Medicare Advantage in Ohio
If you're a Medicare beneficiary in Ohio, a Medicare Advantage plan can provide benefits beyond standard Original Medicare coverage. The specific plans available to you will depend on your zip code and county of residence.
How Medicare Advantage works in Ohio
Medicare Advantage in Ohio works in much the same way as the rest of the country. Also known as Part C, these Medicare health plans provide Original Medicare benefits through private insurance companies. Medicare Advantage plans are required to offer at least the same level of coverage you'd get in Original Medicare. Many plans go beyond this, offering benefits that Original Medicare doesn't cover, such as vision, dental, or prescription drug benefits.
Medicare Advantage is simply another way to get your Medicare coverage. While Original Medicare is administered by the federal government, in Medicare Advantage, you'd work directly with your insurance company when filing claims and handling benefit issues.
Eligibility for Medicare Advantage is the same in all states, including Ohio. To join a Medicare Advantage plan, you must:
- Have Part A and Part B (also known as entitlement).
- Permanently reside in a county covered by the plan you're considering.
- Not have end-stage renal disease (ESRD).
Ohio beneficiaries who meet all eligibility requirements can join a Medicare Advantage plan or make changes to their coverage during the following periods:
- Initial Coverage Election Period: The Initial Coverage Election Period is the period when you're first eligible to enroll in a Medicare Advantage plan. It starts three months before you have Part A and Part B and ends on the date that falls later: the last day before you're enrolled in Part A and Part B or the last day of your Initial Enrollment Period for Part B.
- Annual Election Period: This is the Fall Open Enrollment that runs from October 15 to December 7 every year. During the Annual Election Period, you can switch to Medicare Advantage, make changes to your prescription drug coverage, or disenroll from Medicare Advantage and go back to Original Medicare.
- Medicare Advantage Disenrollment Period: This period runs from January 1 to February 14 every year. During this period, you can only disenroll from Medicare Advantage to return to Original Medicare. You can't make other coverage changes.
- Special Election Period: If you qualify for a Special Election Period, you can join Medicare Advantage or make coverage changes outside of the regular enrollment periods. Only certain situations qualify, such as moving out of your plan's service area.
Types of Medicare Advantage plans in Ohio
There are many different types of Medicare Advantage plans. Your choices as an Ohio beneficiary will depend, as mentioned, on where you live and whether you meet the plan's eligibility criteria.
Here's an overview of the some of the most common types of Medicare Advantage plans.
- Health Maintenance Organization (HMO): HMOs require you to use doctors in the plan's network. You will have a primary care doctor and need a referral to see a specialist.
- Preferred Provider Organization (PPO): PPOs allow you to see out-of-network providers, but you'll have lower costs if you use doctors in the plan's preferred network. You won't need a referral to see a specialist, and you won't have a primary care physician.
- Health Maintenance Organization Point-of-Service (POS): HMO-POS plans have features of HMO and PPO plans. You'll have a primary care doctor, like an HMO, but you'll also be allowed to pay more to see an out-of-network provider. HMO-POS plans may not require referrals if you need to see a specialist.
- Private Fee-for-Service (PFFS): Private Fee-for-Service plans don't have provider networks, and you can use any provider that will accept the plan's payment conditions. Provider contract with your Private Fee-for-Service plan and treat you on a case-by-case scenario, so you'll need to verify that the provider takes your plan on each visit. You'll only pay the plan's cost-sharing requirements, but some providers can charge up to 15% above the Medicare-approved amount.
- Special Needs Plan (SNP): Special Needs Plan membership is limited to people who meet certain eligibility criteria. There are three kinds of Special Needs Plans, each targeting a certain group, including people who have specific medical conditions, live in an institution, or receive Medicaid benefits. Every Special Needs Plan provides prescription drug benefits.
- Medicare Savings Account (MSA): This is a high-deductible Medicare Advantage plan that includes a medical savings account. The Medicare Savings Account plan deposits money into a savings account that you can use to pay for health costs without being taxed. Your plan won't pay for health costs until you reach the deductible. Medicare Savings Account plans don't include drug coverage.
Some Medicare Advantage plans, known as MA-PD plans, may include prescription drug benefits. These plans provide your Part C and Part D benefits under a single plan.
If you have Medicare Advantage, you'd get your drug benefits through the health plan, not a stand-alone Medicare prescription drug plan. The exception is if you're enrolled in a Medicare Savings Account plan (which never includes drug benefits) or a Private Fee-for-Service plan (which doesn't always include it). If you're in a Medicare Savings Account plan or a Private Fee-for-Service plan that doesn't come with drug coverage, you're allowed to enroll in a stand-alone prescription drug plan. For all other types of Medicare Advantage plans, you're required to join a Medicare Advantage plan that includes drug coverage. Aside from Medicare Savings Account plans, any of the other types of Medicare Advantage plans may come with drug benefits.
Comparing Medicare Advantage plans available in Ohio
Considering all the different types of Medicare Advantage plans, along with the fact that costs and benefits vary by insurer and location, and you can begin to see why it's so important to carefully review all of your available options. When comparing Medicare Advantage plans in Ohio, always be sure to input your zip code to search for plans in your service area.
Some factors that may affect your choice of plan include your current and future health needs, budget, provider choice, and whether you take medications. If it's important that you keep seeing a particular doctor, check that the provider is in the plan's network. If you take prescription drugs, verify that any plan you join covers all of your medications, or you could end up paying a lot more out of pocket. Remember that regardless of the plan or insurance company you go with, you'll have to keep paying the Part B premium.
When you're ready to begin comparing Medicare Advantage plans in Ohio, you have many ways to do it:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as eHealth.
- Call eHealth agents at 1- TTY users 711; .
- Or enter your zip code where requested on this page to see a quote.
Medicare has neither reviewed nor endorsed this information.