Medicare is a federally-mandated benefit, which is eligible to people in every state. In Ohio, Medicare Advantage plans (Part C) are available as an alternative to traditional Medicare (parts A and B), if that is your choice. Some of these plans include prescription drug coverage, as well as other benefits, such as vision, and dental. If you prefer, you may also opt into Medicare Part D as an Ohioan.
Medicare Supplement plans are also available in Ohio, for people over 65 who wish to purchase them from private insurers. These plans are also referred to as Medigap.
Medicare plans in Ohio vary in cost and scope from county to county. In addition to original Medicare, Medicare Advantage plans are available in all 88 counties throughout the state. You should be able to find a plan that provides the best type of coverage for you.
Medicare is actually a menu of various choices of plans and parts. Here are your Medicare options in Ohio for 2020.
Medicare Part A refers to hospital coverage. Medicare Part A is available to most Americans and is typically free. When there is no cost associated with Part A, it is referred to as premium-free. In Ohio, as in every state, you are eligible for premium-free Medicare Part A if:
- You are 65 years old, and you or your legal spouse paid enough Medicare taxes while working throughout your lifetime.
- You have received benefits from Social Security or the Railroad Retirement Board for 24 consecutive months, no matter what your age.
- You have end stage renal disease (ESRD).
If you do not meet any of those requirements, you may still be able to purchase Part A for a monthly premium rate. This rate will be determined by the amount of Medicare taxes you or your spouse paid while working, as well as the amount of time you worked.
Medicare Part B refers to medical coverage that, in most instances, takes place outside of a hospital setting. If you are eligible for Medicare Part A, you are also eligible for Medicare Part B.
In Ohio, if you enroll in Medicare on time, your monthly premium for Medicare Part B will cost, on average, $135.50. You will also have an annual deductible of $185 that you will be required to meet before your medical services start to be covered.
As with original Medicare plans nationwide, you will be responsible for 20 percent of most medical services you incur after your deductible is met.
Ohio residents are eligible for Medicare Part C, provided that they are enrolled in Part A and Part B. In addition, you must live within the plan’s service area.
People with end stage renal disease are not eligible for Medicare Part C in Ohio.
Most Medicare Part C plans in Ohio also include prescription drug coverage.
The enrollment dates for Medicare Part C are the same in Ohio as they are in the rest of the country. You can enroll during:
- Initial enrollment: when you first become eligible for Medicare 3 months before through 3 months after your 65th birthday
- Medicare because you are disabled: during the 3-month period prior to receiving your 25th disability benefit, through to the 3-month period after that date
- General enrollment: January 1 through March 31 every year
- Open enrollment: October 15 through December 7 every year
There are many Medicare Part C providers in Ohio, including Humana, Trinity Health, and Aetna. Premiums and copay costs for Part C plans vary, based upon the type of plan you purchase.
You can compare the costs of Medicare Advantage plans at Medicare’s plan finder tool. The range of monthly premiums for Medicare Advantage plans in Ohio is $0 to $224.
Medicare Part D is prescription drug coverage. You are eligible for Medicare Part D if you have or are enrolling in original Medicare. Some Medicare Advantage plans include prescription drug coverage, eliminating your need for a separate Part D plan.
You can enroll in Medicare Part D at the same time you enroll for Medicare, during your initial enrollment period. This 7-month period starts 3 months before your 65th birthday and ends 3 months after that date.
If you have a disability, you can enroll in Part D during the 7-month period that begins 3 months before the 25th month of disability benefit payments, and ends 3 months after that date.
You can also enroll for Medicare Part D during general enrollment along with Part B, if you miss the initial enrollment period.
If you have creditable drug coverage through a group health plan, you may be able to hold off on getting Medicare Part D. If you lose this coverage, you must enroll in Medicare Part D within 63 days of the triggering event.
If you miss signing up for Part D during any of these viable enrollment periods, you may still be able to get it at a later time. However, you will most likely incur a late-enrollment penalty, which will increase the cost of your monthly premium for Part D permanently.
Medigap policies help pay for out-of-pocket expenses, such as deductibles, coinsurance and copayments. In some instances, they may also pay for services that are not covered by original Medicare. MedSup policies are standardized under federal law, as well as under Ohio state law.
Medigap plans vary in terms of cost and coverage. Based on what they offer, they may be listed as one of 10 Medigap plans include plans A, B, C, D, F, G, K, L, M, and N.
In Ohio, a specific type of Medigap plan known as Medicare Select is an available option in all counties. Medicare Select plans require that you use specific hospitals and sometimes, specific doctors. If you buy a Medicare Select plan and find that it does not fit your needs, you may change it to another MedSup plan within 12 months after purchase.
Medigap plans require that you pay a monthly premium. Since they are purchased from private insurance companies, these costs vary. You can access a comprehensive list of private insurers and MedSup plan premium costs here.
Monthly premiums for Medigap plans in Ohio average $100 or less. Potential insurers include the Bankers Fidelity Life Insurance Company and Humana Insurance Company.
Help enrolling in Medicare in Ohio
If you need additional information or help enrolling in Medicare in Ohio, these organizations can help:
- Ohio Senior Health Insurance Information Program (OSHIIP) – 800-686-1578
- Ohio Department of Aging – 800-266-4346
- Local Area Agency on Aging – 866-243-5678
- Centers for Medicare and Medicaid – 1-800-MEDICARE (1-800-633-4227)
- Social Security – 1-800-772-1213
Here are the deadlines for enrolling in Medicare in Ohio and every state in the U.S.
Initial enrollment period
If you currently receive Social Security or Railroad Retirement benefits, your enrollment in in Medicare will be automatic. If not, you will have to enroll for the first time during a 7-month period known as initial enrollment. Initial enrollment begins 3 months before your 65th birthday, and ends 3 months after it takes place, for a total of 7 months.
General enrollment period
If you miss your initial enrollment period, you can still sign up for Medicare during general enrollment. General enrollment takes place annually, from January 1 – March 31. People who miss initial enrollment and sign up during this time may have to pay higher premiums for Medicare. If you sign up during general enrollment, your benefits will begin on July 1 of that same year.
Special enrollment period
If you are currently covered under a group health plan such as one provided at a job, you can sign up for original Medicare (parts A and B) at any point during your coverage, even if you are over 65. You may be enrolled in a group health plan through your job, your spouse’s job, or through a family member’s job, if you are disabled. If you stop working, the special enrollment period will extend for 8 months after your employment is terminated, or your coverage ends. This 8-month period begins on the first day of the month after termination of employment or benefits.
Annual open enrollment
The annual open enrollment period for Medicare in Ohio is the same as it is throughout the rest of the country. It begins on October 15 and ends on December 7 each year. During open enrollment, you can add to or switch your existing plan, including Medicare Part D or C. Any changes you make during an annual enrollment period will go into effect on January 1 of the following year.
Medigap (Medicare Supplement) enrollment
You can enroll in a MedSup plan during your initial enrollment period, and during the 6 months following your 65th birthday.
You can also enroll for a MedSup plan at any time, if you lose your current coverage, for 63 days after that event. This may occur, for example, if your current Medicare Advantage plan leaves the Medicare system. It may also occur if you lose your current group health coverage.
Medicare Part D enrollment
You can enroll in Medicare Part D during your initial enrollment period, or during general enrollment if you miss initial enrollment. You can also add it to your coverage anytime from April 1 – June 30 during your first coverage year.
In addition, you can join, drop, or switch your Part D plan between October 15 and December 7 of any subsequent year, after your first coverage year.
If you are joining for the first time because you didn’t sign up for Part D either during initial enrollment or general enrollment, you may incur an ongoing late penalty fee, which will be added to your monthly Part D premium.
Plan change enrollment
You can join, drop or switch Medicare Part C or Medicare Part D during October 15 to December 7 of any year. This period is known as open enrollment.
Medicare is a federal program which is available to residents of Ohio. The dates for enrollment in Ohio for Medicare parts A, B, C, D, and Medigap are the same as those throughout the rest of the country.