we requested a plan that would NOT increase premiums, that we need to cancel our plans and start over again. This is the second time we were given incorrect information – fortunately , the first time, we caught it during enrollment process and didn’t continue signing up for a plan not suited to our situation. I need info that I can’t seem to get . I called Ohio Dept of Insurance and they told me OPERS would have to deal with this question.Could an informed and knowledgeable person PLEASE provide me with definitive info? I keep getting answers with the word “probably”. I don’t want or need “probably” answers. I need a definitive answer.
Jean,
We recorded a video in February that discussed the issue of how insurance plans are rated. Ohio is an “attained-age” state, meaning that in general rates go up with age. But it’s not like they go up every year. There are bands of ages, such as 65-69, 70-74, etc., in which premiums may increase solely by age.
Insurers generally use this model, although they don’t have to. The insurer, though, should be able to tell you what they base their pricing on, and if/when they would automatically raise premiums based on age. Watch the video beginning at about the 14-minute mark for a discussion about age rating.
–Ohio PERS
Thank you for answer. One Exchange reps need to be informed or better trained, as they didn’t know about these rating models until I explained it to them and they checked with supervisor who still didn’t give me a definite answer. I am glad to finally get the answer – thank you! – but do wonder why it was brought up at our connrctor seminar if we really don’t have a choice anyway.
I am wondering if you have to go through One Exchange to select a plan or can you use your own insurance agent? Earlier there was a comment that the HRA can be set up by the individual themselves, rather than through One Exchange.
A comment earlier by Marlene R indicated there were only 6 choices for a gap plan and 5 of those will not be sold after 2020 (Plan F and Plan C) If allowed to go through our own agent, there are many choices.
Also, when signing up for this and enrolling in a new Gap plan, is there underwriting at this point?
Rhonda,
When a plan is terminated, as our group plan will be in 2016, you are not subject to underwriting when selectnig a new plan. But you do have to go through OneExchange in order to receive your HRA allowance.
–Ohio PERS
I am on medicare and will be receiving an HRA of $396/month. My spouse is not 65, she is 63 and currently has Medical Mutual through OPERS, her plan will increase from $131.month to $411/month. My question is, can I apply any balance of my monthly HRA account towards my spouses premium? I could not get an answer from Medical Mutual or OneExchange, they told me to contact OPERS. When I call OPERS I get put on hold or they give me to option to get called back if I leave my number, which I do but no one has yet called my back. If I can’t use my HRA account money towards her premium I might want to find some other plan for her that might be less. Please someone contact me before Oct. 31st.
Charles,
You can use your HRA funds to pay for any OPERS premiums, including dental or vision, as well as your non-Medicare spouse’s Medical Mutual plan. We are developing a receipt that will be available in January for that purpose.
–Ohio PERS
I was told by a One Exchange staff member and a One Exchange supervisor that I could not use HRA funds for a spouse who was under the age of 65. I have looked at the IRS rules: https://www.irs.gov/pub/irs-pdf/p969.pdf and it appears that the IRS does not have this rule. Can we use our HRA funds for the qualified expenses of spouses under the age of 65?
Ed,
Yes, you can. I confirmed this with OneExchange.
–Ohio PERS
That becomes an income tax reporting issue, right ?
Dorothea,
We can’t provide guidance on tax issues. That question is best left to your tax advisor.
–Ohio PERS