Medicare in Ohio
- Medicare in Ohio can be complex. Find out what plans you can choose from, when you need to apply and who is eligible.
What Ohio Medicare Plans Are Available?
Ohioans can qualify for Medicare Parts A and B, the Medicare Advantage Plan, Medicare Part D and Medicare Supplemental coverage. The cost of these plans is subsidized by Social Security, greatly reducing your financial responsibility. It's important to understand that not all of these plans are free and you will need to review the cost of each plan before enrolling. The differences between each plan are as follows.
- Medicare Part A: This plan provides compensation for inpatient services, which might include emergency care, hospital visits, hospice care or the cost of staying in a nursing home. You will also be covered if you need home health care as an alternative to nursing care.
- Medicare Part B: This plan covers the cost of regular doctor’s visits, examinations, testing and preventative care. It also helps cover the cost of medical devices and equipment as well as your medical supplies.
- Medicare Advantage: There are a number of plans you can choose that fall under Medicare Advantage, also referred to as Medicare Part C. It allows you to choose a private insurer rather than the government and may allow you to add coverage not included in traditional Medicare plans. Medicare Advantage plans are required to provide the same coverage that you would obtain with Part A and Part B.
- Medicare Part D: Any prescribed drugs or treatments you require may be covered under Medicare Part D. If you elect to enroll in Medicare Advantage, review your plan to see if it covers prescription drugs, because some Advantage plans will not. You are still able to enroll in Medicare Part D if you have a Medicare Advantage plan.
- Medicare Supplement Plans: These insurance plans are also referred to as Medigap plans and will cover the costs your Medicare plan does not. Medicare B covers only 80% of your medical expenses after you meet your deductible and your co-payment responsibility can vary with a Medicare Advantage plan. A supplemental plan is designed to help you cover the difference.
In 2020, 1.3 million residents in Ohio were enrolled in Medicare Part A and Part B plans while just under 1 million elected to enroll in Medicare Advantage. The plan that is best for you will depend on your needs and health conditions. If you do not feel you will be able to afford the 20% co-payment for your medical services, you may want to enroll in a Medicare Supplement plan.
Who Is Eligible for Ohio Medicare?
If you’ve already been receiving Social Security for 4 months prior to turning 65 years of age, you will be enrolled in Medicare automatically unless you elect to choose a different plan, such as a Medicare Advantage plan. However, those who have not contributed to Social Security for at least 10 working years or have not begun to receive Social Security yet may need to enroll themselves. It is important to find out what your status is if this is the case.
If you meet all of the criteria, your Medicare Part A plan will not cost you anything, but those who have not met the minimum requirements may be expected to pay a monthly premium. Medicare Part B may cost up to $150 (as of 2021 — the premiums do change over time) per month regardless of whether you meet the requirements to receive Part A free of charge. This is generally taken from your pension or Social Security benefit each month and you do not need to send payment on your own.
Medicare Advantage plans are subsidized, which means the insurer will receive payment from the government to cover your premiums and you will be required to pay the difference. It is still possible to be able to receive a Medicare Advantage plan for free, depending on the type of coverage you choose. Medicare D plans also require a monthly premium and the cost may depend on your medical conditions and the medications that are covered.
Your Initial Enrollment Period is the best time to obtain Medicare coverage. This period begins 3 months before you turn 65 and ends on the last day of the third month after your birthday. If you are not enrolled in a Medicare plan by the end of this date, you may suffer penalties and be required to pay more for your plan in the future.
The General Enrollment Period offers people who missed their initial enrollment period the chance to enroll in the Medicare plan of their choice. This period lasts from the beginning of January to the end of March. There are also Special Enrollment Periods for those who missed their IEP deadline due to service abroad, a disability in the family or being enrolled in a health insurance plan at work past the age of 65. If you qualify for special enrollment, you will not receive the penalty for late enrollment.
Medicare Supplement plans are offered by private insurers, and as long as you enroll within 6 months of turning 65, you are guaranteed to receive coverage. These insurers are also forbidden from raising your premiums or deductibles due solely to your medical history or age.
How Do I Enroll for Medicare in Ohio?
You can enroll in any Medicare plan by visiting medicare.gov and following the instructions offered on the site. You can also check to see if you were already enrolled and change plans if you wish. Medicare Supplement plans are not available through the Medicare website and are instead offered by private insurers.
Contact Information for Ohio Medicare, Medicaid and Insurance Help
To learn more about what Medicare and insurance offers are available in the State of Ohio, you can refer to the following resources.