Medicare in Ohio

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Medicare Plans in Ohio

In Ohio more than 2.3 million residents are enrolled in Medicare plans out of which 16 percent are of under age 65, according to the Centers for Medicare and Medicaid Services. Medicare is a plan designed especially for seniors and disabled people that give them flexibility and choices to obtain high quality healthcare services. Medicare program has played a vital role in providing coverage to individuals who might otherwise not be able to afford health insurance. Majority of Medicare recipients about 83% in Ohio qualify for Medicare plans based on age whereas 17% qualify due to disability. In Ohio about $9,463 per enrollee is spend by the Medicare. Medicare coverage in Ohio is exactly the same like in any other states, as the program ensures uniform services in each and every state. Some of the Medicare plans available in Ohio include:

Original Medicare Plans In Ohio

Generally there are four parts of Medicare that help cover specific services but majority of Medicare beneficiaries prefer to obtain its benefits through Original Medicare. Original Medicare is the traditional fee-for-service program, which is directly offered through the federal government. The Center for Medicare & Medicaid Services reported that as of January 2018, 1,304,591 Ohioans were enrolled in Medicare Part A and Part B. In Original Medicare, the government directly pays for the healthcare services received by the members of the plan. Enrollees of Original Medicare directly visit hospital or doctor in case of any healthcare need and they do not need to obtain any prior approval from Medicare or their primary care provider. Medicare Part A covers skilled nursing facility, nursing home care, inpatient hospital care, limited home health care and hospice care, whereas Medicare Part B cover doctor visits and preventive care like annual health checkup, flu shots, diagnostic test, durable medical equipment along with outpatient surgeries. Some of the Medicare enrollees need to pay a premium for Part A whereas Part B monthly premium is paid by all. For every healthcare services received, enrollees are required to pay a coinsurance. Medicare has also limited the amounts which the doctors and hospitals can charge for the medical services offered.

Medicare Part C or Advantage Plans in Ohio

Around 42% Medicare beneficiaries in Ohio are enrolled in Medicare Advantage plans, as this state has more robust Medicare Advantage market than several other U.S. states. There are 15 Medicare Advantage plans available in every county of Ohio and in some areas there are more than 60 plans available. Medicare beneficiaries in Ohio has the alternative way to obtain coverage through private insurance carriers in the form of Medicare Advantage plans. These plans offered by private insurers varies from one area to another. Medicare Advantage plans in Ohio provide benefits beyond standard Original Medicare coverage like routine vision, dental and prescription drug benefits. The availability of specific Advantage plan depend on the part of Ohio in which residents are looking for the plan. In order to enroll in Medicare Part C or Advantage plan, beneficiaries must have Medicare Part A and Part B, they must permanently reside within the service area of the plan, and they should not have end-stage renal disease.

Types of Medicare Advantage Plans available in Ohio:

  • HMO

  • PPO

  • Point Of Service

  • Private Fee-for-Service

  • Special Needs Plan

  • Medicare Savings Account

Medicare Advantage Plans in Ohio with Prescription Drug Coverage

If Medicare beneficiaries enrolled in Original Medicare wish to obtain prescription drug benefits and if they want convenience of having all benefits covered under a single plan, then they can obtain Medicare Advantage Prescription Drug plan. This health plan provides both health and prescription drug coverage under one comprehensive plan. These plans are offered by private insurance companies having contract with Medicare to provide Part A, Part B and Part D benefits. Every Medicare Advantage Prescription Drug plan covers a documented list of prescription medications that is called a formulary. The plan must offer two or more medications within each category like antidepressant, and antibiotic. People enrolling in this plan must make sure that their ongoing prescription is included in the plan’s formulary because the medications covered vary from plan to plan. Two Medicare Advantage Prescription Drug plans may cover the same prescription drugs but with different out-of-pocket costs, so it is significant to carry out proper search on the plans available to save some significant cost.

Medicare Part D or Prescription Drug Plans in Ohio

Original Medicare only in limited situations cover certain prescription drugs, therefore Medicare beneficiaries in Ohio need to sign up for a stand-alone Medicare Part D Prescription Drug Plan, which is designed to cover some of the medications cost. Offered by private insurance companies, Medicare Part D Prescription Drug Plans are designed to work alongside the Original Medicare coverage. Around 45% of Medicare beneficiaries in the mid of 2019 were enrolled in stand-alone Medicare Part D or Prescription Drug Plans. In Ohio there are 26 Medicare Part D plans available that are offered by ten different health insurance providers. These plans help cover the prescription cost but do not provide medical coverage. In order to enroll in this plan, beneficiaries must have Medicare Part A and Part B plan and they must live within the plan’s service area. Each Part D plan has a separate list of formulary so residents enrolling in this plan should check the formulary list of the plan to ensure that their drugs are included in the list.

Medicare Supplement/Medigap Plans in Ohio

Medicare beneficiaries in Ohio have the option of enrolling in a Medicare Supplement or Medigap plan in Ohio that allow them pay for some of the out-of-pocket costs not covered under Original Medicare. There are ten standardized Medigap plans in Ohio and these plans are labeled by the letters A through N. Medicare Supplement plans available today do not cover prescription drugs, and this plan can’t be used along with Medicare Advantage plans. Medicare Supplement plans are not endorsed by the U.S. government or the federal Medicare program. The six month Medigap Open Enrollment Period begins on the first day of the month in which a Medicare beneficiary is 65 or older and is enrolled in Medicare Part B. During this period beneficiaries can sign up for supplement plans, as they have guaranteed issue, i.e. right to enroll in the Medigap plan of their choice and insurance companies cannot deny them coverage or charge them extra for certain conditions. Beneficiaries enrolling in Medigap after the OEP will be required to submit a detailed medical background and there is a chance that they can be denied coverage or charged higher premium for having pre-existing conditions.

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