2025 Open Enrollment (OE) is coming! During the month of November, all retirees eligible for health care insurance may make changes to their insurance enrollment and re-enroll in in-lieu. Remember that you must re-enroll in health-in-lieu and dental in-lieu annually as those elections do not roll over. For members with dependents under age 24, Open Enrollment is the time you can add your dependent children to your medical, dental and/or vision coverage (some coverage is available until age 26). Members who previously submitted full time student confirmations, and your dependent remains under the age of 26, you may need to re-enroll your dependents.

Open Enrollment 2025 Key Dates:   

October 10, 2024 – ORS staff presentation to Association of Retired San Jose Police Officers and Firefighters at their monthly membership meeting. Click here for more info. 
October 10, 2024 – ORS staff presentation to San Jose Retired Employees Association (SJREA) at their monthly membership meeting. Click here for more info.
October 28, 2024 - Open Enrollment Packets Will Start to Arrive by U.S. Postal Service to your mailing address on file with ORS  
November 1, 2024 – Open Enrollment Begins. First day change forms will be accepted.   
November 1, 2024 – Open Enrollment Website Live with 2025 Information
November 6, 2024 – Retiree In-person  Health Fair  &  Free Flu Shots between 10 am to 2 pm at Leininger Center, Okayama Room
November 30, 2024 – Open Enrollment Ends. Last day change forms will be accepted.  

What’s New in 2025:  

Medicare Prescription Payment Plan 
The Medicare Prescription Payment Plan is a new, voluntary program that allows Medicare members to pay for out-of-pocket prescription drugs in monthly installments instead of paying the full amount at the pharmacy.  These payment plans will be administered by Anthem through SimplicityRx and Kaiser will administer their payment plans directly.  

Kaiser:  GLP-1 Class Prescriptions 
Kaiser providers will only prescribe GLP-1 class medication for the treatment of diabetes and for weight loss with a Morbid Obesity diagnosis.

What’s Changing in 2025: 

Medical Plan Rates
Medical plans are seeing incremental changes for 2025. Non-Medicare rates are increasing between 5% to 6.85%. Your plan’s actual cost is directly related to the lowest cost plan offered for your level of coverage (member, member + spouse, etc.) Please see the 2025 Rate Sheets located on the Non-Medicare and Medicare tabs of the Medical page for your new rate. Dental and Vision Plan rates remain the same as in 2024. 

Medicare Prescription Out-Of-Pocket Maximum 
Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan.  Once a member reaches the $2,000 out-of-pocket limit, they will automatically enter the catastrophic coverage phase, where they won't have to pay out-of-pocket for covered Part D drugs for the rest of the year.

Kaiser Medicare Fitness Program is moving from Silver & Fit to One Pass 
Kaiser One Pass is the new fitness program that includes access to in-network gyms, online fitness classes and resources, home fitness kits and an online brain health program offered at no additional cost to Kaiser Medicare health plan members effective January 01, 2025. Please see flyer for more details. One Pass Fitness Program

What’s Continuing in 2025:

Anthem Medicare Advantage Plans  

Anthem’s SilverSneakers program is a fitness and wellness program offered at no additional cost to eligible Medicare plans that helps all levels and abilities get active, get fit, and connect with others through online and in-person classes, over 15,000 fitness locations, and health & wellness discounts Anthem Silver Sneakers 

Anthem's 24/7 Nurse Line allows you to speak to a registered nurse anytime you need a nurse or have a health-related question. 24/7 Nurse Line

Anthem’s Live Health online brings a doctor and/or a mental health therapist to you via your phone, computer, tablet, or smartphone for $0. Use your Anthem member id number to create an account and be connected with a doctor immediately. 

Kaiser Permanente Senior Advantage (KPSA)

Kaiser’s Over-the-Counter Benefit (California plans ONLY) provides a $70 quarterly credit for the purchase of a wide variety of over-the-counter wellness products. Over-the-Counter Benefit 

Kaiser’s Free Transportation to the Doctor program provides no-cost rides to and from your doctor visits. Transportation Benefits  

Meals Program provides no-cost fresh, healthy meals delivered to your home immediately following an inpatient stay at a hospital or skilled nursing facility. Meal Benefits