How OP&F coverage works with Medicare
OP&F covers Ohio's full-time police officers and firefighters. Since 2019 its retiree health care has been a stipend-based program rather than a group plan:
- Medicare Parts A and B. OP&F says "retirees who are 65 years of age or older must be enrolled in Medicare Part A and Part B and provide OP&F with a copy of your Medicare card." Early Medicare recipients (disability) must do the same.
- A plan bought through OP&F's vendor. OP&F works with a private marketplace vendor that offers Medicare Advantage, Medigap and Part D plans from many national and regional insurance companies. You must enroll in a medical or prescription drug plan through that vendor to receive the stipend. The vendor schedules a phone appointment with a benefits advisor for newly eligible members.
- An HRA funded by the stipend. OP&F deposits a stipend into an HRA in your name, administered by a separate vendor. You pay premiums and qualified costs, then get reimbursed. You receive the full annual stipend amount each January 1, and any amount not used by the end of the year is forfeited.
OP&F set its stipend levels in 2019 and kept them unchanged through 2026; current levels are on OP&F's Health Care page under "Monthly Stipend Levels." The stipend can be higher if eligible dependents are covered, and it's prorated by Medicare status, month of retirement and enrollment date.
Eligibility: retirees receiving service or disability benefits are eligible for the stipend unless they have access to other group coverage (from an employer or another retirement system) or previously waived coverage. If your spouse or dependents have other group coverage, you don't get the increased stipend for them.
Part A
OP&F's web page and rule both call for Part A and Part B. Ohio Administrative Code 742-7-11 requires recipients to "enroll in medicare part A and medicare part B at his or her first eligibility date," and someone eligible for Medicare who "is enrolled in one Part but not the other" can't receive the HRA or stipend.
Most OP&F retirees qualify for premium-free Part A, because police and fire employees hired after March 31, 1986 paid Medicare tax. If you were hired earlier and Social Security says you'd have to pay a Part A premium ($565 a month in 2026 with fewer than 30 quarters of Medicare-covered work, $311 with 30 to 39), ask OP&F how the rule applies to you before you decide. You may also qualify for premium-free Part A through a spouse's work record.
Part B and the Part B reimbursement
Part B is required. The standard 2026 premium is $202.90 a month; higher incomes pay more (see the IRMAA calculator).
OP&F is one of two Ohio systems that still reimburse Part B directly (SERS is the other). Ohio Revised Code 742.45(B) says OP&F "shall … pay monthly" to service, disability and survivor benefit recipients who are eligible for Part B:
- an amount set by the board that can't be less than the minimum written into the law, and can't be more than what you actually pay for Part B;
- starting the month after OP&F receives satisfactory proof that you pay for Part B;
- only one payment per person, even if you receive more than one OP&F benefit; and
- none if another source reimburses your Part B premium, such as Ohio Medicaid or a Medicare Savings Program.
OP&F reports the current amount in its member newsletters; call OP&F to confirm what you'll receive.
What happens if you don't enroll
- No Parts A and B, or only one: no stipend or HRA (OAC 742-7-11).
- Miss the 60-day window: you must enroll through the vendor within 60 days of Medicare eligibility or of losing employer group coverage. After that you need a qualifying life event to become stipend-eligible again.
- Buy a plan outside the vendor: OP&F says you "will become ineligible to participate in OP&F's health care program" until a qualifying life event.
- Medicare penalties: delaying Part B after your Initial Enrollment Period without coverage from current employment brings a lifelong penalty of 10% for each full 12 months. See the penalty calculator.
Guaranteed acceptance when you first enroll. OP&F's vendor says Medicare Advantage and Part D plans you're eligible for are guaranteed issue, at your first transition and in each later open enrollment period, and that most Medigap policies are guaranteed issue when you're losing an employer group plan, with exceptions. Outside those times, a Medigap company in Ohio can ask health questions; see Medigap in Ohio.
Enrollment windows for 2027
| What | When |
|---|---|
| Turning 65 or newly eligible for Medicare | Enroll in Parts A and B through Social Security during your Initial Enrollment Period, then enroll through OP&F's vendor within 60 days of Medicare eligibility. |
| Changing your Medicare plan for 2027 | December 7, 2026 is the deadline for coverage starting January 1, 2027, unless you qualify for a special enrollment period. |
| Low-income stipend increase for 2027 | File OP&F's 2027 application with your latest federal tax return; new retirees and new survivors within 60 days of their qualifying event. |
| Your plan isn't renewing | A special enrollment period applies, and OP&F lists losing a plan that ended its Medicare contract as a qualifying life event. See plans ending in 2027. |
DROP payouts, income and IRMAA
Medicare's income-related monthly adjustment amounts (IRMAA) for Part B and Part D are based on the modified adjusted gross income on your federal tax return from two years earlier. A year with unusually high taxable income, such as a year you take a taxable Deferred Retirement Option Plan (DROP) distribution, can raise your Medicare premiums two years later. How a DROP payout is taxed depends on how you take it; a tax professional can explain your options. If your income falls because you stopped working, you can ask Social Security to use a more recent year with form SSA-44. See the IRMAA calculator.
Spouses and dependents
- Covering eligible dependents can increase your stipend, unless they have access to other group coverage.
- A single HRA in your name covers claims for every eligible participant.
- Medicare is individual: a Medicare-eligible spouse enrolls in Medicare and picks a plan separately.
- Survivor benefit recipients can be eligible for the stipend and the Part B reimbursement.
How to contact OP&F
- OP&F: 1-888-864-8363 (its Health Care page also lists customer service at 1-833-521-4673), op-f.org.
- OP&F's marketplace vendor: 1-844-290-3674, Monday – Friday, 9 a.m. – 9 p.m. Eastern.
- Social Security: 1-800-772-1213, TTY 1-800-325-0778.
OP&F calls its retiree health care support "a discretionary benefit and not a vested right" that can change at any time. See how OP&F compares with the other systems on OPERS vs. STRS vs. SERS retiree coverage and Ohio's public retirement systems and Medicare.
Sources
- Ohio Police & Fire Pension Fund — Health Care
- OP&F — Medicare FAQ
- OP&F — 2027 Low-Income Stipend Increase Application
- Ohio Administrative Code 742-7-11 — Health care stipend eligibility
- Ohio Revised Code 742.45 — Health care and Medicare Part B payments
- OP&F — 2025 Health Care Report to the Ohio Retirement Study Council (June 2026)
- Social Security Administration — Lower your IRMAA
- Medicare.gov — Avoid late enrollment penalties
Frequently asked questions
What happens to OP&F health care when I turn 65?
You must enroll in Medicare Parts A and B, send OP&F a copy of your Medicare card, and enroll in a Medicare medical or prescription drug plan through OP&F's marketplace vendor within 60 days of becoming eligible for Medicare. OP&F then funds your HRA with a stipend you can use to reimburse premiums and other qualified costs.
Do I have to enroll through OP&F's vendor to keep my stipend?
Yes. OP&F says that if you enroll in a plan outside its vendor you become ineligible for OP&F's health care program and need a qualifying life event to become stipend-eligible again. Its rule also denies the stipend to anyone eligible for Medicare who is enrolled in only Part A or only Part B.
Does OP&F reimburse the Medicare Part B premium?
Yes. Ohio Revised Code 742.45 requires OP&F to pay a monthly amount toward Part B to service, disability and survivor benefit recipients who pay for Part B. The board sets the amount, which can't be lower than the minimum in the law or higher than what you pay. Only one payment is made per person, and none if another source reimburses the premium.
Does an OP&F DROP payout count as income for IRMAA?
IRMAA is based on the modified adjusted gross income on your federal tax return from two years earlier, so any taxable distribution in a year, including a taxable DROP payment, can raise your Medicare premiums two years later. Ask a tax professional how your payout will be taxed. If your income later drops because you stopped working, you can ask Social Security to use a more recent year with form SSA-44.
What is the OP&F low-income stipend increase?
For 2027, OP&F may raise the stipend by 30 percent for eligible participants whose household income on their latest federal tax return is at or below 250 percent of the federal poverty level. You must apply each year; newly retired members and new survivors must apply within 60 days of their qualifying event.
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