Medicare in Ohio

Medicare is a federally funded health care program for adults aged 65+ and younger people with qualifying disabilities. As of 2022, 65 million Americans have enrolled in Medicare, with seniors comprising 57.3 million. As of 2023, 2.4 million reside in Ohio, at an annual cost of $13 billion, based on 2021’s figures. However, Ohioans appear to be switching to Medicare Advantage. Figures for 2023 reveal 51% of eligible residents have purchased a plan, 2.36% more than the previous year and above the 48% national average. The pace is accelerating, as the number of Ohioans moving to Medicare Advantage increased by 5.86% more in 2023 than in 2022. 

Original Medicare is the foundation program, comprising two parts: A and B. Part A covers essential care costs, such as nursing home care, hospital stays and certain facets of home health care. Part B covers outpatient care, including doctors’ services, medical transportation and medical supplies and equipment. Most people don’t pay a premium for Part A, but everyone pays a premium for Part B, which is $164.90 in 2023. Part D exclusively covers prescription drug costs. As each prescription differs and drugs are assigned different tiers based on cost, premiums can vary greatly. Medicare doesn’t cover co-pays, coinsurance or deductibles, but seniors can purchase Medicare Supplement Insurance, known as Medigap, to cover out-of-pocket expenses.

Medicare Advantage, also known as Part C, blends the coverage provided by Parts A and B, minus hospice care, into one plan. Ohioans have a choice of 216 plans in 2023, 14 more than in 2022. While the Centers for Medicare and Medicaid Services (CMS) administer Original Medicare, approved private insurance companies manage Medicare Advantage Plans. The initial premium is 0%, but this increases as beneficiaries tailor their coverage, adding options such as hearing, dental and vision care. As a result, Ohio’s median monthly premium is $16.03, which is more affordable than 2022’s average of $18.17.

This guide covers different ways Ohio’s seniors can get more from Medicare. It explains coverage options and lists nonprofits that provide direct assistance, often for little or no cost.

Options for Medicare Coverage in Ohio

Original Medicare is the most popular choice for Ohio seniors, but it isn’t the only option available. Ohio residents have a lot of other options to get coverage, and Medicare-eligible seniors are free to craft a care plan that better meets their needs. Along with the federal program, there are several privately offered alternatives to choose from.

Original Medicare (Parts A & B)

Original Medicare beneficiaries qualify for the same services wherever they are in the country. This includes while they’re vacationing or if they move to another state. Medicare hardly ever pays for medical care in other countries, so beneficiaries are strongly advised to purchase appropriate insurance before they start their journey. 

Original Medicare beneficiaries must pay for their medical care when they receive it. They must also pay an annual deductible for Parts A and B, which are, in 2023, $1,600 and $226, respectively. Medicare will subsequently cover 80% of the final cost, with the senior covering 20%.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage’s appeal is its flexibility. There are five standard plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee-for-Service plans (PFFS)
• Special Needs Plans (SNPs)
• Medicare Savings Account (MSA)

Private insurance companies approved by the CMS can tailor these plans to provide customers with the coverage they want and need. For example, a senior with a chronic illness can get appropriate coverage with an SNP plan, while someone wanting more control over their medical expenses may choose an MSA plan. Whichever plan the senior adopts, it will comply with the rules and regulations imposed by the CMS.

Who Should Consider Medicare Advantage

Medicare Advantage can be a good choice for seniors who:

• Want a single premium bill for their entire coverage plan
• Want more precise control over their costs and benefit structure
• Need services Original Medicare doesn’t offer, such as dental and vision care
• Are looking for routine medical services at a relatively low and predictable cost
• Prefer the convenience of managed care

The Top 10 Medicare Advantage Plans in Ohio

Ohio seniors have access to several popular and highly rated Medicare Advantage plans. The table below lists some of the top providers and cost data current as of August 2023. More information about Part C is on the Medicare Advantage Plans in Ohio page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

In Ohio, there are 10 types of Medigap plans, eight of which are available to new enrollees. Plans are standardized, meaning policyholders get the exact same coverage from a given plan regardless of the health insurance provider they buy it from. For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Ohio

It can be challenging to make sense of all the different options for Ohio Medicare. Fortunately, Ohio seniors can get help understanding all their options through several local and national resources. These agencies assist seniors with navigating the different policy options available to find the best coverage for them. The resources listed below offer one-on-one counseling about benefits, impartial advice and help enrolling in Original Medicare Parts A and B, various drug coverage options, Medicare Advantage and privately issued Medigap plans in Ohio.