Health Care Coverage
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:
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.
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
1. Your Total Costs for Health Care: Premium, Deductible, and Out-of-Pocket Costs
- 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
2. Plan Type and Provider Network
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
3. What Prescription Drugs are Covered?
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.
4. If You Are Not Yet Medicare Eligible (Under 65)
Health care premiums are expensive when you are under age 65 because you do not yet qualify for Medicare.
The SERS Wraparound Health Reimbursement Arrangement (HRA) is SERS’ most affordable non-Medicare coverage option.
The SERS Wraparound HRA works in combination with the Health Insurance Marketplace, offering low premiums. If you choose this plan, your health care coverage will be through the Marketplace plan you select.
You pay premiums directly to the Marketplace plan. The SERS Wraparound HRA reimburses you for eligible out-of-pocket expenses up to $1,950 annual per family.
This option is only available for SERS enrollees under age 65 who do not choose to enroll a spouse in SERS’ Medicare Advantage plan.
For more information, see the SERS Wraparound HRA Brochure and Wraparound Cost Sheet.
