- In 2019, there were 122 Medicare Advantage Plans available in Ohio.
- 37% of the total Medicare population in Ohio is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,288 per beneficiary in Ohio, which is 2% higher than the national average.
- Available Medicare Advantage Plans range from 25 to 77 across Ohio’s 88 counties.
Medicare Advantage Plans give you a choice in how you receive your health care. Plans vary based on cost, benefits offered, and delivery of care, so you can select a policy that meets your needs. Keep in mind that the selection of plans is unique to each service area, so a Medicare Advantage Plan available in Cincinnati, for example, may not be an option for residents in Akron.
Medicare Advantage Plans in Ohio
Types of Medicare Advantage Plans
When shopping for a Medicare Advantage Plan, consider the benefits you need, costs, and your preferences in choosing your health care providers. Ohio’s Medicare Advantage program consists of four main types of plans.
Health Maintenance Organizations (HMO)
HMO plans have agreements with networks of hospitals and doctors. You must stay within the network for services to be covered. If your current doctor is not part of the HMO, you’ll need to find a new primary care physician. HMOs also require a referral from your primary doctor before you can see a specialist.
Preferred Provider Organizations (PPO)
PPO plans have agreements with networks of hospitals and doctors, but you’re not restricted to providers within the network. You can use any health care provider, but it costs you more if you go outside of the PPO’s network. This type of plan doesn’t require you to have a primary care doctor, and you can schedule an appointment with a specialist without a referral.
Private Fee-For-Service Plans (PFFS)
PFFS plans typically pay all health care providers the same rate per service. Under this plan, you can see any Medicare-approved provider that accepts this service fee, regardless of whether or not the plan has a network. However, you may find that providers may accept the PFFS fee for certain services and not others, so it’s best to confirm whether you can use your plan in advance of each treatment.
Special Needs Plans (SNP)
SNPs provide coverage to those with chronic illnesses, such as heart failure, severe hematologic disorders, stroke, end-stage liver disease, and diabetes mellitus. There are also SNPs for those who live in nursing homes or are dual-eligible for Medicare and Medicaid. SNPs tailor coverage to meet the needs of their beneficiaries. If your health improves and you’re no longer eligible for an SNP, you must switch to another plan.
Enrollment and eligibility for Medicare Advantage Plans in Ohio
Most Americans are automatically enrolled in Medicare when they turn 65 and begin receiving Social Security benefits. As long as you’re enrolled in Medicare Part A and Part B and not in a Medicare Supplement Insurance plan (Medigap), you can join a Medicare Advantage Plan. You can only enroll in plans offered in the service area you live in. Those with end-stage renal disease are eligible to join a Medicare Advantage Plan as of 2021.
You can enroll in a Medicare Advantage Plan during certain windows. If you decide your coverage isn’t meeting your needs, be sure to research your options and prepare in advance to switch so you don’t miss your enrollment windows.
You can enroll in a Medicare Advantage Plan:
- When you’re newly eligible for Medicare, the Initial Enrollment period is a seven-month window that begins three months before and ends three months after the month you turn 65.
- When you’re already enrolled in Medicare Part A and join Medicare Part B for the first time, the Part B enrollment must be done during the Part B General Enrollment period (January 1 to March 31). Once your Part B enrollment is complete, you have between April 1 and June 30 of that same year to join a Medicare Advantage Plan.
- During the Medicare Advantage Open Enrollment period from January 1 to March 31 each year, you may switch between Medicare Advantage Plans or back to Original Medicare at this time. However, you can’t switch to a Medicare Advantage Plan from Original Medicare.
- During Medicare’s Open Enrollment Period from October 15 to December 7 of each year you can switch between Medicare Advantage Plans or switch to a Medicare Advantage Plan from Original Medicare.
You may qualify for Special Enrollment Periods if you lose existing coverage; for example, if you move outside of your service area, no longer qualify for Medicaid, or no longer have coverage from an employer.
Prescription drug coverage
Original Medicare doesn’t provide prescription drug coverage, but you should consider joining a plan when you’re first eligible. Otherwise, you may have a permanent penalty applied to your premiums when you join a plan later.
To get help with paying for brand-name and generic prescription drugs, you can:
- Stay in Original Medicare and purchase a separate Part D prescription drug plan through a private insurance company
- Enroll in a Medicare Advantage Plan that includes prescription drug coverage
You can’t have Medicare Advantage and a separate Part D prescription drug plan at the same time unless you’re in selected PFFS plans.
Medicare Advantage Resources in Ohio
It’s common to have questions when you’re considering your options for Medicare coverage. You can draw on the expertise of staff and volunteers at local and state agencies in Ohio to better understand your choices. Here are some resources:
Ohio Senior Health Insurance Information Program (OSHIIP)
OSHIIP provides free information and counseling for those enrolled in or eligible for Medicare. The agency’s trained volunteers can answer questions about Medicare Advantage, prescription drug plans, Medigap, and Medicaid. For more information, call the OSHIIP toll-free number, make an appointment for one-on-one virtual counseling, or register for a Welcome to Medicare informational webinar.
Contact Information: Website | 800-686-1578
Ohio Department of Insurance
The Ohio Department of Insurance has a website of resources about Medicare, Medicare Advantage, and Medigap programs. It also has a Medicare 101 PowerPoint presentation for download, bringing together basic information about the application process, savings programs, and secondary insurance.
Contact Information: Website | 800-686-1578
Area Agencies on Aging
The Ohio Department of Aging provides funding to 12 area agencies that serve specific regions of the state. The agencies coordinate programs to support older adults, such as nutrition programs, caregiver support, and transportation assistance. Some agencies provide workshops to help you understand how Medicare programs work. Services vary by location, so contact the agency in your area for more information.
Contact Information: Website | 866-243-5678
Central Ohio Area Agency on Aging (COAAA)
Based in Columbus, COAAA works with partner agencies to help older adults with services, such as homemaking, meal delivery, personal care, and transportation. The agency’s staff may be contacted with questions about Medicare via email, phone, or online form. COAAA also offers free Medicare for Beginners workshops and a series of online informational videos. The agency serves residents in eight counties, including Franklin, Delaware, and Fairfield.
Contact Information: Website | 800-589-7277
Learn More From Our Sources
- Medicare | Joining a Health or Drug Plan | Last accessed June 2021
- Medicare | Health Maintenance Organizations | Last accessed June 2021
- Medicare | Preferred Provider Organizations | Last accessed June 2021
- Medicare | How Special Needs Plans Work | Last accessed June 2021
- CMS | Private Fee-for-Service Plans | Last accessed June 2021
- Medicare | Drug Coverage (Part D) | Last accessed June 2021
- Medicare | Part D Late Enrollment Penalty | Last accessed June 2021
- Medicare | Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods | Last accessed June 2021