Medicare in Ohio

Resources for Ohio Medicare Beneficiaries

Starting to wonder about Medicare’s various components, enrollment windows, and applications, or comparing and choosing a Medicare plan?  Healthpilot is here to help you choose a Medicare plan and offer tips on sorting through the overwhelming amount of information. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

You may benefit from advice when making decisions about Medicare. You have a number of resources available to you as an Ohioan, including the State Health Insurance Program (SHIP), also known as the Ohio Senior Health Insurance Information Program (OSHIIP) in your area. In order to give people in Ohio information about Medicare, OSHIIP has counselors all around the state who work with regional nonprofits, public health organizations, and Area Agencies on Aging (AAAs) unique to your county. 

Medicare Plan Options in Ohio  

You can choose from several Medicare options if you’re a Buckeye. You can apply for Original Medicare if you are at least 65 years old or if you have a disability and are eligible for Medicare. With a large variety of options in Ohio, a Medicare Advantage plan can be a better choice if you prefer more comprehensive coverage. Prescription drug plans and Medicare Supplement Insurance are other examples of Medicare plan possibilities. 

Original Medicare (Parts A & B)  

Original Medicare is the basic Medicare program. It is divided into two parts: Medicare Part A, which is hospital insurance, and Medicare Part B, which is medical insurance. Part A of Medicare covers hospitalization, skilled nursing facility stays, home health care, and hospice care. Part B of Medicare covers doctor’s visits, outpatient care, lab testing, and preventive services such as cancer screenings, flu shots, and yearly wellness visits. Parts A and B of Medicare have different deductibles that apply to different services. Part A, for example, has an inpatient hospital deductible per benefit period (every time you are admitted), whereas Part B has an annual deductible before Original Medicare kicks in for payment. Things to consider if keeping Original Medicare: 

• If you want the freedom to choose and access providers who accept Medicare anywhere in the United States, Original Medicare in Ohio is a solid solution. 
• If you don’t need a lot of health care or prescription drugs, know that there is no cap on how much you can pay out of pocket, so you can just pay for what you need when you need it. In the absence of any existing credible coverage and to avoid any late enrollment fees that may pop up in the future, stand-alone prescription drug plans are available. 

Medicare Advantage (Part C)  

Medicare Part C, also known as Medicare Advantage plans, is a private insurance company-provided alternative to Original Medicare coverage. These plans cover, at a minimum, what Medicare Parts A and B would, and they frequently include additional benefits. Most services are administered by a network of providers, which may require you to have a primary care physician, provide a referral to see a specialist, and prior approval for certain services, treatments, and medications, similar to how a Health Maintenance Organization (HMO) plan works. Other insurance products available include Preferred Provider Organization (PPO), Health Maintenance Organization-Point of Service (HMO-POS) (a hybrid model of an HMO and a PPO), and a Private Fee for Service (PFFS) plan. 

Check out our Medicare Part C Resource Page to find out more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

Many Medicare Advantage plans include Medicare Part D prescription drug coverage by default. Part D coverage is offered independently by private insurance companies that have been approved by Medicare. You can also complement Original Medicare or a Medicare Supplement Insurance policy with a stand-alone Prescription Drug Plan (PDP). Depending on the plan, each covered medication may be subject to a deductible, copay, or co-insurance. 

Medicare Supplement Insurance (Medigap)  

Some Ohio Medicare beneficiaries purchase Medicare Supplement Insurance (Medigap). These plans are intended to supplement what Original Medicare does not cover. Some of these differences include coverage for medical care outside the United States, as well as Part A and Part B deductibles and coinsurance. 

Because Original Medicare does not cover all of your medical expenses, the Ohio Department of Insurance (ODI) provides guides that explain how Medicare Supplement Insurance coverage reduces out-of-pocket expenses. 

Please note, Medigap insurance does not cover anything related to Medicare Advantage and that you cannot have a Medigap policy and a Medicare Advantage Plan at the same time. If you have a Medicare Advantage plan and want to buy a Medigap policy, the effective date for the Medigap policy should be after your Medicare Advantage plan expires.  

Medicaid 

According to federal regulations, each state agency administers its own Medicaid program. Medicaid is a public health insurance that coordinates care with the federal government. The broad federal rules give states significant leeway in designing and implementing their programs. As a result, Medicaid eligibility and benefits can and frequently do vary significantly among states. Medicaid provides access to health care for eligible low-income families and individuals, such as children, parents, pregnant women, the elderly, and people with disabilities. 

How and when to sign up for Medicare in Ohio

Medicare is a government-managed insurance program available to those who qualify based on age or disability. Most Americans become eligible for Medicare when they reach the age of 65.  

The following events also trigger Medicare eligibility: 

• You are under 65, permanently disabled, and have been receiving Social Security disability benefits for at least 24 months, or you receive disability benefits from the Railroad Retirement Board. 
• End-Stage Renal Disease (ESRD) has been diagnosed in you. 
• You have Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Ohio and nationwide  

Here is a quick overview of the Medicare enrollment periods in which you can elect or change your Medicare Advantage plan.

We know it’s a lot, Ohio, but we’re nearly done. Healthpilot understands that navigating Medicare can be difficult and that adding enrollment timelines can be stressful. 

Ready for some good news? Healthpilot will do all of the legwork for you. Answer a few questions, and we’ll recommend the right Medicare plan for your specific needs, even allowing you to enroll in a Medicare plan safely online in minutes. 

Once you become a Healthpilot customer, we can do a yearly check-up on your Medicare plan. You notify us of changes to your healthcare or prescriptions for an updated recommendation so you will know that you are in the best plan for you. When you have Healthpilot on your side, there is no need to have to keep track of enrollment periods. 

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Key Stats

Some interesting facts about Medicare coverage in Ohio:   

• Ohio’s Medicare coverage rate is 20%, higher than the national average of 19%. 
• Around 48% of Medicare customers in Ohio are enrolled in private Medicare Advantage programs. 
• Buckeyes will have access to 216 Medicare Advantage plans in 2023, up from 202 in 2022. This is a 6.9% increase in plan options. 
• In Ohio, there are 24 separate stand-alone Part D prescription programs, establishing that all Ohioans with Medicare have access to a Medicare prescription drug plan. 
• And, because we promised you a fun fact about Ohio: “The Heart of It All” is more than a state slogan. Columbus is within 500 miles of 48 percent of the United States’ population.

We both know you are eager to see your recommended Medicare plan.

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