Medicare Advantage Plans in Ohio
Written by: Vanessa Jerusalimiec
Reviewed by: Kai Martinez, Licensed Insurance Agent
Medicare Advantage plans in Ohio offer coverage to residents over 65.
Younger adults can also enroll in Medicare in OH under special circumstances.
Ohio Medicare Advantage plans provide you with coverage through PPO or HMO networks.
Some Medicare Advantage plans have premiums starting as low as $0, and each plan sets its copayment and coinsurance rates.
The ideal time to enroll in a Medicare Advantage plan is in the months just before your 65th birthday.
Home to the Rock & Roll Hall of Fame and the Ohio and Erie Canalway, Ohio draws visitors from across the country. The Buckeye State has another claim to fame: Cincinnati chili!
If you’re ready for legendary healthcare coverage, a GoHealth licensed insurance agent can help identify the right fit for you.
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Ohio Medicare Advantage Plan Coverage
Medicare Advantage plans, also called Medicare Part C, offer comprehensive healthcare coverage. These are standalone plans offered by private insurance companies. Medicare Advantage plans are an alternative to Original Medicare, the federal Medicare plan.
Every Medicare Advantage plan must provide at least the same coverage as Original Medicare Part A and Part B. This covers hospital and medical bills. But Medicare Advantage plan providers are free to add additional coverage and benefits. Medicare Advantage plans often offer other great benefits, such as:
- Hospital coverage
- Comprehensive medical coverage
- Preventative services
- Ambulance services
- Durable medical equipment
- Dental, vision, and hearing coverage
- Fitness membership with the SilverSneakers program
- Prescription drug benefits
OH Medicare Advantage Plan Costs
The cost of each Medicare Advantage plan varies. That’s because Medicare Advantage plans are offered by private insurance companies that can set their rates. Original Medicare, on the other hand, has a fixed national rate.
Depending on your healthcare needs, Medicare Advantage plans can be a cost-effective option. Medicare Advantage plans set their prices based on the services they cover. Medicare Advantage plans in Ohio typically have a cap on out-of-pocket spending, and they have lower copayment and coinsurance rates than Original Medicare.
Plan premiums can start as low as $0 per month. But it all depends on the type of Medicare Advantage plan you choose.
Types of Medicare Advantage Plans
Medicare isn’t a one-size-fits-all solution. If you’ve decided to enroll in a Medicare Advantage plan, you have a few options to choose from.
- Health Maintenance Organization Plans (HMO) give you excellent healthcare coverage. These plans usually have low monthly premiums. If you enroll in an HMO plan, you’ll work with a primary physician to monitor your health. This means you’ll have someone who knows your healthcare needs. But if you want to see a specialist, you’ll need a referral from your doctor. You may have less flexibility in choosing your specialist, and the provider network may be smaller.
- Preferred Provider Organization Plans (PPO) give you access to a more extensive network of care providers. You won’t need to choose a primary physician, and you don’t need to get a referral to see a specialist. You’ll get more flexibility, but this often comes with higher monthly premiums.
- Private Fee-for-Service plans (PFFS) provide the most flexibility. These plans don’t have a network of providers. Instead, you can visit any provider in your area and take charge of your health. Before you make an appointment, you’ll need to make sure the provider will accept your insurance plan. The downside of this plan is that it can get pricey. Both premiums and out-of-pocket costs tend to be higher.
- Special Needs Plans (SNP) design their coverage around the needs of adults with certain health conditions or financial challenges. Adults with end-stage renal disease (ESRD) or ALS can get specialized coverage from an SNP plan. Benefits, provider coverage, and drug coverage are tailored to match these specific healthcare needs.
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Medicare Advantage Plan Eligibility and Enrollment in Ohio
Adults over 65 are eligible for Medicare. As long as you’re a U.S. citizen or permanent resident of Ohio, you can enroll in Medicare.
Adults under 65 can also qualify for Medicare coverage. Adults who receive Social Security Disability Benefits can enroll in Medicare. This includes adults with a qualifying condition such as ESRD.
When to Enroll in Medicare
The best time to enroll in Medicare Ohio is right around your 65th birthday. When you turn 65, you will have a seven-month Initial Enrollment Period (IEP). This starts three months before the month you turn 65, and ends three months after the month of your birthday. You’ll have lots of time to enroll in Medicare and then find the perfect Medicare Advantage plan.
As an Ohio resident, you can also enroll in a Medicare Advantage plan during the Open Enrollment Period. Also called the Annual Enrollment Period, this enrollment period starts on October 15 and ends on December 7. If you enroll in a Medicare Advantage plan during this period, your coverage kicks in on January 1.
How to Enroll in Medicare
Most people are not automatically enrolled in Medicare. But the enrollment process is easy.
- You can apply for Medicare online by creating a Social Security account.
- You can enroll over the phone by calling your local Social Security office or the SSA national toll-free number: 1-800-772-1213.
- You can apply in person by visiting your local Social Security office.
Enrolling in a Medicare Advantage Plan in Ohio
After you have your Medicare number, the rest is easy. Just call a licensed insurance agent at GoHealth, and find out what plans are available in your area. We’re committed to helping you find the right plan.
Decide on your coverage priorities and compare the benefits, premiums and network options of each plan. You can also check the star rating of the plans to see what other Ohio residents think about the cost and coverage.
Once you pick a plan, a licensed insurance agent will walk you through the enrollment process.
Are there Ohio Medicare Advantage Plans with Prescription Drug Coverage?
Most Medicare Advantage plans in Ohio have prescription drug coverage. This can replace Part D coverage, giving you all the convenience of one comprehensive Medicare plan.
Each Medicare Advantage plan has a set list of covered medications. This is called the plan formulary. Before you enroll in a Medicare Advantage plan with prescription coverage, take a close look at the formulary. Check if your medications are on the list. If your meds aren’t covered, keep looking until you find a plan that gives you the coverage you need.
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Medicare Learning Guides
If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you!
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status