The choices at a glance
This comparison is for Medicare-eligible retirees with coverage through the Employees Group Insurance Division (EGID), part of the Oklahoma Health Care Authority since July 2024. It uses EGID's 2027 Medicare Options Benefit Guide, the OTRS and OPERS rules, and Medicare's own rules. It doesn't compare specific plans' premiums or benefits; those are in EGID's guide and each plan's documents.
| Option | How it works | Medicare you need | Retirement system premium help |
|---|---|---|---|
| HealthChoice Medicare supplement (High or Low Option) through EGID | Pays after Original Medicare; any provider that accepts Medicare; includes Part D | Part A required; plan pays as if you have Part B, so you need Part B in practice | Yes, OTRS or OPERS contribution continues if you're eligible |
| Medicare Advantage plan through EGID (PPO or HMO) | Replaces Original Medicare and includes Part D; HMOs limited to certain Oklahoma ZIP codes | Part A and Part B | Yes, contribution continues if you're eligible |
| Your own Medigap policy plus a Part D plan (leaving EGID) | Standardized Medigap plan pays after Original Medicare; separate drug plan | Part A and Part B | No; EGID says you lose it |
| Your own Medicare Advantage plan (leaving EGID) | Individual plan that replaces Original Medicare, usually with Part D | Part A and Part B | No; EGID says you lose it |
What you give up by leaving EGID
| Question | Staying in an EGID plan | Leaving EGID for your own plan |
|---|---|---|
| Can you come back later? | You can switch among EGID plans each Option Period | EGID says you can't regain EGID coverage in the future |
| OTRS supplement | Paid toward your EGID or participating employer premium if you're eligible | OTRS says it pays only if you stay with your employer's insurance |
| OPERS contribution | Paid toward your EGID or eligible employer plan premium if you're eligible | OPERS rules say it isn't paid directly to retirees |
| Dependents | EGID requires covered dependents to enroll in the same plan you choose | Each person with Medicare buys their own individual plan |
| When you can change | EGID Option Period, October 15 to December 7 | Medicare's enrollment periods; Medigap can be bought any time, but outside guaranteed-issue situations a company may use medical underwriting |
If you're thinking about your own Medigap policy
- Timing matters. Medicare.gov says the best time to buy is your Medigap Open Enrollment Period: the 6 months starting the first day of the month you're 65 or older and enrolled in Part B. After that, your options may be limited and the policy may cost more. Many retirees who stayed on HealthChoice when they turned 65 are already past this window.
- Guaranteed issue is narrow. Federal rules give you a right to buy certain Medigap plans within 63 days after an employer group plan (including retiree coverage) that pays after Medicare ends. Choosing to drop coverage you could have kept generally isn't the plan ending.
- Oklahoma's birthday rule lets people who already have a Medigap policy switch each year around their birthday; see does Oklahoma have a Medigap birthday rule? and Medigap in Oklahoma.
Two Part D plans won't work
Every EGID Medicare plan includes Part D, and Medicare allows only one Part D plan at a time. EGID says that if you join an outside plan with Part D, Medicare ends your EGID Part D, and EGID moves you to a plan without Part D at a higher premium until the next Option Period. If you're comparing an outside plan, decide before you enroll; don't enroll first to see what happens.
How to decide
- Make sure you have Part A and Part B. Every option here needs Part B in practice, and retiree coverage doesn't give you a later special enrollment period.
- Add up the real cost of staying. Take the EGID premium for your plan from EGID's guide, then subtract your OTRS or OPERS contribution, which EGID's listed premiums don't include.
- Price the outside options honestly. Include a Part D plan with any Medigap policy, and check whether a Medigap company will accept you if you're outside your open enrollment period.
- Check doctors and drugs. For any Medicare Advantage plan, inside or outside EGID, confirm your doctors and pharmacies are in the network.
- Get help before you leave. Leaving EGID is generally permanent. To compare Medigap and Medicare Advantage plans from the companies they work with against what you have now, you can request a call from a licensed insurance agent, or see plans for your ZIP code. For EGID questions, call EGID Member Services at 405-717-8780 or 800-752-9475 (TTY 711).
Read the full guide: Oklahoma state and teacher retirees and Medicare. See also Medigap vs. Medicare Advantage in Oklahoma.
Sources
- EGID (Oklahoma Health Care Authority) — 2027 Medicare Options Benefit Guide
- EGID (Oklahoma Health Care Authority) — Medicare plans for former employees
- EGID (Oklahoma Health Care Authority) — Option Period for Medicare-eligible members
- Teachers' Retirement System of Oklahoma — OMES Employees Group Insurance Division FAQ
- OSCN — 74 O.S. § 1316.3
- OSCN — 74 O.S. § 1316.2
- OPERS — Oklahoma Administrative Code Title 590, Chapter 10 (590:10-1-4)
- Medicare.gov — When can I buy Medigap?
- Medicare.gov — Choosing a Medigap Policy (guaranteed issue rights)
- Medicare.gov — Retiree insurance
Frequently asked questions
If I leave HealthChoice, can I come back?
Generally not. EGID's 2027 Medicare guide says that if you drop your health plan through EGID, you can't regain coverage through EGID in the future. OTRS describes a narrow exception for retirees who move to a spouse's state plan with no break in coverage.
Do I lose the OTRS or OPERS premium help if I buy my own plan?
Yes. OTRS says it subsidizes your health insurance only if you stay with your employer's insurance, and OPERS rules say its contribution goes only to the state plan or another eligible employer group plan, never directly to you. EGID also says you lose any premium contribution from your retirement system when you drop EGID coverage.
Can I buy a Medigap policy without health questions after leaving HealthChoice?
Not always. Your best time to buy Medigap is your 6-month Medigap Open Enrollment Period, which starts when you're 65 or older and have Part B. After that, federal guaranteed-issue rights apply in specific cases, such as when retiree coverage that pays after Medicare ends. Choosing to drop retiree coverage isn't the same as the plan ending, so a company may be able to use medical underwriting.
Can I switch between HealthChoice and an EGID Medicare Advantage plan?
Yes, during EGID's Option Period each year, October 15 to December 7, with changes effective January 1. Staying within EGID keeps your eligibility and your retirement system's premium contribution.
Medicare in your Oklahoma county
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