Medicare Plans in Ohio
There are different Medicare plans in Ohio to choose from. But finding the right coverage can be strenuous. We don’t think it should be. We’ve done the research to help you navigate the Medicare plans in Ohio to find the right coverage for you.
Who’s eligible for a Medicare Plans in Ohio?
Medicare is a federally sponsored health insurance program for people 65 and older and people under the age of 65 with certain disabilities or illnesses. Typically, people qualify for Medicare plans in Ohio upon reaching 65 years of age. Persons under the age of 65 can qualify for Medicare if they have received Social Security Disability Insurance (SSDI) for the past 24 months or have been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease.
To qualify for Medicare, you must be a citizen or permanent resident, having lived in the US for the past 5 years. In addition, you or your spouse must have worked at a job that contributed to your Medicare coverage via Social Security deductions for a minimum of 10 years.
We’re here to help if you’ll be turning 65 within the next six months or need help determining your eligibility for Medicare plans in Ohio. Call us to speak with a licensed insurance agent.
What are the Medicare Plans in Ohio?
Orginial Medicare Part A & Part B
Original Medicare is the federal part of Medicare and has two components:
Medicare Part A (Hospital Insurance): This part covers inpatient services, like hospital admissions, skilled nursing facility care, and hospice.
Medicare Part B (Medical Insurance): This part covers outpatient services and supplies, as well as durable medical equipment. It also covers some services that prevent or detect illnesses at an early stage, such as flu shots, cardiovascular screenings, and diabetes screenings.
Services generally not covered by Original Medicare include:
- Long-term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
Medicare Advantage Plans (Part C)
Medicare Advantage plans are provided by Medicare-approved private insurance companies and work as an alternative to Original Medicare (Parts A and B). These plans must provide the same coverage as Original Medicare (with the exception of hospice care, which remains covered by Part A). They can also provide additional benefits, such as dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
To enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Premiums for these plans can start at $0, increasing with the level of coverage selected. You’ll need to continue paying your Part B premium in addition to your Part C premium.
Medicare Prescription Drug Plans (Part D)
Prescription Drug coverage is generally not covered by Original Medicare or Medigap Plans. Stand-alone Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare (Parts A and B) to add prescription drug coverage. With these plans, a tier system is used to grade medications, and copays/coinsurance for each medication are set in accordance with their tiers. Drugs graded in the lowest tiers have the lowest copays/coinsurance, and vice versa. Each plan provides a drug formulary for you to see which tier(s) your medications fall into. This allows you to compare plans and select one with the best overall value for your specific prescription needs.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans add an additional layer of coverage to your Original Medicare by filling in coverage gaps. Medigap plans are provided by Medicare-approved private insurance companies and work alongside your Original Medicare to help reduce your out-of-pocket costs by paying certain healthcare costs, like copayments, coinsurance, and deductibles.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
You are first eligible to sign up for Medicare plans in Ohio during your Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and continues for an additional three months. This means you have a total of seven months to enroll.
Following this period, you will be able to make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period occurs once per year, from October 15th to December 7th.
Medicare Initial Enrollment Period
7-Month Initial Enrollment Period | Begins 3 months before the month you turn 65
*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.
KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.
Additional Medicare Resources in Ohio
Ohio Senior Health Insurance Information Program (OSHIIP) provides Medicare beneficiaries with free, objective health insurance information and one-on-one counseling.
Ohio Medicare Savings Program may cover deductibles and coinsurance for Medicare Part B. Additionally, the Low-Income Subsidy (LIS), or “Extra Help” program, may help pay for Medicare Part D monthly premiums, deductibles and co-pays. Individuals on Medicare with limited income and resources also may be eligible for financial assistance for medical expenses not covered by Medicare.
Sources: Medicare.gov; www.insurance.ohio.gov; https://aging.ohio.gov