How HPRS coverage works with Medicare
HPRS is the pension system for members of the Ohio State Highway Patrol. It's the smallest of Ohio's five statewide systems, and it finished moving Medicare-eligible retirees to an exchange model in January 2022:
- Medicare Parts A and B. Medicare pays first. You pay your Part B premium to Medicare.
- An individual plan bought through the HPRS Medicare Connector. The Connector is a marketplace run by a vendor HPRS partnered with; the vendor isn't an insurance company but contracts with several. You choose a Medicare Advantage plan or a Medicare Supplement (Medigap) policy, usually with a Part D plan. HPRS has no prescription plan of its own.
- A monthly HRA allowance. HPRS funds the HRA; only HPRS can contribute to it. You pay costs up front, then submit them for tax-free reimbursement under IRS rules.
HPRS says Medicare-eligible retirees "will be required to access their health care through" the Connector to be eligible for the HRA. A plan bought anywhere else doesn't qualify.
What the HRA pays for
The HRA reimburses qualified medical expenses such as monthly insurance premiums (including Medicare premiums), deductibles, coinsurance and copays, for you and your eligible spouse or dependents. Only the retiree receives the allowance, but you can use it for an eligible spouse's or dependent's expenses. Surviving spouses who qualify receive their own allowance.
The HPRS board sets the HRA allowance each year based on actuarial projections and available funds, and it raised the Medicare allowance for 2027. HPRS posts the 2027 HRA allowance on its Health Care Benefits page.
Eligibility: for a pension or DROP that starts on or after November 1, 2023, you need at least 20 years of health care service credit (OAC 5505-7-04). Anyone currently employed by the Highway Patrol isn't eligible for the HRA.
Parts A and B
HPRS's HRA plan document sets three enrollment requirements for the Medicare HRA: enrollment in Medicare Parts A and B, enrollment in a Medicare plan bought through the Connector, and completion of HPRS's enrollment forms. The allowance is paid for a month only if your Parts A and B and your Connector plan are in effect on the first day of that month.
- Part A: most HPRS retirees qualify for premium-free Part A, because state employees hired after March 31, 1986 paid Medicare tax. HPRS's Connector page has a section for retirees hired before 1986. If you must pay a Part A premium ($565 a month in 2026 with fewer than 30 quarters of Medicare-covered work, $311 with 30 to 39), the HRA plan lets the HPRS board add a supplemental allowance toward it, up to the premium you pay. Ask HPRS before you enroll.
- Part B: required for the HRA. The standard 2026 premium is $202.90 a month; higher incomes pay more (see the IRMAA calculator). HPRS's Part B reimbursement was eliminated in 2017. The Part B premium is an HRA-eligible expense instead.
What happens if you don't enroll
- Drop Part A or Part B, or your Connector plan: participation ends the first of the month after, claims after that date aren't reimbursed, and unused money is forfeited 90 days after participation ends. It's restored if you later become eligible again.
- Miss your first window: retirees who become eligible after January 1, 2024 must join the Medicare HRA during their Initial Enrollment Period. Otherwise you wait for the next open enrollment unless you have a special enrollment period (within 60 days of losing coverage or another IRS-recognized change).
- Medicare penalties: delaying Part B without coverage from current employment brings a lifelong penalty of 10% for each full 12 months. HPRS retiree coverage isn't current-employment coverage. See the penalty calculator.
Enrollment windows for 2027
| What | When |
|---|---|
| Turning 65 | Enroll in Parts A and B through Social Security, then in a plan through the HPRS Medicare Connector during your Initial Enrollment Period. |
| Medicare Advantage and Part D changes for 2027 | Medicare Open Enrollment, Oct. 15 – Dec. 7, 2026, through the Connector. |
| HPRS dental and vision | November open enrollment, or after a qualifying event. |
| Your plan isn't renewing | A special enrollment period applies; see plans ending in 2027. |
Medigap policies bought through the Connector follow Ohio's Medigap rules: outside your 6-month Medigap open enrollment period or a guaranteed-issue right, a company can ask health questions. See Medigap in Ohio.
Spouses and dependents
- Your HRA can reimburse an eligible spouse's or dependent's qualified expenses.
- You and a Medicare-eligible covered dependent can choose different plans through the Connector.
- A dependent who has health coverage available through another state or federal retirement system, whether or not they take it, can't join the HPRS Medicare HRA.
How to contact HPRS
- HPRS: 614-431-0781, ohprs.org, 1900 Polaris Parkway, Suite 201, Columbus (8 a.m. – 4:30 p.m. weekdays).
- HPRS Medicare Connector: 1-833-431-1358.
- Social Security: 1-800-772-1213, TTY 1-800-325-0778.
HPRS says it provides these benefits "as funds are available" and that retiree health care isn't required by statute. Compare HPRS with the other systems on OPERS vs. STRS vs. SERS retiree coverage and Ohio's public retirement systems and Medicare.
Sources
- Ohio Highway Patrol Retirement System — Health Care Benefits
- HPRS — Medicare Connector Information
- HPRS — Medicare Connector Frequently Asked Questions
- HPRS — Retiree Pre-Medicare and Medicare HRA Plan Document (October 2023, with addenda)
- Ohio Administrative Code 5505-7-04 — HPRS health care
- HPRS — 2025 Health Care Report to the Ohio Retirement Study Council (June 2026)
- Social Security Administration — Mandatory Medicare Coverage
- Medicare.gov — Avoid late enrollment penalties
Frequently asked questions
How does HPRS retiree health care work with Medicare?
HPRS deposits a monthly HRA allowance for Medicare-eligible retirees who are enrolled in Medicare Parts A and B and who buy a Medicare plan through the HPRS Medicare Connector, a marketplace run by a vendor HPRS chose. You pay your premiums and costs, then get reimbursed from the HRA. HPRS has no prescription plan of its own; drug coverage comes from the plan you choose.
Does HPRS pay for Medicare Part B?
Not separately. HPRS eliminated its Part B reimbursement in 2017, and Ohio Administrative Code 5505-7-04 sets the amount at zero for 2017 and later. Medicare premiums, including Part B, are expenses your HRA can reimburse.
Do HPRS retirees have to enroll in Medicare Parts A and B?
To get the HRA, yes. HPRS's HRA plan document makes enrollment in Medicare Parts A and B, plus a Medicare plan bought through the Connector, a condition of joining the Medicare HRA, and participation ends the month after you're not enrolled in both parts.
What if I don't qualify for premium-free Part A?
HPRS's HRA plan lets its board add a supplemental allowance for retirees and surviving spouses who must pay a Part A premium, up to the premium they pay. Ask HPRS whether a supplemental allowance applies to you before you enroll.
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