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Medicare in Ohio

October 6, 2016

Medicare beneficiaries living in Ohio may have several Medicare plan options in addition to the  federally-administered Original Medicare, Part A and Part B. Through the Medicare Part C program, Medicare beneficiaries may receive their Medicare benefits from Medicare Advantage plans offered by Medicare-approved private insurance companies. Through the Medicare Part D program, beneficiaries may receive Medicare prescription drug coverage either from Medicare Advantage Prescription Drug plans or stand-alone Medicare Part D Prescription Drug Plans. If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs.

Unlike Medicare Part A and Part B, available Medicare plans vary depending on where you live.

Original Medicare for Ohio beneficiaries

Original Medicare consists of Medicare Part A (hospital insurance) and Part B (medical insurance). It is the health insurance program created and administered by the federal government. Part A covers inpatient hospital care, skilled nursing and nursing home care, home health care and hospice care; Part B covers doctor’s visits and preventive services such as annual wellness exams, outpatient medical and mental health care, durable medical equipment.

To be eligible for Original Medicare, you must be 65 or older and a U.S. citizen or legal permanent resident of five continuous years or more. People who are younger than 65 may be eligible for Medicare if they have certain health conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or if they’ve collected disability benefits for 24 continuous months or more from the Social Security Administration (SSA) or the Railroad Retirement Board.

Many beneficiaries are enrolled automatically, provided they already receive benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). In these cases, the red, white, and blue Medicare membership card is mailed to you approximately three months before your coverage begins, along with a “Welcome to Medicare” packet that contains educational information concerning the program.

Eligible beneficiaries in Ohio who are not enrolled automatically can apply for Medicare during the Initial Enrollment Period (IEP), a period that begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month (for a total of seven months). It’s usually best to sign up during the IEP. If you don’t, you can enroll during the General Enrollment Period (January 1 – March 31 annually), but you could have to pay late enrollment penalties.

If you’re still working at the age of 65 and/or covered under an employer’s or union’s group health plan (or a spouse’s plan), you can delay enrolling in Medicare Part B. Before the group health plan coverage ends, you can sign up for Part B during a Special Enrollment Period without a late enrollment penalty.

People who are not eligible for social security benefits and those with end-stage renal disease (ESRD) are not automatically enrolled in Medicare. Contact the SSA for details (see contact information below).

To sign up for Medicare, you can go to your local SSA office or register online. You can also enroll by telephone:

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM.
  • If you worked for a railroad, call the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701. Representatives are available Monday through Friday, from 9AM to 3:30PM.

Medicare plan options in Ohio

There are  Medicare plan options in Ohio besides Original Medicare. The best time to sign up for these plans is often during the Initial Enrollment Period.

  • Medicare Part C, more commonly known as Medicare Advantage is the program that provides access to Medicare Advantage plans offered by a private insurance company that contracts with Medicare. While these plans must provide at least the same coverage as Original Medicare (excluding hospice care, which remains covered through Medicare Part A), Medicare Advantage plans may include additional benefits, such as routine vision, hearing, dental, and prescription drug coverage. Not every Medicare Advantage plan has prescription drug coverage, but the ones that do are referred to as Medicare Advantage Prescription Drug plans (sometimes abbreviated as MA-PDs). These plans provide all of your health and prescription drug coverage in one plan. You can also sign up for a Medicare Advantage Plan or change plans during the Annual Election Period (from October 15 to December 7 each year). You still continue to pay your Medicare Part B premium when you’re enrolled in a Medicare Advantage plan.
  • Medicare Supplement (Medigap) plans help pay for some of your out-of-pocket costs under Original Medicare, including cost-sharing expenses and emergency overseas travel coverage. Plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. In 47 states, including North Carolina, Medigap plans offer the same standardized benefits for plans of the same letter type.

Medicare Supplement plans can only be used to help with Original Medicare costs. You must stay enrolled in Part A and Part B for your hospital and medical coverage. In addition, keep in mind that prescription drug coverage isn’t included in these plans, so if you want help with your medication costs, you should enroll in a stand-alone Medicare Prescription Drug Plan.

Specific plan types and premium amounts may vary depending on where you live in the state.

  • Medicare Part D prescription drug coverage is available not only from Medicare Advantage Prescription Drug plans but also from stand-alone Medicare Part D Prescription Drug Plans. To enroll in a Medicare Part D Prescription Drug Plan you must have Medicare Part A and/or Medicare Part B. Each plan has a formulary, which is a list of prescription medications covered by that plan. Formularies and costs will vary by plan, so it’s a good idea to compare the plans available where you live to identify the one that best suits your needs.

If you’d like to sign up for a Medicare prescription drug plan, the best time to do so is usually during your Initial Enrollment Period. You can also sign up during the Annual Election Period (from October 15 to December 7), but if you don’t sign up when you’re first eligible, you could pay a Part D late-enrollment penalty if you are without creditable coverage for at least 63 consecutive days after your initial enrollment period ends. Creditable coverage means prescription drug coverage that provides approximately the same coverage as Medicare Part D.

Ohio resources for Medicare beneficiaries

There are numerous resources at your disposal at Medicare.gov. Many of these are established to assist you with any Medicare questions you might have, as well as providing answers to additional questions you may have.

  • Ohio State Health Insurance Assistance Program (SHIP): Toll-free number 1-800-686-1578, TTY users call 1-614-644-3745; Monday through Friday 7:30AM to 5PM ET.Website.
  • National Institute on Aging Information Center: Toll-free number 1-800-222-2225, TTY users call 1-800-222-4225; Monday through Friday 8:30AM to 5PM ET.Website.

Learn more about how Medicare plans work in Ohio including:

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