Medical Coverage

If you are a PSERS retiree, survivor annuitant, or the spouse or dependent child of a PSERS retiree or survivor annuitant, and you are eligible for Medicare, you can enroll in:

• Medicare Supplement plan:
  • HOP Medical Plan
  • Value Medical Plan
• Medicare Advantage plan (Highmark, Aetna, Independent Blue Cross, Capital Blue Cross, or UPMC)

Medicare Supplement Plans

If you keep Original Medicare, you can supplement it by enrolling in a Medicare Supplement plan. With both Medicare Supplement plans, you can enroll in medical-only coverage or add prescription drug coverage with the Enhanced, Basic, or Value Medicare Rx Option.

HOP Medical Plan

The HOP Medical Plan covers many of the deductibles, coinsurance, and other expenses that you are required to pay under Original Medicare.

Plan highlights:

• Use any health care provider (doctor or hospital) that accepts Medicare.
• Pay nothing for covered hospital and medical expenses, except for a $10-per-physician visit or $20-per-specialist-visit copay. 
• Stay covered anywhere in the United States and abroad while traveling. 
• Access the SilverSneakers fitness program at no additional cost.
• Add additional coverage through the MetLife Dental and EyeMed Vision Option.

Value Medical Plan

The Value Medical Plan offers a low monthly premium in exchange for paying more out of pocket when obtaining services. It is designed to provide financial protection in the event of unexpected high-cost medical and hospital expenses. 

Plan highlights:

• Use any health care provider (doctor or hospital) that accepts Medicare. Coverage while traveling abroad is limited to services covered by Medicare. 
• Pay an annual deductible ($240 in 2024) before the Plan starts sharing in the cost of covered services. Note: If you exhaust your Medicare benefits, this plan does not provide additional coverage. 
• Pay a $300-per-admission copay if you are admitted to the hospital. Then the Plan pays 100% of Medicare’s hospital deductible and daily copays.
• Add additional coverage through the MetLife Dental and EyeMed Vision Option.

Medicare Advantage Plans

The Medicare Advantage plans (also known as Medicare Part C plans) provide benefits designed especially for the Health Options Program. Medicare Advantage plans are available through Highmark, Aetna, Independent Blue Cross, Capital Blue Cross, and UPMC.

You can choose a Medicare Advantage plan instead of Original Medicare and a Medicare Supplement plan. 

Highlights:

• Plan combines medical and prescription drug benefits in a single program. If you choose this option, you cannot enroll in any other Medicare prescription drug plan.
• Insurance companies have contracted with the federal government to provide Medicare benefits. Each insurance company sets its own benefits and member rates.
• Each plan serves only certain areas, so the plans available to you depend on where you live. 
• You must use an in-network provider to receive the maximum benefit. 

See the regional Medicare Advantage plan guides for descriptions of the Medicare Advantage plans available where you live, the benefits they provide, and their rates.

Comparable coverage for your spouse

If you and your spouse are both PSERS retirees, you may individually enroll in any option. If your spouse is NOT a PSERS retiree and is Medicare-eligible, he or she must enroll in the same plan in which you are enrolled. If your spouse is not eligible for Medicare, he or she must enroll in the same type of plan in which you are enrolled (the HOP Pre-65 Medical Plan if you enroll in the HOP or Value Medical Plan, or a managed care plan offered by the same insurance company if you enroll in a Medicare Advantage plan).

Last Modified: April 22, 2024