OPERS Medicare Connector: How Via Benefits Enrollment Works

Two Health Care Paths: Pre-Medicare and Medicare

OPERS retiree health care splits at age 65. Before Medicare eligibility, qualified retirees shop for individual health plans on the OPERS pre-Medicare exchange platform and receive monthly Health Reimbursement Arrangement (HRA) deposits to offset premiums. Once you turn 65 and enroll in Medicare Parts A and B, you transition to the OPERS Medicare Connector — a separate exchange administered by Via Benefits.

Eligibility depends on age and transition group. At age 65 or older, OPERS lists 20 years of qualifying health care service credit. For pre-Medicare coverage, ages 60 to 64 require 30 years of pension credit plus 20 years of health credit in Group A, 31 plus 20 in Group B, or 32 plus 20 in Group C. Under age 60, Group A requires 30 years of health credit; Group B requires 32 years (or 31 at age 52); and Group C requires 32 years of health credit and age 55 or older.

What Via Benefits Actually Does

Via Benefits is a Marketplace exchange specifically for Medicare-eligible retirees. OPERS contracts with Via Benefits to provide licensed benefits advisors who help you compare Medicare supplement plans (Medigap), Medicare Advantage plans, and Part D prescription drug plans available in your area.

You're not buying insurance from Via Benefits. You're using them as a guided shopping platform — they show you what's available, help you compare, and handle enrollment. The actual insurance comes from commercial carriers (Humana, UnitedHealthcare, Aetna, etc.) whose plans are sold on the Medicare market.

Your monthly HRA deposit from OPERS goes into an account that reimburses eligible expenses: Medicare supplement premiums, Part D premiums, and qualified out-of-pocket medical costs. The deposit amount depends on your years of qualifying health care service credit — more years means a higher monthly HRA allowance.

Timing the Medicare Transition

The transition from pre-Medicare coverage to the Medicare Connector needs to be coordinated with your Medicare enrollment:

At age 65: You must enroll in Medicare Part A and Part B. If you're already retired and receiving OPERS health care, your pre-Medicare HRA coverage ends when you turn 65 and becomes Medicare Connector coverage. If you delay Medicare enrollment beyond age 65 without qualifying for a Special Enrollment Period, you'll face Medicare late-enrollment penalties — a permanent premium surcharge on Part B and Part D.

If you retire at or after 65: You may already have Medicare. Contact Via Benefits through the OPERS Medicare Connector to set up your HRA reimbursement and select your Medicare supplement plan. Your employer group health coverage (if you had it) typically triggers a Special Enrollment Period for Medicare, so the transition can happen without penalties.

If you retire before 65: You start on the pre-Medicare exchange with HRA deposits. When you approach 65, OPERS and Via Benefits reach out with transition instructions. Don't wait for the outreach — start Medicare enrollment 3 months before your 65th birthday to ensure seamless coverage.

What the HRA Covers Under Medicare

Once you're on the Medicare Connector, your OPERS HRA deposits reimburse:

• Medicare Part B premiums (the standard monthly premium or IRMAA-adjusted amount)
• Medicare supplement (Medigap) premiums
• Part D prescription drug plan premiums
• Qualified out-of-pocket medical expenses (copays, deductibles, certain dental and vision costs)

The HRA is a reimbursement model — you pay the premiums first, then submit claims for reimbursement. Via Benefits handles the claims process. Some premiums can be set up for automatic reimbursement so you're not filing monthly paperwork.

Dental and Vision: Separate and Unsubsidized

OPERS offers optional dental coverage through MetLife and vision coverage through Aetna for retirees. These are standalone voluntary plans — your HRA deposits do not cover dental or vision premiums. You pay the full premium through benefit deductions.

Whether these plans make sense depends on the premiums versus your expected usage. Compare them against individual dental and vision plans available on the open market before enrolling automatically.

The Common Mistakes

Not enrolling in Medicare Part B: Some retirees assume OPERS health care replaces Medicare. It doesn't — the HRA supplements Medicare, it doesn't substitute for it. Without Part B, you'll face gaps in coverage and the HRA won't reimburse many expenses.

Missing the Initial Enrollment Period: If you turn 65 while still actively employed with employer coverage, you may have a Special Enrollment Period. But if you're already retired when you hit 65, your Initial Enrollment Period is the 7-month window around your 65th birthday. Missing it means waiting until the General Enrollment Period (January through March) with coverage starting July — plus the late penalty.

Ignoring plan reviews annually: Medicare plan networks and formularies change every year during Open Enrollment (October 15 through December 7). Via Benefits advisors can help you compare your current plan against new options. Staying on the same plan by default may cost you more than switching.

The OPERS Retirement Guide maps the full health care transition — from the T-12 service credit audit through pre-Medicare enrollment to the Medicare Connector switch — with the Health Care Eligibility Tracker to confirm your qualifying years before you file.

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