Medicare for Ohio public-pension and union retirees

Ask a room of Ohio 65-year-olds where their health coverage comes from and you will hear OPERS, STRS, SERS, OP&F, “the trust,” a steel or auto retiree plan, a hospital system’s retiree plan, or a city or county plan long before you hear “I picked one off Medicare.gov.” That is the Ohio twist. The retirement system or trust usually decides the shape of your Medicare coverage, and the mistakes people make are not about choosing the wrong plan but about missing the step their system required. Here is how each of the big ones works, and where an independent agent fits.

The rule every system shares: enroll in Parts A and B on time

Retiree coverage is not “current employer coverage” for Medicare’s purposes, so it does not let you delay Part B without a penalty. Every Ohio system expects you to enroll in Parts A and B during your Initial Enrollment Period and send proof. Miss it and you can lose both ways: Medicare’s lifelong Part B penalty on one side, and your pension system’s subsidy or plan enrollment on the other. If you are approaching 65 on any of these plans, the first thing we check is your Part B date.

OPERS: an allowance, but only through the Connector

The Ohio Public Employees Retirement System does not enrol Medicare-eligible retirees in a group plan. Instead it funds a Health Reimbursement Arrangement (HRA) — a tax-free account that reimburses premiums, deductibles, copays and other eligible expenses — and administers it through Via Benefits, the OPERS Connector. To receive the monthly HRA deposits you must enroll in Medicare Parts A and B and then choose a Medicare Advantage plan, or a Medigap policy, plus a Part D plan, through Via Benefits. A Via Benefits licensed benefit advisor does the enrollment; the plans themselves are ordinary individual-market plans sold in your county.

STRS Ohio and SERS Ohio: a group Medicare Advantage plan of their own

The State Teachers Retirement System and the School Employees Retirement System both sponsor a group Aetna Medicare Advantage PPO for Medicare-eligible retirees, with prescription coverage through SilverScript, a Medicare Part D plan, and pharmacy administration by CVS Caremark. STRS moves you from its pre-Medicare Aetna plan into the Aetna Medicare Plan once it has proof of your Medicare enrollment; failing to send that proof affects your STRS coverage. SERS runs the same structure with its own premiums, and offers dental through Delta Dental and vision through VSP. Because the group plan already includes Part D, buying a separate individual Part D plan — or an individual Advantage plan — can knock you out of the group coverage, so do not sign anything without checking with your system first.

Where we help STRS and SERS retirees: deciding whether the group plan or the individual market is the better fit for you and your spouse (some retirees with a high premium tier compare a Medigap policy and an individual Part D plan against it), understanding the network and the Part B premium you still pay Medicare, and handling the spouse who is on Medicare but not eligible for the group plan. If you do leave the group plan, we make sure you understand what you give up and whether you can return.

OP&F: a stipend through Alight

The Ohio Police & Fire Pension Fund stopped sponsoring group health insurance in 2019 and now pays a monthly stipend into an HRA for retirees who buy coverage on the individual market through its connector, Alight Retiree Health Solutions. Medicare-eligible retirees enrol through Alight in a Medicare Advantage plan or a Medigap policy plus Part D; open enrollment runs November 1 to December 15, and enrolling through Alight within the window after your employer coverage ends is what turns the stipend on. As with OPERS, the enrollment must go through the connector to keep the money flowing, and we tell you that first.

The UAW Retiree Medical Benefits Trust and other union plans

Ohio’s auto retirees — the Toledo Jeep and transmission plants, Avon Lake, Lordstown, the Honda supply chain’s union shops, Defiance, Parma — largely carry coverage through the UAW Retiree Medical Benefits Trust. The Trust requires enrollment in Part A at 65 and pays its benefits as if you have Parts A and B whether or not you enrolled in Part B; if you skip Part B, the Trust does not pay what Medicare would have paid and you owe it yourself. Surviving spouses 65 and over must enrol in both A and B to keep Trust coverage. Retiree Health Care Connect (866-637-7555) is the Trust’s help line. Steelworker, utility, railroad and building-trades retiree plans follow their own documents, but the pattern is the same: Parts A and B on time, and check with the plan before adding anything.

Spouses, second homes and Florida

• A spouse under 65 usually stays on the pre-Medicare side of the same system; the Medicare-eligible spouse’s choice should not strand them. We map both timelines.
• A spouse without the pension is often on the open Medicare market while you are in a group plan or an HRA. That is where an independent agent does the most good.
• Snowbirds. A Medigap policy travels; the STRS and SERS Aetna PPO and most individual PPOs cover out-of-network care at a price; an HMO covers emergencies only. If you spend winters in Florida, price the plan on how it behaves in Naples or The Villages, not at home. Our Florida section covers the other end, and the state-by-state Medigap switching rules are on switching Medigap plans.

ECOS Medicare Solutions is a private insurance agency. It is not affiliated with OPERS, STRS Ohio, SERS Ohio, OP&F, HPRS, Via Benefits, Alight, the UAW Retiree Medical Benefits Trust, or any employer or union plan, and it cannot enrol you in a plan that those systems require you to purchase through their own connector.