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Medicare in Ohio

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If you’re a Medicare beneficiary in Ohio—or soon to be one—you are one of more than 2.2 million people living in Ohio in 2018 who may enjoy the flexibility of receiving Medicare coverage from among several Medicare plan options and/or the federally-administered Original Medicare, Part A and Part B. The Center for Medicare & Medicaid Services (CMS) reported that as of January 2018,  1,304,591 Ohioans were enrolled in Medicare Part A and/or Part B (Original Medicare), while 966,282 were enrolled in Medicare health plans available from private, Medicare-approved insurance companies.

Original Medicare for Ohio beneficiaries

Original Medicare consists of Medicare Part A (hospital insurance) and Part B (medical insurance). Part A may cover inpatient hospital care, skilled nursing facility and nursing home care, limited home health care, and hospice care; Part B may cover doctor visits and preventive care such as annual wellness exams and flu shots, as well as outpatient surgeries, diagnostic tests, and durable medical equipment, and other approved items and services.

To be eligible for Original Medicare, you must be age 65 or older and a U.S. citizen or legal permanent resident of five continuous years or more. People who are younger than 65 may be eligible for Medicare in certain situations.

Medicare plan options in Ohio

There are Medicare plan options in Ohio besides Original Medicare, although plan availability may vary throughout the state. The most common options appear below.

Medicare Supplement (Medigap) insurance plans are offered by private insurance companies and can help you pay for Original Medicare’s out-of-pocket costs. Different Medigap insurance plans in Ohio pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement insurance plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.

Another popular option in Ohio is Medicare Advantage (Medicare Part C). Private insurance companies that contract with Medicare to offer Medicare Advantage plans to beneficiaries within particular regions, states, or counties. According to the Centers for Medicare & Medicaid Services (CMS), 139 different Medicare Advantage plans are available to Ohio residents in 2018, and 100% of people with Medicare had access to at least one Medicare Advantage plan.

Medicare Advantage plans must provide at least the same coverage as Original Medicare (excluding hospice care, which remains covered through Medicare Part A); however, Medicare Advantage plans often include additional benefits, such as routine vision, hearing, or dental coverage as well as prescription drug coverage. Not every Medicare Advantage plan has prescription drug coverage, but the ones that do are referred to as Medicare Advantage Prescription Drug plans. These plans provide all of your medical and prescription drug coverage in one plan.

As an Ohio resident, you can usually sign up for a Medicare Advantage plan or change plans during the Annual Election Period (from October 15 to December 7 each year) or during the 7-month period when you first become eligible for Medicare. This is called the Medicare Initial Enrollment Period.

Medicare Part D prescription drug coverage is available not only from Medicare Advantage Prescription Drug plans but also from stand-alone Medicare Part D Prescription Drug Plans. In 2018, more than 1.7 million Medicare beneficiaries living in Ohio chose to enroll in a Medicare plan offering Part D prescription drug coverage, according to the Center for Medicare & Medicaid Services (CMS). In 2018, about 59% of Medicare beneficiaries who had prescription drug coverage were enrolled in stand-alone Medicare Prescription Drug Plans. To enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must have Medicare Part A and/or Part B. Each plan has a formulary, which is a list of prescription medications covered by the plan. Formularies and costs may vary by plan, so it’s a good idea to compare the plans available where you live to identify the one that best suits your needs. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

Ohio resources for Medicare beneficiaries

Several Ohio agencies can help you with questions you may have about your Medicare benefits and other lifestyle, health and wellness, and financial matters. Some of these agencies are listed below.

  • Ohio Department of Aging administers Ohio’s long term care services and support program and the home, community and caregiver support program.
  • Ohio Department of Insurance provides consumer protection through education as well as information on topics important to Ohio seniors.

Statistical data from the Centers for Medicare & Medicaid Services, “2018 MA Part D Landscape State-by-State Fact Sheet and “Medicare Enrollment Dashboard”

Data in this article was checked when the article was written and might not be updated as newer data becomes available.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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