Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage bundles the benefits of Medicare Part A and Medicare Part B into a single package. Also called Medicare Part C, this type of coverage is offered by private insurance companies, while the federal government administers Original Medicare. Every Medicare Advantage plan must include at least as much coverage as Medicare Parts A and B, except for hospice care covered by Part A. Many Part C insurers provide extra benefits such as vision, dental and hearing services, senior wellness programs and transportation to medical appointments.
Medicare Advantage plans also differ from Original Medicare in offering prescription medicine benefits, making it no longer necessary to buy a supplemental prescription plan. While Medicare Advantage plan providers must follow mandates set by the Centers for Medicare & Medicaid Services, they’re allowed to limit provider networks, set their own out-of-pocket costs and sometimes charge an extra premium beyond the monthly Part B premium all Medicare enrollees must pay.
Out of the estimated 2,371,223 Ohioans eligible for Medicare in 2020, about 1,000,000 are enrolled in Medicare Advantage. They make up 45.2% of the state’s Medicare-eligible population, a slightly higher proportion than the national average of 42%.
This guide reviews Medicare Advantage plans in Ohio and discusses what they cover, how residents qualify and how to find and sign up with a Medicare Advantage plan.
The Top 10 Medicare Advantage Plans in Ohio
More than 50 private insurers offer Medicare Advantage plans in Ohio, giving Medicare-eligible residents a variety of options. The following table lists the 10 most popular Medicare Advantage providers in the state by enrollment. Most of these companies offer multiple Medical Advantage plans, so we show cost information as a range rather than average prices. We also combined the enrollment numbers for each provider’s plan together to arrive at a provider’s total enrollment in the state. This plan information was last updated in April 2022, but you can check with Medicare.gov for more current information on available plans in your area.
Anthem Blue Cross and Blue Shield
HMO, PPO, PFFS
Medical Mutual of Ohio
SummaCare Medicare Advantage Plans
PrimeTime Health Plan
Wellcare by Allwell
Paramount Elite Medicare Plans
How Medicare Advantage Plans Work in Ohio
It’s important to understand how Medicare Advantage works in Ohio before enrolling in this program. Insurers typically sell multiple plans including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Each type of plan carries different stipulations regarding in-network and out-of-network coverage, choosing a primary care provider, prescription drug coverage and referrals. Here’s how Ohio’s four most popular plans work:
What Medicare Advantage Plans Cover in Ohio
All Medicare Advantage plans must cover the same benefits available to Original Medicare beneficiaries except for hospice care. These services include preventive screenings, X-rays, lab tests and care provided during a hospital stay. Medicare Advantage providers may also offer additional benefits such as eye care, dental care and hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Ohio
To qualify for Medicare Advantage, an applicant must already be enrolled in Medicare Part A and Medicare Part B. They must also reside within the plan’s service area and satisfy all other Medicare eligibility criteria. Enrollees must be at least 65 years old or have a disability that makes them eligible for Medicare at a younger age. They must be a U.S. citizen or legal immigrant. As with other types of health insurance, Medicare has limited enrollment periods, so it’s important to know the deadlines for applying for Medicare or changing plans. Refer to the list below for more details regarding enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Ohio
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The Ohio Senior Health Insurance Information Program (OSHIIP) provides free one-on-one counseling to Medicare beneficiaries and caregivers statewide. Trained counselors and volunteers help residents compare Medicare Advantage Plans and other alternatives, including Medigap coverage and Part D Prescription Drug Plans. Experts can also provide additional information about financial assistance programs like Extra Help. Counseling services are available via OSHIP’s toll-free hotline. The agency also organizes webinars and hosts more than 1,400 outreach events. Every year, more than 260,000 consumers receive impartial advice through this award-winning program.
Low-income seniors may access a variety of benefits through the Ohio Department of Medicaid. This agency manages the Medicare Premium Assistance Program (MPAP), which helps qualifying individuals pay for their Medicare premiums, prescription drugs and out-of-pocket costs, including deductibles and/or coinsurance payments. Eligibility is based on the applicant’s income and assets.
The Ohio Department of Insurance is a regulatory agency and consumer protection bureau that licenses insurance agents, provides educational resources and investigates complaints. Residents can contact the ODI’s toll-free hotline for assistance with questions related to Medicare, Part D drug plans, long-term care insurance and all other policies.
UHCAN Ohio is a statewide coalition representing more than 20 regional consumer advocacy groups, including Ohio Consumers for Health Coverage. This organization focuses on influencing government policies, giving consumers a voice and ensuring that all Ohioans have access to affordable, quality medical care. The agency provides information about insurance enrollment, prescription drug assistance, Medicare Extra Help and insurance complaints.
The Central Ohio Area Agency on Aging (COAAA) provides a variety of resources to help seniors select the best Medicare plan for their needs. The organization hosts monthly workshops and has published a series of short, informative Medicare for Beginners videos that seniors can watch online anytime. Trained staff members provide insurance counseling to some 10,000 seniors in Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Pickaway and Union counties.
COAAA serves seniors in Columbus and cities across central Ohio. Residents in the agency’s eight-county service area can reach the organization online, at [email protected] or by calling 1-800-589-7277.
Licensed social workers and OSHIP-certified experts provide personalized Medicare counseling at Cincinnati-based Jewish Family Service. Trained professionals help seniors of all faiths compare Medicare plans, including HMOs, PPOs and prescription drug coverage. Similar services are available for long-term care insurance, retiree health plans and Medicare supplements.
The Ohio District 5 Area Agency on Aging, Inc. (AAA) has served seniors in nine north-central Ohio counties for the past 45 years. Options counselors can answer insurance questions and help residents compare Part D prescription drug plans. The agency can also help low- and moderate-income seniors apply for Extra Help that can reduce their Part B premiums and prescription drug costs.
Ohio District 5 Area Agency on Aging serves seniors, caregivers and disabled adults in Richland, Ashland, Crawford, Huron, Knox, Marion, Morrow, Seneca and Wyandot counties. Residents can learn more online, by calling 1-800-860-5799 or by visiting the AAA office in Ontario.
Located in southeast Ohio, the Buckeye Hills Regional Council has served area seniors for more than 50 years. The agency offers Medicare/Medicaid counseling, information and referrals. During Medicare open enrollment, seniors can sign up for a group workshop or schedule a one-on-one consultation. Certified staff members help residents apply for Medicare Extra Help benefits, including the Low-Income Subsidy and Medicare Savings Program. The center also connects seniors with financial assistance available through the Medicare Improvements for Patients and Providers Act of 2008.
The Buckeye Hills Regional Council serves seniors in Athens, Hocking, Meigs, Monroe, Morgan, Noble, Perry and Washington counties. For insurance counseling or information about other programs and resources, seniors can call 740-374-9436 or email the agency at [email protected].