What the law allows
Section 1316.3 of Title 74 lists the plans an OTRS retiree can continue: plans offered through the Oklahoma Health Care Authority (which now runs EGID and HealthChoice), including its Medicare supplements and the Medicare Advantage ("Medicare risk-sharing") plans it offers as alternatives, plus a participating education employer's own plan if that employer doesn't use the state plans. It also says where OTRS sends the money:
| Where your coverage is | Does the OTRS supplement apply? | Who OTRS pays |
|---|---|---|
| HealthChoice Medicare supplement through EGID | Yes | The Oklahoma Health Care Authority (EGID) |
| A Medicare Advantage drug plan offered through EGID | Yes | The Oklahoma Health Care Authority (EGID) |
| A participating school district's own retiree plan | Yes | The education employer |
| A Medigap, Medicare Advantage or Part D plan you buy yourself | No | Not paid |
OTRS's rule, OAC 715:10-23-2, says the same: the supplement is for retired members enrolled in the State and Education Employees Group plan or in a participating education employer's program who had at least 10 years of Oklahoma service. A related rule, 715:10-23-5, says retirees in neither are not eligible. OTRS's own FAQ puts it plainly: it subsidizes your health insurance only if you stay with your employer's insurance.
Before you leave EGID for your own plan
- Add up the real cost. Compare an individual plan's premium with your EGID premium after the OTRS supplement, which you'd give up.
- Know it's usually permanent. EGID's 2027 guide says you can't regain EGID coverage after you drop it.
- Check your family. A spouse or dependent on your EGID account would need coverage of their own.
- Time it. EGID changes happen during its Option Period, October 15 to December 7, for coverage starting January 1.
Medigap rights also matter: leaving group coverage doesn't always give you a guaranteed right to buy a Medigap policy without health questions. See Medigap in Oklahoma.
Related questions
Do OTRS retirees need Part B?
What each plan requires.
What Medicare options do state and education retirees have?
EGID's plans for 2027.
Do I need Part B with the HealthChoice supplement?
How HealthChoice pays without Part B.
More in state and teacher retirees and Medicare. To compare EGID's options with individual plans from the companies they work with, you can request a call from a licensed insurance agent.
Sources
- OSCN — 74 O.S. § 1316.3, continuation of health insurance for OTRS members
- Oklahoma Administrative Code — OAC 715:10-23-2, health insurance premium supplement
- Oklahoma Administrative Code — OAC 715:10-23-5, ineligibility for the supplement
- Teachers' Retirement System of Oklahoma — Employees Group Insurance Division FAQ
- Teachers' Retirement System of Oklahoma — Frequently asked questions (health coverage)
- OHCA Employees Group Insurance Division — 2027 Medicare Options Benefit Guide
More questions in this guide
- Do I need Medicare Part B with the HealthChoice Medicare supplement?
- Do Oklahoma Teachers' Retirement (OTRS) retirees need Medicare Part B?
- What Medicare options do Oklahoma state and education retirees have?
- What do Oklahoma state retirees on HealthChoice need to do when they turn 65?
Part of the guide: Oklahoma State and Teacher Retirees: HealthChoice and Medicare · All questions
Frequently asked questions
Who qualifies for the OTRS supplement?
A retired OTRS member with at least 10 years of Oklahoma service who kept their employer's health coverage, electing it within 30 days of leaving employment. OTRS rules say retirees who aren't receiving monthly OTRS benefits, or who aren't in the state plan or a participating employer's plan, aren't eligible.
How much is the supplement?
It's set by a schedule in 74 O.S. § 1316.3 based on your years of service and the average salary used for your retirement, and it can't exceed your plan's premium. For EGID plans, it's applied first to the drug coverage part of the premium.
If I switch to an individual Medicare Advantage or Medigap plan, can I come back to EGID?
Generally no. EGID's 2027 guide says that if you drop your EGID health plan, you can't regain coverage through EGID later and you lose any premium contribution from your retirement system.
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