OPERS Medicare Connector Enrollment Closes Dec. 31, 2015
For par t icipant s in the OPER S health care plan .OPERS Medicare Connector enrollment closes Dec. 31, 2015Effective Dec. 31, 2015, OPERS no longersponsors the group Humana Medicare Advantageplan or Medicare Part D prescription drugplan. Instead, with the help of a OneExchangeLicensed Benefit Advisor, retirees enrolledin both Medicare Parts A and B should haveselected a Medicare Advantage plan or aMedigap (Medicare Supplement) Plan and aMedicare D prescription drug plan using theOPERS Medicare Connector. There are manyaffordable plans available on the individualmarket and the Connector allows OPERS retireesaccess to more plan choices than ever before.Enrollments with the OPERS Medicare Connectorclose at the end of 2015. If you are enrolledin both Medicare Parts A and B and haven’tenrolled in a plan through OneExchange,please call 1-844-287-9945 as soon as possible.If you have not enrolled with OneExchange byDec. 31, 2015, you will not have any coverage tosupplement Original Medicare in 2016 and willnot have prescription drug coverage.You will also not have a Health ReimbursementArrangement established or receive a monthlyallowance from OPERS.OPERS would like to thank our Medicareeligible retirees for reading the informationwe’ve provided, educating themselves byresearching available plans and making a planselection using the OPERS Medicare Connector.OneExchange was charged with enrolling morethan 145,000 retirees and dependents in the last90 days. We apologize if you experienced longerthan-expected wait times before or during yourenrollment call. OPERS and One Exchange aredoing everything possible to reduce wait timesand assist you in this process.(Continued on page 2)Table of contentsHealthReimbursementArrangement (HRA)Resources, help,education3Tips for ReducingPrescription DrugCosts in 20164For non-MedicareOPERS Retirees5-6Important changesto non-Medicareprescription drugcoverage7Become a healthierYOU with HealthyU Ohio in 2016 –and earn 507Making smarthealth care choices8
OPERS Medicare Connectorenrollment closesDec. 31, 2015 (continued)Special Connector enrollment schedule forretirees not eligible for premium-free MedicarePart ARetirees enrolled in Medicare Part B but noteligible for premium-free Medicare Part A willautomatically be enrolled in the Humana InterimMedicare Plan until June 30, 2016. By thatdate, these retirees will need to have enrolledin a Medicare plan using the OPERS MedicareConnector. This group recently received apacket of information explaining how and whento enroll in Medicare Part A and also how toreceive Part A reimbursement from OPERS.These retirees will receive more informationabout enrollment through the OPERS MedicareConnector early next year.2Health care coverage options change forre-employed retirees in 2016If you are receiving an OPERS pension andhave returned to work for an OPERS-coveredemployer, OPERS requires you to enroll in youremployer’s health plan if your employer offerscoverage to other employees in similarpositions. If your employer does not offerhealth care coverage, OPERS providescoverage options.OPERS Health Care NewsletterIn response to Federal health care regulations,coverage options for re-employed retireeshave changed for 2016. If you are currently are-employed retiree, you have received specialcommunications explaining your options. If yourequire more information, please visit www.opers.org and click on “Re-employment”. Or callOPERS at 1-800-222-7377 if you have additionalquestions.Important reminder: Medicare Part Breimbursement reductionIf you are currently receiving a Medicare Part Bpremium reimbursement from OPERS, you will see anadditional reduction beginning Jan. 1, 2016. MedicarePart B premium reimbursements will transitionto a 0 reimbursement in 2017. You can receivereimbursement for Medicare Part B premium fromyour HRA but only for the portion of the premiumthat is not already reimbursed by another source likeOPERS. Many retirees will have enough money leftoverin their HRA to use toward the cost of their MedicarePart B premium. 2015 reimbursement: 63.622016 reimbursement: 31.812017 and after: 0Re-employed retirees:Re-employed retirees participating in the HumanaInterim Medicare Plan are eligible to receivereimbursement for a portion of the cost of theirMedicare Part B premium. Re-employed retireesparticipating in a plan they chose throughOneExchange, but not receiving an HRA allowanceare not eligible to receive reimbursement for thecost of their Medicare Part B premium.
Health ReimbursementArrangement (HRA) –Resources, help, educationOnce you have enrolled in an individualMedicare plan through the Connector, youmay have questions about the HRA and thereimbursement process. Answers to yourquestions about the reimbursement processcan be found by reading OneExchange’s GettingReimbursed Guide. OneExchange mails theseguides within a few days of a retiree enrollingin a plan. If you have enrolled, but haven’treceived this guide, please contact OneExchange.The guide is also available at www.medicare.Also, in an effort to educate our retirees onthis new process, OPERS will be presenting the“Moving Forward with OneExchange” seminararound Ohio in early 2016. Dates and locationsare listed below. The first hour of this seminarwill focus on the Health ReimbursementArrangement and the reimbursement process.The second hour will focus on Connectorenrollment for those retirees without premiumfree Medicare Part A.oneexchange.com/opers.To sign up for a seminar, access your OPERS online accountat www.opers.org or call OPERS at 1-800-222-7377.JANUARYCleveland North IndependenceJan. 19,2016Cleveland South StrongsvilleJan.19 & 20, 2016WestlakeJan. 25, 2016CincinnatiJan. 25, 2016ColumbusJan. 25 & 26, 2016NewarkJan. 25 & 26, 2016YoungstownJan. 26 & 27, 2016FEBRUARYWestchesterFeb. 2, 2016ToledoFeb. 2 & 3, 2016SharonvilleFeb. 2 & 3, 2016Columbus WorthingtonFeb. 4, 2016CambridgeFeb. 4 & 5, 2016MentorFeb. 9 & 10, 2016RootstownFeb. 9 & 10, 2016Dayton/BeavercreekFeb. 16 & 17, 2016AthensFeb. 17, 2016Cuyahoga FallsFeb. 17 & 18, 2016FindlayFeb. 23 & 24, 2016AkronFeb. 23 & 24, 2016BellvilleFeb. 23 & 24, 20163
Tips for Reducing PrescriptionDrug Costs in 2016Prescription drugs can be costly and someMedicare-eligible retirees moving to anindividual Medicare Part D prescription drugplan in 2016 will see an increase in their outof-pocket drug costs. OPERS has provided somereminders and tips for reducing out-of-pocketprescription costs below.Use your resourcesIf there is money left over in your HealthReimbursement Arrangement (HRA), use it toreimburse out-of-pocket drug costs. In 2016,eligible plan participants will have access to anHRA with monthly deposits made by OPERSthat can be used to reimburse medical andprescription plan costs. In addition to a monthlyallowance amount, retirees will receive a 300lump sum deposit each January through 2018.This lump sum could also be used to offset someof the out-of-pocket prescription drug costs. HRAaccount balances will roll over from month tomonth and year to year.24OPERS Health Care NewsletterPrescription drugs: Know your optionsPrescription drugs are commonly categorizedinto buckets or tiers. These tiers start with lessexpensive to more expensive generic options andthen move into formulary and non-formularybrand name drugs before topping out with themore costly specialty medications.Many brand name medications have generic orover-the-counter alternatives. Be sure to ask yourdoctor if a generic version of your prescribedmedication is available and right for you.Specialty medications are typically high-costdrugs used to treat serious medical conditionssuch as multiple sclerosis, rheumatoid arthritisand cancer. These drugs are expensive andoften require close monitoring, frequent dosageadjustments and special storage requirements.If you are treating an illness with specialtymedications, here are a few tips to helpmaximize your savings:Consider changing to a drug covered byMedicare Part B, typically administered in adoctor’s office or hospitalDrugs administered in a doctor’s office are oftenprocessed through Medicare Part B and thiscould lower your out-of-pocket prescriptioncosts. Talk to your provider to find out if having aprovider administer the drug in their office is anoption for you.Consider switching to lower cost oral or selfinjectable traditional, specialty or biosimilardrugsBiosimilar drugs are just coming to the marketand are essentially a copy of a drug made bya different company and are expected to be25 to 30 percent less expensive. Talk to yourprovider to find out if there are lower cost drugoptions available to you. You may also ask yourpharmacist about drug options and prices, andthen talk to your doctor.Maximize the effectiveness of specialtymedicationsTake advantage of individualized counselingand education sessions provided by specialtypharmacies. Discuss with a pharmacist how toget the maximum benefit from your specialtymedications including, for example, how tomanage side effects.
For non-Medicare OPERSRetireesA New Way to Save Money on Lab Costs in2016 for participants in the OPERS RetireeHealth PlanYou’ve been hearing a lot lately about how costsfor health care services vary. Different providershave different rates. Rates can also vary based onwhere services are received. OPERS is workingwith Medical Mutual to help lower the costs oflab tests.Beginning Jan. 1, 2016, the OPERS Retiree HealthPlan administered by Medical Mutual willcover 40 lab tests only up to a certain price, thecoverage maximum.Here’s how the coverage maximum works:If a laboratory services provider offers arate that matches or is below the coveragemaximum, you will only pay your normalout-of-pocket costs. These costs may includedeductibles and co-insurance.If a laboratory services provider offersa rate that is above the coverage maximum,you owe the difference between the coveragemaximum and your provider’s rate inaddition to any applicable deductibles andco-insurance. The difference you pay doesnot count toward your deductible orout-of-pocket maximum.You can still choose any network lab servicesprovider you want. However, some providers’rates are above the coverage maximum. To savemoney, use a lab services provider whose ratesmatch or are below the coverage maximum.You can check costs for many health servicesincluding lab work by using My Care Compare,Medical Mutual’s online tool which comparesthe rates offered by doctors and healthservices providers as well as provides coveragemaximums for the 40 effected labs. Log into MyHealth Plan at MedMutual.com/member andclick “My Care Compare” under Quick Links tostart comparing today.Coming to My Health Plan:A step-by-step video on how touse My Care Compare to find labproviders whose rates match or arebelow the coverage maximums5
For non-Medicare OPERSRetirees (continued)In November, Medical Mutual sent you aguide with more information about coveragemaximums, including:A list of coverage maximums for each of the40 lab testsInstructions to access and use My CareCompareInstructions on how to talk to your doctorabout coverage maximumsAn example of how to figure out your out-ofpocket costsQuestions and answers about coveragemaximumsIf you have any questions or would like torequest another copy of the guide, call MedicalMutual Customer Care at (877) 520-6728.6When you shop smartly, you save money.Coverage maximums help you and OPERS spendhealth care dollars wisely. The good news is thatonce we announced our coverage maximumsfor lab tests, dozens of labs have lowered theirprices.OPERS Health Care NewsletterOPERS discontinuing DiseaseManagement Program in 2016It’s important to OPERS thatour health care programshave a positive effect onthe participants. Recently,OPERS conducted a study tomeasure the effectiveness ofthe Medical Mutual DiseaseManagement program.The results showed that overall the programdid not improve how participants manage theirchronic conditions including COPD, diabetes,chronic heart failure and coronary artery disease.Therefore, OPERS decided to end the diseasemanagement program for all conditions as ofDec. 31, 2015.If you have any of these conditions, your genericmedications will still be covered with a 0 copayin 2016. If you are a non-Medicare participantwith diabetes and enrolled in the diseasemanagement program before Dec. 1, 2015, branddiabetic medications or supplies will still becovered with a 0 copay through the end of 2015only. Starting Jan. 1, 2016, they will be coveredlike any other brand medication, subject to thedeductible and cost sharing.Although OPERS is ending the DiseaseManagement programs, other wellness andclinical programs will still be available throughMedical Mutual including a tobacco QuitLine,Weight Watchers, lifestyle coaching and casemanagement.If you are a current Disease Managementprogram participant, you should have receiveda letter providing official notice of thetermination of the program. If you haveany questions, contact Medical MutualCustomer Care at (877) 520-6728.
Important changes to nonMedicare prescription drugcoverageImportant changes to non-Medicareprescription drug coveragePlease keep in mind the following changes tothe OPERS Retiree Health Plan prescription drugcoverage are effective Jan. 1, 2016.There will be an annual deductible in theamount of 100 for generic drugs and 200for brand name drugs.Instead of a co-payment, generic drugswill be subject to a 20 percent co-insuranceif filled at a Preferred Pharmacy and a25 percent co-insurance if filled at a nonpreferred pharmacy. There is a 4 min/ 8 max for retail and a 10 min/ 20 maxfor mail order.OPERS will discontinue offering free brandmedications and testing supplies fordiabetes. These medications and supplieswill be subject to a 30 percent co-insurance,same as a formulary brand medication.Over-the-counter Proton Pump Inhibitor(PPI) medications, which treat heartburn,will not be covered.Generic PPI medications will be subject to a50 percent co-insurance. There is a 25 minfor retail and a 62.50 max for mail order.The annual out-of-pocket maximum willbe reduced from 3,250 to 1,950 perAffordable Care Act guidelines.Coverage for specialty drugs will go froma 40 percent co-insurance with a 60maximum to a 40 percent co-insurance witha 150 maximum.7Become a healthier YOU with Healthy U Ohio in 2016 – and earn 50Retirees enrolled in the OPERS Retiree HealthPlan administered by Medical Mutual willreceive a 50 Retiree Medical Account (RMA)incentive for participating in and completing anin-person Healthy U workshop in 2016.Living a healthy, active life with chronicconditions can be a challenge especially as weage. That’s why the Ohio Department of Agingand Ohio’s area agencies on aging offer theHEALTHY U Ohio program. Through a series ofin-person workshops held in your communityor online workshops, you can learn strategies toeffectively manage your symptoms and live thelife you want to live.To learn more and find a workshop starting soonnear you, visit ingprograms/ orcall your local area agency on aging at1-866-243-5678. When you sign up,be sure to tell them that you are enrolledin the Medical Mutual plan.Changes made during OPERS Open Enrollmenteffective Jan.1, 2016Any changes made to OPERS medical, dental andvision coverage during open enrollment will takeeffect Jan. 1, 2016. If you have questions aboutplan coverage, the 2016 Health Care CoverageGuide is available on the OPERS website,www.opers.org.
Making smart health carechoicesWhen it comes to health care, more is notnecessarily better. Visit the wellness sectiontitled Making Smart Health Care Choicesat www.opers.org for easy access to informationand tools that may assist you in makingimportant decisions about your medical care.Visit www.opers.org and click on the MakingSmart Health Care Choices link under theRetirees section of the website to experience allthe great features and information OPERS hasprovided.Making Smart Health Care Choices providesmany valuable features including a programdeveloped by the American Board of InternalMedicine (ABIM) Foundation called ChoosingWisely. With the support of Consumer ReportsHealth, Choosing Wisely can help assistyou and your doctor in choosing the mostappropriate care for you. Informational videosand articles are available to help you with thoseconversations and decisions.Whether it’s talking to your doctor, deciding tohave a particular procedure or simply gaininga higher comfort level about advance careplanning, the information included in theMaking Smart Health Care Choices section willimprove your knowledge and help you as youmake health care decisions.Ohio PublicEmployeesRetirementSystem277 East Town StreetColumbus, rtwitter.com/ohiopers
sponsors the group Humana Medicare Advantage plan or Medicare Part D prescription drug plan. Instead, with the help of a OneExchange Licensed Benefit Advisor, retirees enrolled in both Medicare Parts A and B should have selected a Medicare Advantage plan or a Medigap (Medicare Supplement) Plan and a Medicare D prescription drug plan using the
Participate in an OPERS Connector Readiness webinar. If you are turning 65 this year, visit www.ssa.gov to sign up for Medicare. OPERS recently launched dedicated OPERS Medicare Connector Web pages on OPERS.org. These pages feature basic information on what the Connector is
OPERS Medicare Connector implementation Work on the OPERS Medicare Connector (Connector) did not end with the enrollment of close to 131,000 OPERS retirees, spouses and dependents into plans via the Connector . In 2016, OPERS embarked on a concentrated communications effort to reach any eligible
OPERS Medicare Connector . Throughout 2020, OPERS continued efforts to ensure all eligible participants enrolled in individual Medicare plans via the OPERS Medicare Connector were successfully using their HRA account if they so desired. These efforts included interactive webinars and personal outreach to retirees with little or no HRA activity.
OPERS Medicare Connector . Throughout 2021, OPERS sustained efforts to ensure all eligible participants enrolled in individual Medicare plans via the OPERS Connector were successfully using their HRA account if they so desired. These efforts included interactive webinars and personal outreach to retirees with little or no HRA activity.
OPERS has been providing participants with information about our move to the OPERS Medicare Connector for more than a year. We hope by now you have a good grasp on why the Connector is a positive change a
For Medicare Retirees, Surviving Spouses, Long-Term Disability (LTD) Terminees, and/or Medicare Dependents For Sandia Medicare Eligible Participants 2016 Medicare Retiree Open Enrollment: Wednesday, October 15 - Monday, December 7, 2015 Note: The Medicare open enrollment period is longer than that for PreMedicare to allow Medicare
Centers for Medicare & Medicaid Services National Train‐the‐Trainer Workshops Instructor Information Sheet Module 1: Understanding Medicare Module Description Original Medicare, Medicare Advantage and Other Medicare Health Plans, and Medicare Prescription Drug Coverage are choices in the Medicare program.
Created Date: 9/14/2012 11:18:25 AM
