OP&F's Medicare rules
OP&F ended its group health plans in 2018 and 2019 and moved to a stipend model. For retirees with Medicare, its Health Care page and Ohio Administrative Code 742-7-11 set these rules:
- Parts A and B: required at 65 (and for early Medicare). The rule says you must enroll in both at your first eligibility date; being in one part but not the other makes you ineligible for the HRA and stipend.
- Proof: send OP&F a copy of your Medicare card.
- 60 days: enroll in a medical and/or prescription drug plan through OP&F's marketplace vendor within 60 days of Medicare eligibility or losing employer coverage.
- No other group coverage: you're stipend-eligible unless you have access to other group coverage, such as from an employer or another retirement system, or previously waived it.
Retiree health care support from OP&F is discretionary, not a vested right; the board can change it.
How the stipend and HRA work
OP&F funds a single health reimbursement arrangement (HRA) in your name with a monthly stipend based on your and your dependents' Medicare status. You use it to repay premiums for your marketplace plan and other qualified costs. A full annual stipend is credited each January 1, and any amount you don't use by year-end is forfeited. OP&F publishes current stipend levels on its Health Care page, and a low-income stipend increase application for 2027 is available for households at or below 250% of the federal poverty level.
Through the vendor you can choose Medicare Advantage, Medigap and Part D plans available in your Ohio county (or wherever you live). OP&F's vendor FAQ lists December 7 as the deadline for January 1 changes, matching Medicare's Open Enrollment.
Your checklist at 65
- Enroll in Parts A and B. Through Social Security (ssa.gov or 1-800-772-1213), during your Initial Enrollment Period.
- Send OP&F your Medicare card. Keep a copy.
- Book the vendor appointment. A benefits advisor reviews plans; the call number is on OP&F's Health Care page.
- Enroll within 60 days. Missing the window means waiting for a qualifying life event.
For a second opinion on plans, you can request a call from a licensed insurance agent. OP&F customer service: 1-833-521-4673. More in our guide to OP&F and Medicare.
Related questions
How does the OPERS Medicare Connector work?
A similar marketplace model.
How does HPRS work with Medicare?
Highway Patrol retirees.
Does the Social Security Fairness Act change Medicare?
What it did for police and firefighters.
Sources
- OP&F — Health Care
- Ohio Administrative Code 742-7-11 — Health reimbursement arrangement and stipend program
- Ohio Revised Code 742.45 — Health care coverage; Medicare Part B
- OP&F — 2025 Health Care Report to the Ohio Retirement Study Council
- Social Security — Lower your IRMAA
More questions in this guide
- Can STRS Ohio retirees join a different Part D plan?
- Do federal retirees in Ohio need Medicare Part B with FEHB?
- Do Ohio teachers have to pay for Medicare Part A?
- Do OPERS retirees have to enroll in Medicare?
- Do postal retirees in Ohio need Medicare Part B for PSHB?
- Do STRS Ohio retirees need Medicare Part B?
- Does OPERS pay for Medicare Part B?
- Does SERS reimburse Medicare Part B?
- Does the Social Security Fairness Act change Medicare for Ohio public retirees?
- How does HPRS retiree health care work with Medicare?
- How does the OPERS Medicare Connector work?
Part of the guide: Ohio's public retirement systems and Medicare · All questions
Frequently asked questions
What if I enroll in a Medicare plan outside OP&F's marketplace?
OP&F says enrolling in a plan outside its vendor makes you ineligible for OP&F's health care program, and you'd need a qualifying life event to become stipend-eligible again.
Does OP&F reimburse Medicare Part B?
Yes. Ohio Revised Code 742.45 requires OP&F to pay a monthly Part B amount to eligible benefit recipients, at least a minimum set in the law and no more than what you pay. It isn't paid if another source reimburses your Part B. OP&F publishes the current amount.
Does an OP&F DROP payout count as income for IRMAA?
If it's taxable, it can. Social Security bases IRMAA on the adjusted gross income plus tax-exempt interest on your federal tax return from two years earlier. Ask a tax professional about rollover options, and if your income drops after you stop working, you can ask Social Security for a new decision with form SSA-44.
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