Your Health Care Coverage in Retirement

Currently SERS offers health care coverage, which includes medical and prescription drug coverage, to qualifying benefit recipients. When you enroll, you may cover your spouse, and children up to age 26.

To the extent that resources permit, SERS intends to continue offering access to health care coverage. However, SERS reserves the right to change or discontinue any plan or program at any time.

Health care coverage from a school employer is different than coverage available for retirees. Employers typically offer more generous health care benefits as part of their overall compensation package. Once you retire, you may find that your costs are higher.

Please see the Member Health Care Guide for a comprehensive guide to SERS’ health care program.


Health Care Eligibility

You are eligible for coverage if you have 10 years of qualified service credit.

Qualified service credit includes:

  • Earned or restored service
  • Contributing STRS, OPERS, Ohio Police & Fire, Ohio Highway Patrol Retirement System, and Cincinnati Retirement System service credit, provided the credit is not earned at the same time SERS service credit is earned
  • Workers’ Compensation credit

Qualified service credit does not include:

  • Military (other than free or interrupted military service credit)
  • Federal government, private school, or out-of-state service
  • Exempted service
  • ERI (Early Retirement Incentive), or ‘buy out’

There are three times when you can enroll in SERS’ coverage:

  • When you retire or begin receiving a disability benefit
  • Within 90 days of becoming eligible for Medicare
  • Within 31 days of the involuntary termination of health care coverage under another plan. Proof of involuntary termination is required.

 


Eligible for Medicare?

If you are retiring because you are nearing age 65 and will be eligible for Medicare, learn more about Medicare enrollment.


 

How do I Qualify for a Premium Subsidy?

SERS helps reduce health care premiums by providing a subsidy to those who qualify. You must have at least 20 years of qualified service credit, or be receiving a disability benefit. In addition, at the time of retirement, disability, or separation from service, you must:

  • be eligible to participate in the health care plan of your last school employer, or
  • have been eligible to participate in the health care plan of your school employer at
    least three of the last five years of service

If you are eligible for your employer’s health care coverage and have slightly less than 20 years of service credit, it may be beneficial to work until you have 20 qualified years of service.

The following charts show monthly premiums with and without a premium subsidy for a service retiree:

2022 Non-Medicare Premiums


Non-Medicare Plans

No Premium Subsidy

20 Years Qualified Service Credit

25 Years Qualified Service Credit

30 Years Qualified Service Credit

Aetna Choice POS II

$1,524*

$780

$482

$333

AultCare PPO

$1,075*

$555

$347

$243

*If you do not qualify for a premium subsidy, you must pay the full premium regardless of your qualified years of service credit.

2023 Non-Medicare Premiums


Non-Medicare Plans

No Premium Subsidy

20 Years Qualified Service Credit

25 Years Qualified Service Credit

30 Years Qualified Service Credit

Aetna Choice POS II

$1,524*

$780

$482

$333

AultCare PPO

$1,106*

$571

$356

$249

*If you do not qualify for a premium subsidy, you must pay the full premium regardless of your qualified years of service credit.

2022/2023 Medicare Premiums


With Medicare Part A and B

No Premium Subsidy

20 Years Qualified Service Credit

25 Years Qualified Service Credit

30 Years Qualified Service Credit

Aetna Medicare Plan (PPO)

$198*

$117

$84

$68

*If you do not qualify for a premium subsidy, you must pay the full premium regardless of your qualified years of service credit.

Things to Consider When Choosing Health Insurance

  • Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services).
  • Co-pays and coinsurance: Payments you make each time you get a medical service after reaching your deductible.
  • Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

View and download: Member Health Care Guide

Are your doctors and hospitals in the plan’s network? When you go out of network, your costs could be higher or may not be covered depending on the plan type.

Provider Search for Aetna Medicare Plan PPO

Provider Search for Aetna Choice POS II

Provider Search for AultCare PPO

It is best to look at a plan’s list of covered prescription drugs. Generic coverage is normal but coverage for brand-name medications varies.

Will My Prescription Drugs Be Covered?

Drug Cost Estimate Worksheet

Before You Call: Answers to Frequently Asked QuestionsCLICK HERE