Medicare Plans in Ohio – Coverage and Benefits
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).
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)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
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 a Medicare Advantage Plan, 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 an affordable supplement – 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|
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.
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:
[chart category=”supplement” name=”planTypes” state=”OH” zipcode=”43229″]
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.
[chart category=”advantage” name=”topHMOPlans” zipcode=”43229″ state=”OH”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”43229″ state=”OH”]
More about Medigap Supplement vs. Medicare Advantage
Because each person’s medical needs are different, it can be challenging to determine whether a Medigap Supplement plan is the most flexible and affordable coverage option, or whether Medicare Advantage might work better for you. We’ve spelled out some of the more important differences between the two plans below.
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
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.
[chart category=”general” name=”usefulContacts”]
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.