Ohio Medicare Guide

Get free information and advice from one of our licensed Ohio Medicare Advisors! Schedule a consultation or give us a call at (888) 604-0055 to get started.

In this guide you’ll find the information about Medicare in Ohio to choose the Medicare coverage that best meets your health and financial needs.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Ohio

• Medicare Eligibility and Enrollment Steps

• Ohio Medicare Advantage Plans

• Ohio Medicare Supplement Plans

• Ohio Medicare Part D Plans

• Get help paying for Medicare in Ohio

A Snapshot of Medicare in Ohio

There are 2.4 million Ohio Medicare beneficiaries, making up 20% of the state’s total population. Most beneficiaries are on Medicare due to age, but about 14% are on Medicare due to disability. 16% of Medicare enrollees also receive Medicaid benefits to help them pay for their healthcare expenses.

There’s more than one option when you enroll in Medicare. One of the big decisions beneficiaries need to make is between Original Medicare and Medicare Advantage. In Ohio, preferences are split about 50/50. 51% of Medicare beneficiaries stick with Original Medicare and 49% choose to switch to Medicare Advantage.

Ohio Medicare Eligibility and Enrollment Steps

All US citizens over the age of 65 are eligible for Medicare. You’re also eligible if you’re under 65 and have certain disabilities like ALS or End-Stage Renal Disease.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

Most people age into Medicare and can enroll when they turn 65. If you’re already receiving Social Security benefits or Railroad Retirement benefits, you’ll automatically be enrolled. If you aren’t automatically enrolled in Original Medicare, you’ll be eligible up to three months before your 65th birthday, at the start of your Initial Enrollment Period (IEP). Your IEP lasts for seven months, starting three months before the month you turn 65 and ending three months after it. Some people choose to delay enrollment for Part B because they’re still working and receiving employer-linked coverage. If you do this, just be sure you’re eligible for a Special Enrollment Period, or you may incur a late enrollment penalty! 

2. Compare additional coverage options

Once you’ve enrolled in Original Medicare, you can choose to stay on Original Medicare or switch to a Medicare Advantage plan. If you stay on Original Medicare, you can add a Medicare Supplement (Medigap) plan and/or a Part D plan to your insurance coverage. Which option is right for you depends on your unique financial and health situation. We’ll share more detail about each of your Medicare options below, but you don’t have to make Medicare decisions alone! Our licensed Ohio Medicare Advisors are here to help you understand your options and make the best decision to get the most out of your Medicare.

3. Get the most value from Medicare

Once you’ve chosen the best plan to maximize the value you get from Medicare, you’re not quite done. You don’t have to re-enroll in Medicare every year, but we recommend you shop around! During the Open Enrollment Period, which lasts from October 15 - December 7 every year, you have the option to switch Medicare Advantage plans and/or Part D plans. Why would you want to switch if you were so careful to pick the best plan for your needs the first time around? Medicare plans can change, and so can your healthcare needs! While we often recommend people stay on their current plan, in some cases, we’re able to help people save thousands by switching. 

Ohio Medicare Advantage Plans

There are 156 Medicare Advantage plans available in Ohio, but insurance carriers, pricing, and availability vary by county. For example, Franklin County, OH has 65 Medicare Advantage plans from 11 different insurance carriers and Hamilton County has 80 plans offered by 14 insurance carriers (in 2023).

Medicare Advantage plans bundle together different parts of Medicare and provide additional benefits. Legally, they must cover at least the same amount as Part A & Part B. Most of them also include Part D (prescription drug) coverage. Finally, they offer added health-related benefits, which may include:

• Dental, vision, and hearing coverage

• Flex cards

• Fitness perks

• Transportation services

• Meal services

Medicare Advantage plans are attractive because they offer additional coverage and benefits. They also generally have low or no additional premiums (Medicare Advantage enrollees still need to pay Original Medicare premiums). 

More coverage without much added cost sounds nice, so why doesn’t everyone make the move  to Medicare Advantage? Medicare Advantage plans have some serious drawbacks, including:

• Limited provider networks that limit your choice of doctors

• Frequent prior authorization requirements and denials

• Higher out-of-pocket costs (when compared to Original Medicare + Medicare Supplement)

Ohio Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement (also called Medigap) plans pair with Original Medicare. They don’t cover additional services or provide extra benefits, but they help beneficiaries cover the 20% of costs not covered by Original Medicare. 

Unlike Medicare Advantage plans, Medigap plans don’t limit the doctors you can see or require prior authorizations for covered services. They also significantly reduce your out-of-pocket costs! With a Medigap Plan G, for example, you don’t owe anything for Medicare-covered services once you meet your Part B deductible, which is $226 in 2023. 

There are ten types of Medigap plans in Ohio, labeled by letters A through N. While pricing may vary by insurance company and based off of personal factors like your age, location, gender, and smoking status, all plans of the same type (e.g., all Plan Ns) are identical. 

When you enroll in a Medigap plan matters, and the best time to enroll is during your Medigap Open Enrollment Period, which lasts for six months following your Part B effective date. During this time, insurance companies cannot ask you questions about your health history and you are guaranteed acceptance into any Medigap plan. Outside of this period (and a handful of other special guaranteed issue periods), insurance can ask questions about your health history and deny you coverage.

Ohio Part D Plans

Original Medicare doesn’t provide prescription drug coverage, which is why Part D was introduced. Ohio Medicare beneficiaries can get prescription drug coverage by either enrolling in a Medicare Advantage plan that includes it or enrolling in a stand-alone Part D plan. There are 24 Ohio Part D plans, but each county will have different pricing and availability.

Even if you don’t currently take any prescriptions, you should consider enrolling in a low-cost drug plan to avoid the Part D penalty. 

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Ohio Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Ohio

Ohio Medicare enrollees with low income and resources can apply for three programs to get help paying for Medicare-related costs: Medicaid, Medicare Extra Help, and Supplemental Security Income benefits.

Ohio Medicaid

Medicaid is a joint federal and state program that helps US citizens with low income and resources pay for medical expenses. Each state runs its own Medicaid program, and each is a little different. The Ohio Department of Medicaid has several programs, including one for individuals: Aged, Blind, or Disabled (ABD) Medicaid. Ohio also offers Medicare Savings Programs, which may also be called Medicare Premium Assistance Programs (MPAPs). 

Ohio Medicare Savings Programs / Medicare Premium Assistance Programs

Medicare Premium Assistance Programs help Medicare beneficiaries with low income and resources get help with Medicare costs. Each program is different, but benefits may include help with Medicare premiums, deductibles, and coinsurance. There are four MPAPs:

• Qualified Medicare Beneficiary (QMB)

• Specified Low-Income Medicare Beneficiary (SLMB)

• Qualified Individual-1 (QI-1)

• Qualified Disabled and Working Individuals (QDWI)

For more information about the eligibility requirements and application process for Ohio’s Medicare Savings Programs click here.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage. Extra Help is also commonly referred to as the Part D Low Income Subsidy (or LIS). 

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Ohio

• Ohio pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you may still be eligible. Talk to one of our licensed Ohio Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.