Citizens of all 50 states, including Ohio, are eligible to enroll in the Medicare program once they meet all the prerequisites. What most people refer to as “Traditional Medicare” is actually Parts A and B of the federal Medicare plan. Despite the fact that Parts A and B are fairly comprehensive, it is highly unlikely that being enrolled in Medicare will cover 100% of your medical expenses. Most people choose to cover these “gaps” with some form of supplemental insurance (which will be discussed in detail later on in this article).

Coverage and Benefits for Medicare Plans In Ohio

To get Medicare Part A for free, you must have a minimum employment history of 10 years or more (the equivalent of 40 quarters). Those enrollees who have less than 10 years of work experience may have to pay premiums for Medicare Part A. Medicare Part B automatically requires a premium, in addition to Part A premiums if you don’t have a sufficient level of work history. Your state’s social security office has detailed information on premium costs for Parts A and B.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

If you have recently qualified for Medicare you have some choices to make. For better or worse, you won’t be able to choose whether or not you get Part A benefits. Those will be yours whether you like them or not; but you have more of a choice when it comes to Part B benefits. You can choose to accept both Part A and B, or you can only pay for Part A. Part A benefits typically deal with hospital expenses, whereas Part B benefits relate to outpatient treatment and preventative care.

Next are Medicare Part C and Medicare Part D. Medicare Part D is government-sponsored prescription drug coverage which you can only qualify for if you do decide to accept Part A and Part B benefits. You cannot get Medicare Part D if you are only paying for Medicare Part A. Medicare Part C is a private health insurance policy which starts out as being identical to Medicare Parts A & B. But you can choose to purchase additional coverage if you wish.

Multiple Medicare Plans In Ohio

In the state of Ohio, there are more than 1.9 million people currently accepting Medicare benefits. 38% of those enrollees (more than 750,000 Ohio residents) are receiving their medical benefits through Medicare Plans In Ohio, also known as Medicare Part C. And additional 18% (355,533 people) are supplementing their Medicare benefits through a Medicare Supplemental policy (a.k.a. “Medigap”). The other 44% of the Ohio elderly population are either covering their medical expenses through an employer-sponsored group/retiree plan, an alternative individual health care plan, or relying on Medicare Parts A and B alone to cover all of their healthcare expenses.

Ohio seniors who are currently receiving Medicare benefits can (and should) be looking for affordable Medicare Plans In Ohio – but the first step is to make sure you’re enrolled in the federal Medicare program. Without enrollment, you can’t supplement your benefits.

Who Do So Many People Choose to Purchase Additional Coverage Beyond Traditional Medicare?

To put it simply: they are trying to protect themselves from out-of-pocket expenses. Medicare Parts A and B will cover some basic inpatient and outpatient expenses, but if you need anything beyond that, surprise expenses can mount quickly. Additionally, in order to have access to Traditional Medicare coverage, your up-front expenses could cost hundreds if not thousands of dollars (as outlined in the table below).

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Most people do not feel secure leaving their medical expenses up to chance. For this reason, many Medicare beneficiaries seek out supplemental health insurance to protect their savings from Medicare coverage gaps. Next, we’ll cover the top coverage choices most people turn to when looking for comprehensive medical coverage under Medicare.

If you have recently qualified for Medicare you have some choices to make. For better or worse, you won’t be able to choose whether or not you get Part A benefits. Those will be yours whether you like them or not; but you have more of a choice when it comes to Part B benefits. You can choose to accept both Part A and B, or you can only pay for Part A. Part A benefits typically deal with hospital expenses, whereas Part B benefits relate to outpatient treatment and preventative care.

Next are Medicare Part C and Medicare Part D. Medicare Part D is government-sponsored prescription drug coverage which you can only qualify for if you do decide to accept Part A and Part B benefits. You cannot get Medicare Part D if you are only paying for Medicare Part A. Medicare Part C is a private health insurance policy which starts out as being identical to Medicare Parts A & B. But you can choose to purchase additional coverage if you wish.

Personal circumstances are very important when trying to decide among your many options. The population size of your city is a good indicator of how many medical options you have to choose from – which can make or break your healthcare costs in the future. Your age and your overall health will also determine how expensive your care can be. There’s no one-size-fits-all solution to the gaps in Original Medicare coverage – there’s only what works and what doesn’t.

Coverage Choice #1: A Medicare Supplement Plan

Medigap Plans, also sometimes referred to as Medicare Supplement Plans, fill in the coverage gaps which you would normally be financially responsible for – hence the “gap” part of the term “Medigap”. The federal government of the United States has designed and currently regulates 10 different coverage plans. They are codified by a letter system and organized alphabetically: Plans A-D, F, G, and K-N. Back in the summer of 2010, plans E, H, I, & J were eliminated thanks to the Medicare Modernization Act. Regardless of your state or insurance company, All 10 plans offer the exact same coverage and benefits; the only thing that varies by region or insurer is the price you pay for your chosen plan.

For clarification, take a look at this handy Medigap policy comparison chart:

Coverage Choice #2: A Medicare Advantage Plan

A Medicare Advantage Plan may also be referred to as “Medicare Part C” or a “Medicare Replacement Policy”. Medicare Advantage can be confusing at first, but we will try to clear the air with this article. For starters, choosing a Medicare Advantage plan means that your healthcare will no longer be managed by Traditional Medicare, although you will still receive the exact same benefits (or more, depending on your policy). Instead, your benefits and costs will go through a private company which provides “equal or greater” coverage compared to Medicare Parts A and B.

More often than not, Part C plans combine all of the benefits of Traditional Medicare plus things like drug coverage, dental, vision, and more into one single plan. Many enrollees feel that this makes their healthcare expenses easier to manage. However, this can often lead to very restrictive medical networks, depending on the private insurance company which is handling your Advantage plan. HMOs are the most restrictive policies, whereas PPOs give you a little more freedom. Regardless, your ability to choose your own doctors and providers will be hindered.

Seniors who sign up for Medicare Advantage will be required to seek medical care through either a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). You will not be able to choose doctors or facilities outside of your HMO or PPO.

More about Medigap Supplement vs. Medicare Advantage

Shopping for supplemental Medicare insurance will leave you choosing between a Medicare Part C plan or a Medicare Supplement insurance policy. These two have similar goals but are very different. We’ll tell you a little bit about what makes each plan unique so that you can make a well-informed choice.

Medicare Advantage, another name for Medicare Part C, is certainly very popular.. It’s a private health insurance policy which is completely separate from and which you can purchase in place of Medicare Parts A & B. You can also replace your Part D coverage if you decide to add that to your policy. Your benefits start by being identical to Original Medicare, and you will have the option to add the types of coverage which you believe will protect you the most as you get older and your healthcare needs change.

Medigap, otherwise known as a Medicare Supplement insurance, is a different option. You can think of Medicare Advantage like a sledgehammer and Medigap insurance like a scalpel. Medigap policies are designed to be smaller and specifically target Medicare coverage gaps. You won’t have the option to add custom coverage, but you will be able to protect yourself from Medicare coverage gaps and have some of your other Medicare costs mitigated for a low monthly premium.

On the one hand, we can understand why many seniors would find Medicare Advantage appealing. You can bundle many different types of coverage under a single policy for convenience. However, purchasing all that extra coverage will definitely increase your monthly premium, among other things. Medigap policies don’t give you extra options like prescription drug coverage or vision, but they can give you exactly what you need for a low monthly premium. Best of all, there are 10 different plans to choose from so you won’t end up paying for extra coverage that you neither need nor want.

Of course, this is just the tip of the iceberg. Below is our FAQ where we tackle some of the other major differences between these two insurance plans. If you still have questions, we are ready and waiting to hear from you. Just call our toll-free number for a chance to speak to one of our agents who can help you find a free quote for the policy which works best for you.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? Your insurance provider estimates what your expected premiums will be and charges the government. Whatever the government does not pay for gets passed on to you. You will be required to pay one low monthly premium for all of your coverage. This can be a real bargain if you happen to purchase a very comprehensive policy.
Will I still have to pay for Part B? Yes Yes
What will it cost me? The answer to that question depends on many things like the share of your premium the government is paying; the amount of in-network facilities you are allowed to choose from; and whether or not you are in good health. The most comprehensive plans will cover almost all of your costs, including either your Part B premiums or your Part B coinsurance. Less comprehensive plans may cost you more money in co-pays and other fees.
What will the plan cover? Medicare Advantage plans start by offering you identical benefits to Medicare Parts A & B because of government mandates. From there you have the option to choose as much additional coverage as your insurance provider is willing to sell you. Medigap supplements start by covering the expensive gaps in Part A coverage. As you progress to more comprehensive policies, some of them will start to cover more or almost all of Part B coverage gaps, too.
Is it easy to budget my health care expenses? The less healthcare you require, the easier it will be to budget for a Medicare Advantage plan because you won’t be sharing as many medical expenses with your insurance provider. Comprehensive plans like F or G will cover more of the variable costs like premiums or coinsurance which makes budgeting much easier.
Is my plan guaranteed? Or can it be cancelled? There are no guarantees that your coverage will not be cancelled; your insurance provider has a lot of discretion in that department. Once you start paying for a Medigap insurance policy, it’s yours for life (unless you stop paying your premiums or the company goes under financially).
Do I have to clear a pre-approval or pre-certification process? Just like there aren’t many rules about guaranteeing your coverage, your Medicare Advantage provider is allowed to put you through a pre-certification process if they see fit. As long as you are already approved for Medicare, your Medigap insurance company cannot demand any more of you.
Am I limited to specific doctors or hospitals? In some areas, Medicare Advantage is more affordable than other plans because their very restrictive networks keep costs low enough to be competitively affordable. Medigap insurance is accepted everywhere that Medicare is, so you will have virtually no problem finding doctors and hospitals who accept your coverage.
What type of plan is best for me? If you are on the younger side, in very good health, and live near many different doctors and hospitals to choose from, you can probably find a fairly affordable deal on a Medicare Advantage policy. Medigap policies are much more affordable in areas where your healthcare options are limited, when you require more medical care more often, or when you don’t need much extra coverage.

Helpful Medicare Resources

Use the directory below to learn more information on Medicare-related topics. This tool contains phone numbers and other valuable forms of contact information for agencies such as Medicare, your local Social Security office, your State Health Insurance & Assistance Program, and many more.

Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
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