Medicare in Ohio

Seniors in the United States are generally eligible for low-cost and free health insurance through the federal Medicare program. Nationwide, Medicare enrolls about 64 million people, nearly all of them seniors or adults with certain qualifying medical conditions. Over 2.3 million Medicare beneficiaries live in Ohio, where the total population is 7.7 million. 

Ohio Medicare participants have a few options to get their benefits. Beneficiaries who opt into Original Medicare get Part A, the inpatient hospital coverage, premium-free with a copay due at the point of service. Part B comes with a monthly premium,The standard Part B premium amount in 2022 is $170.10 a month, and covers outpatient expenses such as office visits, ambulance rides and durable medical equipment. Part D is Original Medicare’s prescription drug benefit. Its benefits and costs vary considerably from one beneficiary to another and from place to place.

In 2021, about 42% of Ohio’s seniors got their Medicare benefits through authorized private resellers. This is Medicare Advantage, often called Part C, and it is a popular choice for Ohio seniors. Under Part C, it folds together all the benefits provided under Parts A and B into a single coverage plan with one monthly premium. The program can include some prescription drug benefits in this package, as well as extra coverage for services Medicare usually doesn’t pay for, such as dental care, hearing and vision services. Medicare currently spends about $830 billion a year on coverage for qualified beneficiaries nationwide.

This guide goes through the various ways Ohio seniors can use their Medicare benefits. It explains what each part of Medicare is, how it works and how eligible seniors can combine services to get the best coverage possible. Finally, it includes a list of helpful and informative resources for seniors planning their care options.

Options for Medicare Coverage in Ohio

Original Medicare is the most popular choice for Ohio seniors, but it isn’t the only option available. Ohio residents have a lot of other options to get coverage, and Medicare-eligible seniors are free to craft a care plan that better meets their needs. Along with the federal program, there are several privately offered alternatives to choose from.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage, or Part C, is another option for seniors to structure their Medicare benefits. Private insurance carriers offer Part C plans. These plans must include all Parts A and B coverage, except hospice care, which remains a Part A benefit. Customers are free to go beyond Medicare Advantage plans’ minimum levels and add prescription drug benefits and dental and vision care. Some plans offer discounts for over-the-counter medications, non-emergency medical transportation and even fitness programs.

Medicare Advantage offers plans in four main types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee For Service (PFFS) plans and Special Needs Plans (SNPs). Each plan’s benefits depend on premium, deductible and maximum out-of-pocket costs and the extent of coverage. Seniors should research each plan before deciding.

Who Should Consider Medicare Advantage

Medicare Advantage can be a good choice for seniors who:

• Want a single premium bill for their entire coverage plan
• Want more precise control over their costs and benefit structure
• Need services Original Medicare doesn’t offer, such as dental and vision care
• Are looking for routine medical services at a relatively low and predictable cost
• Prefer the convenience of managed care

The Top 10 Medicare Advantage Plans in Ohio

Ohio seniors have access to several popular and highly rated Medicare Advantage plans. The table below lists some of the top providers and cost data current as of April 2022. More information about Part C is on the Medicare Advantage Plans in Ohio page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

In Ohio, there are 10 types of Medigap plans, eight of which are available to new enrollees. Plans are standardized, meaning policyholders get the exact same coverage from a given plan regardless of the health insurance provider they buy it from. For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Ohio

It can be challenging to make sense of all the different options for Ohio Medicare. Fortunately, Ohio seniors can get help understanding all their options through several local and national resources. These agencies assist seniors with navigating the different policy options available to find the best coverage for them. The resources listed below offer one-on-one counseling about benefits, impartial advice and help enrolling in Original Medicare Parts A and B, various drug coverage options, Medicare Advantage and privately issued Medigap plans in Ohio.