Understand Medicare in Ohio
Medicare, the United States federal medical insurance program, provides coverage for more than 1 million people in Ohio who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 122 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in Ohio.
Medicare Plans in Ohio
|Compare ratings of Ohio’s Medicare plan providers:|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||5 out of 10|
|Anthem Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of ten|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
Medicare Plan Options in Ohio
Residents of Ohio have multiple Medicare plans to choose from. Many are tiered to help Ohioans find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Ohio’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
|Original Medicare (Parts A and B)||Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|Medicare Advantage Plans (Part C)||Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|Medicare Prescription Drug Coverage Plans (Part D)||Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|Medicare Supplement Insurance Plans (Medigap)||Some Ohio seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
Medicare in Ohio by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|1,270,501||Plan A: $0 to $499 per month*
Plan B: $170.10 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Ohio
Getting support can help when you’re making Medicare decisions. Ohio has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as OhioCares. OhioCares has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
Pro Seniors is an Ohio nonprofit providing legal aid to state residents. It’s also responsible for operating the state Senior Medicare Patrol (SMP) program, which helps beneficiaries identify, prevent and report Medicare fraud and abuse. Volunteers can review your Medicare statements with you to identify any fraudulent claims or charges for services you didn’t receive.
Contact information: Website | (800) 488-6070
Ohio Senior Insurance Information Program (SHIIP)
The Ohio Senior Insurance Information Program (SHIIP) is a statewide program that provides free health insurance information to seniors and their family members living in the state. Trained volunteers will speak with you one-on-one about Medicare’s benefits and coverage options. You can also get help with Medicare Supplement Insurance, Medicare Advantage and prescription drug plans.
Contact information: Website | (800) 686-1578
Ohio Department of Insurance
The Ohio Department of Insurance is responsible for regulating insurance policies sold within the state. It advocates on behalf of residents to help ensure everyone has access to fair coverage. The department also provides a directory of Ohio State Insurance Information Program coordinators who can connect you with agencies and information about Medicare and the Medicare Savings Program.
Contact information: Website | (614) 644-2658
Ohio Area Agencies on Aging
There are 12 local Agencies on Aging throughout Ohio state. Each office provides services to seniors age 60 and over living within the county, including free Medicare counseling. Trained counselors can help answer your questions about Medicare coverage, policy options and how to reduce your out-of-pocket costs. Since counselors are not affiliated with any insurance company or licensed to sell insurance products, you can trust you’ll receive unbiased information.
Contact information: Website | (866) 243-5678