Health Care Program News

Health Care Open Enrollment for 2018 Has Begun

Open enrollment for the STRS Ohio Health Care Program is Nov. 1–21, 2017. This is your opportunity to enroll for coverage, continue your coverage or enroll in a new plan for calendar year 2018. In late October, all plan enrollees received personalized open-enrollment information and instructions. The open-enrollment packet has been streamlined this year. With health benefits remaining largely the same in 2018, the open-enrollment guide has been eliminated, allowing the packet to be mailed to you in a standard business envelope marked, “Your health care open-enrollment materials are enclosed.”

STRS Ohio has prepared a personalized list of plans and premiums for all current plan enrollees. The plan listed on the front of the letter is the plan you will be enrolled in for 2018 unless you contact STRS Ohio. Additional plan options (if available) are listed on the back of the letter. You and your eligible dependents must enroll in the same option. If two medical plans are listed under an option, you and your dependents are eligible for different plans under that option based on Medicare status. If you are not currently enrolled in coverage through STRS Ohio and would like a personalized enrollment packet, contact the Member Services Center toll-free at 888‑227‑7877 to request these materials.

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2018 Health Care Premiums – About 80% of Plan Enrollees Will See No Premium Increase for 2018

Open-enrollment packets included personalized information that provided 2018 plan options and monthly premiums. Premiums are also available through the Member Services Center and posted on the STRS Ohio website. A sampling of the medical plan premiums is shown below. Better than projected claims experience for the self-insured plans in 2015 and 2016 and low overall administrative expenses resulted in favorable premiums for 2018 for most members. About 80% of plan enrollees — including 100,000 Aetna Medicare Plan enrollees — will have 2018 premiums equal to or lower than their 2017 premiums.

Monthly Enrollee Premiums for 2018 — With Medicare

Benefit Recipient Years of Service Aetna Medicare Plan (Medicare Advantage PPO)
Total Cost: $342
Medical Mutual Basic (Indemnity or PPO)
Total Cost: $300
AultCare PPO
Total Cost $464
Paramount Elite HMO (Medicare Advantage)
Total Cost: $350
30+ $127 $111 $249 $135
25 $162 $142 $284 $170
20 $198 $174 $320 $206
15 $234 $205 $356 $242
<15* $342 $300 $464 $350
Spouse $342 $300 $464 $350
Per Child $342 $300 $464 $350

Monthly Enrollee Premiums for 2018 — Without Medicare

Benefit Recipient Years of Service Aetna Basic/Medical Mutual Basic (Indemnity or PPO)
Total Cost: $927
AultCare PPO
Total Cost $847
Paramount Health Care (HMO)
Total Cost: $816
30+ $399 $364 $351
25 $487 $445 $428
20 $575 $525 $506
15 $663 $606 $583
<15* $927 $847 $816
Spouse $927 $847 $816
Per Child $243 $234 $226

*Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to the STRS Ohio Health Care Program but pay the full cost of the premium. Members who retire on or after Jan. 1, 2004, and before Aug. 1, 2023, must have at least 15 years of qualifying service credit to access coverage. Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to access coverage.

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Health Care Items of Note

  • Aetna’s network now includes Canton’s Aultman Hospital, along with many related providers. Aultman Hospital is also in-network for the Medical Mutual and AultCare plans.
  • Medical Mutual’s provider network now includes the University Hospitals system in northeast Ohio.
  • Paramount Elite’s service area expanded to include Allen, Erie, Ottawa and Sandusky counties.
  • Most health care plans offer online cost-comparison tools to help you plan ahead and save money. Visit the plan’s website for details.
  • All non-Medicare enrollees must verify employment and access to employer health coverage annually. STRS Ohio will notify you when it’s time to complete the verification process.
  • Medicare enrollment is required for all enrollees age 65 or older. Submit your Medicare information to STRS Ohio to verify your enrollment.

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STRS Ohio’s Open-Enrollment Resource Center Has the Plan Details You Need

Visit STRS Ohio’s Open-Enrollment Resource Center for the information and materials you need to enroll in a health plan. This section of the website includes enrollment instructions, plan coverage features, premiums, the health care enrollment application and more.

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Limited Plan Design Changes for 2018 Eliminate the Need for Health Care Program Highlights Meetings This Fall

For the 2018 plan year, the only plan design change is a $50 increase in the out-of-pocket limit for prescriptions, to $5,000 from $4,950. Since this is the only change to the health care plan for the upcoming year, STRS Ohio will not hold its Health Care Program Highlights meetings. If you have questions regarding your open-enrollment materials, please call STRS Ohio’s Member Services Center toll-free at 888‑227‑7877.

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Sign Up for Premium-Free Medicare Part A

Are you age 65 or older or turning age 65 soon? If so, don’t forget to sign up for premium-free Medicare Part A. STRS Ohio requires all eligible medical plan participants to enroll in Medicare Part B and pay a monthly premium to Medicare. But that’s not all. You also need to sign up for premium-free Medicare Part A if it’s available.

Medicare enrollment is not a new requirement for health care program enrollees, but it’s an important requirement to meet. If you do not enroll in Medicare, you may become ineligible for STRS Ohio medical coverage.

Some retirees may believe they do not qualify for Medicare because they did not contribute to Social Security. However, you are eligible for Medicare Part B when you turn age 65 even if you are not eligible for Social Security retirement benefits. A monthly premium is required for this coverage.

Premium-free Medicare Part A coverage may also be available. Most U.S. citizens or permanent residents age 65 or older qualify for premium-free Medicare Part A (hospital insurance) based on their own or their current or former spouse’s employment history. Some individuals under age 65 with a qualifying disability, end-stage renal disease or ALS may also be eligible for Medicare Part A.

Here are some facts about premium-free Medicare Part A eligibility:

  • You are eligible at age 65 based on your own employment history if you paid Medicare taxes for at least 40 quarters while working in a federal, state or local government job (including public education). This applies to most STRS Ohio members. You also qualify for premium-free Part A coverage if you receive Social Security or Railroad Retirement benefits or you are eligible to receive these benefits but haven’t filed for them yet.
  • If you do not qualify for premium-free Medicare Part A based on your own employment history, you may qualify based on your current or former spouse’s work history if: (1) you are currently married for at least one year and your spouse is age 62 or older; (2) you are divorced and currently single, and you were married for at least 10 years; or (3) you are widowed and currently single, and you were married for at least nine months before your spouse died.
  • Your spouse does not need to apply for Social Security benefits for you to be eligible for premium-free Medicare Part A based on his or her employment history.
  • If you are not eligible for premium-free Medicare Part A at age 65 but you later become eligible through your spouse, you must contact Social Security to sign up at no cost.
  • If premium-free Medicare Part A is available, you must enroll and provide proof of enrollment to STRS Ohio.

Please contact Social Security if you have questions about qualifying for premium-free Medicare Part A. For more information about Medicare enrollment, visit the Health Care section of the STRS Ohio website.

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Retirement Board Adopts Health Care Premium Subsidy Plan for 2019 and Beyond That Is Designed to Extend the Life of the Health Care Fund

At its October meeting, the Retirement Board adopted a new plan for providing health care premium subsidy assistance to benefit recipients who are enrolled in the STRS Ohio Health Care Program. The new subsidy strategy will go into effect in 2019 and will not affect the 2018 health care plan or premiums.

Since STRS Ohio health care plan enrollees are eligible for Medicare for most of their retirement years, the board-approved subsidy plan will offer greater protection against health care inflation for Medicare enrollees than for non-Medicare enrollees. Under the new subsidy plan, benefit recipients who are enrolled in an STRS Ohio health care plan under Medicare will receive a subsidy that will grow with health care inflation up to a cap of 6%. Non-Medicare enrollees will receive the same subsidy dollar amounts that are offered in 2018; however, this dollar amount will not grow with inflation in the future.

The newly adopted plan is projected to extend the solvency of the Health Care Fund to the year 2047. The fund previously was estimated to remain solvent through 2034. Additional details on subsidies, plan design and 2019 plan premiums will be shared in the spring/summer 2018 newsletters.

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Health Care Assistance Program Available to Help With Health Care Costs

STRS Ohio’s Health Care Assistance Program (HCAP) provides qualifying benefit recipients with medical and prescription drug coverage for no monthly premium. Eligibility for the program is based on an annual family income limit of $23,800 and a household liquid asset limit of $23,800. (A home is not considered a liquid asset.)

New HCAP applicants must be eligible for a subsidy under the STRS Ohio Health Care Program to qualify for HCAP enrollment. Benefit recipients, survivors and beneficiaries who are currently enrolled in HCAP are not subject to the subsidy requirement as long as they continue to meet all other HCAP requirements and remain continuously enrolled in the program. New and current STRS Ohio Health Care Program enrollees may apply. The application is available on the STRS Ohio website or by request from the Member Services Center at 888‑227‑7877 (toll-free).

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