Medicare is the federal government’s health insurance plan for people age 65 and older, as well as some younger people with disabilities. As your 65th birthday approaches, you may be wondering about how to sign up for Medicare in Ohio.
This article provides an overview of Medicare plans in Ohio, including current Medicare Advantage options and things to consider when shopping around.
Ohio residents have two options for Medicare coverage: original Medicare and Medicare Advantage.
Original Medicare has two components:
- Part A (Hospital Insurance): This part helps pay for inpatient care you receive in the hospital, as well as hospice care and home health care. If you have a qualified hospital stay, it also covers short-term care in a skilled nursing facility.
- Part B (Medical Insurance): This part helps pay for medically necessary doctor services, outpatient hospital services, and preventative services. It also covers durable medical equipment, such as wheelchairs.
Original Medicare doesn’t pay for all healthcare costs. Depending on your needs, you may decide to get Medicare Supplement insurance. Also called MedSup or Medigap, these policies can help you pay for deductibles, coinsurance, and copayments.
Original Medicare doesn’t cover prescription drugs, but you can enroll in a stand-alone prescription drug plan. These drug plans are called Medicare Part D.
Medicare Advantage plans
Medicare Advantage plans are an alternative to original Medicare. They’re offered by private companies, and they need to cover all services included in Medicare parts A and B. Most plans include Part D drug benefits, too.
Many Medicare Advantage plans also cover extra services that original Medicare doesn’t, such as dental, vision, and hearing care.
If you’re interested in Medicare Advantage plans in Ohio, there are many options available. In 2020, the following carriers offer Medicare Advantage plans:
- Aetna Life Insurance Company
- Community Insurance Company
- Humana Insurance Company
- Mount Carmel Health Plan, Inc.
- Medical Mutual of Ohio
- Sierra Health and Life Insurance Company, Inc.
- Summacare Inc.
- Aultcare Health Insuring Corporation
- Paramount Care, Inc.
- Buckeye Community Health Plan, Inc.
- UnitedHealthcare Community Plan of Ohio, Inc.
- Molina Healthcare of Ohio, Inc.
- Coventry Health and Life Insurance Company
- Care Improvement Plus South Central Insurance Co.
- Highmark Senior Health Company
Not all plans are available in every county. Check provider websites to see which plans are available in your area.
If you live in Ohio, you’re generally eligible for Medicare if you’re in one of the following groups:
- you’re 65 years or older
- you’ve received Social Security Disability Insurance (SSDI) for at least 24 months
- you’ve been diagnosed with end stage renal disease (ERSD)
To find out if you’re eligible for Medicare, you can use Social Security’s online Benefit Eligibility Screening Tool. This tool isn’t an application for Medicare.
To be eligible for a Medicare Advantage plans in Ohio, you need to live in the plan’s service area and be enrolled in Medicare parts A and B.
In Ohio, you’re not eligible for a Medicare Advantage plan if you have ESRD.
You may be enrolled in Medicare automatically in some cases. For example, if you’re receiving Social Security retirement benefits, you’ll be automatically enrolled in Medicare parts A and B when you turn 65.
If you’re under 65 and receive SSDI checks, you should be automatically enrolled at the start of your 25th month on SSDI.
If you won’t be automatically enrolled, keep reading to learn how you can sign up.
When your first become eligible for Medicare at 65, you can sign up for parts A and B during your initial enrollment period. This 7-month period starts 3 months before the month of your 65th birthday, includes your birthday month, and ends 3 months after the month you turn 65.
If you don’t sign up for Medicare parts A and B during your initial enrollment period, you can sign up later during the general enrollment period. The general enrollment period occurs every year between January 1 and March 31.
Some people are allowed to sign up for parts A and B at other times of the year during a special enrollment period (SEP). If you or your spouse are working, and you have a group health plan from that job, the SEP lets you sign up at anytime. There’s also an 8-month SEP that starts the month after you leave your job, or the month after your employer’s group health plan ends, whichever comes first.
Unless you make another choice, you’ll have original Medicare. Some people may prefer to join a Medicare Advantage plan.
When you first become eligible for Medicare, you can sign up for a Medicare Advantage plan during your 7-month initial enrollment period. You can also switch from original Medicare to a Medicare Advantage plan between October 15 and December 7 every year.
If you’re deciding between original Medicare and Medicare Advantage, or if you’ve already decided on Medicare Advantage, it can be hard to choose the right plan for your needs. As you shop around for a plan, you may want to keep the following considerations in mind:
- Costs. You may need to pay a higher monthly premium for plans that offer drug coverage or other extra benefits, such as dental and vision care. Don’t forget to consider each plan’s annual out-of-pocket maximum.
- Types of coverage. Medicare Advantage plans in Ohio may offer dental, vision, and hearing coverage, and some plans may cover perks like fitness memberships. Determine what types of coverage you want or need before you choose a plan.
- Provider network. People with original Medicare can see any doctor who accepts Medicare, but Medicare Advantage plans usually have a provider network. Before you sign up for a plan, ask your doctor if they’re in the network.
- Ratings. The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage plans based on many factors, such as plan performance and customer service. The CMS Five-Star Rating System can help you find quality plans in Ohio. To view the ratings, visit CMS.gov and download the 2020 Star Ratings Fact Sheet.
- Other coverage. You may have other health coverage, such as from a union or former employer. If you leave your current plan, you may not be able to rejoin later. Contact your insurer to find out how your existing coverage is affected by Medicare.
To learn more about Medicare Ohio, visit these resources:
If you’re ready to enroll in Medicare, you can:
- Visit the Social Security website to apply for Medicare online, or stop by your local Social Security office.
- Visit Medicare.gov to search for drug plans (Part D) or Medicare Advantage plans that are available in your area.
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