Health Options Program

What Health Options Program does

The Health Options Program (HOP) is a voluntary health benefits program sponsored exclusively by the Pennsylvania Public School Employees' Retirement System (PSERS) for the benefit of PSERS retirees, their spouses, surviving spouses, and dependents. Established in 2005 and operated from Lancaster, PA, HOP administers a portfolio of Medicare Supplement plans (HOP Medical Plan, Value Medical Plan), Medicare Advantage plans (distributed through Highmark, Aetna, Capital Blue Cross, Independence Blue Cross, and UPMC), Medicare Part D prescription drug coverage (Medicare Plus Rx Option and Medicare Standard Rx Option, administered by OptumRx), MetLife Dental and EyeMed Vision, and Pre-65 Medical Plans for non-Medicare-eligible members. The program also bundles SilverSneakers fitness benefits, an Elder Care Program, Case Management services, Medication Therapy Management, CareKitOnline eldercare resources, and telehealth access. Customers are reached via the Luminare Health Member Portal (relaunched February 2026), direct mail, webinars, virtual benefits fairs, and 1-800 phone consultations; premiums are collected primarily through PSERS pension check deduction or via Invoice Cloud online payment. The program is self-insured — most economic risk sits with participating members via premiums rather than commercial insurance carriers — and benefits from a legislatively funded Premium Assistance benefit of up to $100 per month for eligible retirees that is unavailable through commercial carriers. CMS has rated HOP's prescription drug plans 4.5 stars for four consecutive years (2025–2026), and member surveys during the 2026 Option Selection Period showed 93.6% satisfaction with materials and 90% of respondents rating materials 7+ on a 10-point scale across 5,100+ respondents.

Name

Health Options Program

Legal name

PSERS Health Options Program

Website

https://hopbenefits.com

Company type

Private

Founded year

2005

Operating status

Operating

Headcount range

11–50 employees

Short description

The Health Options Program is a PSERS-sponsored voluntary health benefits program offering self-insured Medicare Supplement, Medicare Advantage, and Medicare Part D coverage to retired Pennsylvania public school employees and their dependents, administered by Luminare Health.

Ownership category

akta.pro rank

Product category

Medicare Health Benefits Administration

NAICS

Direct Health and Medical Insurance Carriers (524114), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicare Supplement (Medigap) (FSAIAEAG)

akta.pro secondary industries

Medicare Part D Prescription Drug Plans (PDP) (FSAIAGAC), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), Eligibility, Enrollment & Benefits Administration (HLAEALAH)

Keywords

• Medicare Supplement plans
• Medicare Advantage coverage
• Medicare Part D drug coverage
• Retiree health benefits
• Dental and vision insurance

Headquarters

HQ city

Lancaster

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Technology or R&D, Marketing or Sales, Personnel

Revenue model

1. Medicare Supplement Premiums: Self-insured Medicare Supplement plans (HOP Medical Plan and Value Medical Plan) funded exclusively by participant premiums. Premiums deducted from PSERS pension checks or billed directly. Premium Assistance available up to $100/month for eligible retirees.
2. Medicare Advantage Premiums: Medicare Advantage plans offered through third-party insurers (Highmark, Aetna, Capital Blue Cross, Independence Blue Cross, UPMC) with plan-specific premiums.
3. Medicare Part D Prescription Drug Premiums: Medicare Plus Rx Option and Medicare Standard Rx Option prescription drug coverage funded by participant premiums. Plans are self-insured unlike publicly traded commercial carriers.
4. Pre-65 Medical Plan Premiums: HOP Pre-65 Medical Plan and managed care plan premiums for retirees not yet eligible for Medicare.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels7 records

Core offering

Health Options Program is a voluntary, self-insured health benefits program sponsored by the Pennsylvania Public School Employees' Retirement System (PSERS) that provides Medicare Supplement plans (HOP Medical Plan, Value Medical Plan), Medicare Advantage plans through partner carriers, Medicare Part D prescription drug coverage, dental and vision benefits, and fitness programs to PSERS retirees, their spouses, surviving spouses, and dependents. The program is funded exclusively by participant premiums, with administration handled by Luminare Health and prescription drug coverage managed by OptumRx.

Product overview

The Health Options Program is a comprehensive health benefits program sponsored by the Pennsylvania Public School Employees' Retirement System (PSERS) for PSERS retirees, their spouses, and dependents. The program offers a portfolio of products including Medicare Supplement plans (HOP Medical Plan and Value Medical Plan), Medicare Advantage plans through multiple carriers (Highmark, Aetna, Capital BlueCross, Independence Blue Cross, UPMC), Medicare Part D prescription drug options (Medicare Plus Rx Option and Medicare Standard Rx Option), MetLife Dental and EyeMed Vision coverage, and Pre-65 Medical Plans. Members also have access to SilverSneakers fitness program, Elder Care services, Case Management, Medication Therapy Management, CareKitOnline, and Telehealth Services. The program is administered by Luminare Health with prescription drug coverage managed by OptumRx.

Differentiator

Problem solved

Functional benefit

Brands

• HOP Medical Plan: Medicare Supplement plan with $50 deductible for physician services and no hospital deductible
• Value Medical Plan
• Medicare Plus Rx Option
• Medicare Standard Rx Option
• HOP Pre-65 Medical Plan
• CareKitOnline
• SilverSneakers
• Elder Care Program
• Medication Therapy Management Program (MTMP)

Products and services

• HOP Medical Plan

Quantifiable outcome

• 4.5-star Medicare rating for prescription drug plans (2025, 2026)
• +3 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

Feature6 records

Partnerships

Twelve partnerships are on record, tiered core and minor.

• Luminare HealthcoreImplementation/ SI/ Consulting PartnerAdministers the Health Options Program's benefits and manages the secure member dashboard portal. Provides customer service, claims processing, and case management services. Formerly known as Trustmark Companies.
• OptumRxcoreTechnology or IntegrationAdministers Medicare Part D prescription drug coverage including Medicare Plus Rx Option and Medicare Standard Rx Option. Manages pharmacy network, prior authorizations, step therapy, medication therapy management, and mail-order pharmacy services.
• MetLife DentalcoreTechnology or IntegrationProvides dental coverage through the MetLife Dental and EyeMed Vision Option, covering preventive, basic, and major dental services, cleanings, x-rays, and dentures through a national network.
• EyeMed VisioncoreTechnology or IntegrationProvides vision coverage through the MetLife Dental and EyeMed Vision Option, covering eye examinations, frames, prescription lenses, and medically necessary contact lenses.
• SilverSneakers (Tivity Health)coreTechnology or IntegrationFitness benefit program available to HOP Medical Plan and Pre-65 Medical Plan members. Provides access to thousands of fitness locations, SilverSneakers classes, virtual classes, on-demand videos, and the SilverSneakers GO mobile app.
• HighmarkcoreChannel Partner/ Reseller/ DistributorProvides Medicare Advantage plans and Pre-65 Managed Care Plans to HOP members in various Pennsylvania regions. 2026 reference codes provided for different service areas (Southwest PA, Southeast PA, North & Central PA, Out of State).
• AetnacoreChannel Partner/ Reseller/ DistributorProvides Medicare Advantage plans and Pre-65 Managed Care Plans to HOP members. Medicare-eligible information: 1-800-307-4830. Pre-65 information: 1-888-982-3862.
• Capital Blue CrosscoreChannel Partner/ Reseller/ DistributorProvides Medicare Advantage and Pre-65 Managed Care Plans to HOP members. Pre-enrollment information: 1-800-542-6373. Current HMO members: 1-800-779-6962. Current PPO members: 1-866-987-4213.
• Independence Blue Cross (Keystone/IBC)coreChannel Partner/ Reseller/ DistributorProvides Medicare Advantage plans including Keystone Select 65 and Personal Choice 65 for Medicare-eligible members, and Pre-65 managed care options.
• UPMCcoreChannel Partner/ Reseller/ DistributorProvides Medicare Advantage plans and Pre-65 Managed Care Plans to HOP members. Medicare-eligible information: 1-866-517-2806. Pre-65 information: 1-888-876-2756.
• Pennsylvania Public School Employees' Retirement System (PSERS)coreStrategic or Co-development PartnerState-sponsored retirement system that sponsors the Health Options Program exclusively for PSERS retirees, their spouses, surviving spouses, and dependents. Sets Premium Assistance benefit levels through Pennsylvania legislature.
• Matrix Group InternationalminorImplementation/ SI/ Consulting PartnerWebsite development partner credited for creating the HOP website (hopbenefits.com).

Scale indicators5 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• CalPERS Health Benefits: California Public Employees' Retirement System administers health benefits (including Medicare and supplemental coverage) for California state and public agency retirees, mirroring HOP's role as the sole sponsored health program for PSERS retirees.
• New York State Health Insurance Program (NYSHIP): NYSHIP provides health insurance to New York State and local government retirees, including Medicare-coordinating supplemental coverage, comparable to HOP's structure for Pennsylvania school retirees.
• SERS Ohio Health Care: School Employees Retirement System of Ohio offers retiree health coverage to non-teaching Ohio public school retirees, comparable in employer-sponsored retiree Medicare-coordinating model.
• State Health Benefits Program (New Jersey): New Jersey's Division of Pensions and Benefits administers retiree health coverage for state and public employees, offering Medicare supplemental plans in a structure analogous to HOP/PSERS.
• STRS Ohio Health Care: School Teachers Retirement System of Ohio provides health care coverage including Medicare supplemental plans to Ohio's retired educators, the closest functional analog to HOP for school retirees.
• CalSTRS Health Benefits: California State Teachers' Retirement System provides health benefit programs to retired California educators, closely paralleling HOP's educator-retiree focus and voluntary enrollment model.
• Teacher Retirement System of Texas (TRS-Care): TRS-Care delivers health benefits (including Medicare Advantage) to Texas public school retirees, a near-direct parallel in target population and Medicare-coordinating benefits.

Broad incumbents

• AARP Medicare Supplement (UnitedHealthcare): Largest national Medigap carrier marketed through AARP, directly competing with HOP Medical Plan and Value Medical Plan among PSERS retirees who opt for commercial carriers.
• Mutual of Omaha Medicare Supplement: Established national Medigap underwriter with broad agent distribution, competing for retiree Medigap premium share against HOP's self-insured Medicare Supplement plans.
• Highmark Blue Cross Blue Shield: Major regional insurer and HOP's own Medicare Advantage distribution partner; competes broadly in Pennsylvania Medigap and MA markets and is a key peer against which HOP's Premium Assistance advantage must be defended.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries10 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Health Options Program