If you need Medicare in Ohio, you have many options for coverage. Get some of the details about benefits and eligibility in this simple guide.

By Joseph Arroyo
Updated June 24, 2020

Key Takeaways:

  • More than 150 Medicare Advantage plans are offered in Ohio

  • For 2020, the combined Medicare Part A and B deductibles exceed $1,600

  • Ohio is one of the 47 states with standardized Medicare Supplement plans

  • You must be enrolled in both Part A and Part B to choose Medicare Supplement or Medicare Advantage coverage

Many dynamic options are available for Medicare in Ohio. Sometimes having many choices can make choosing difficult. As an independent insurance agent, my clients want help assessing their needs and finding the plan that best fits their needs.

Out-of-Pocket Medicare Expenses in Ohio

Everyone I meet with is interested in lowering their out-of-pocket spending on what's not covered by Original Medicare. You also need to remember that with Original Medicare you'll be responsible for paying the Part A deductible ($1,408 for 2020) and Part B deductible ($198 for 2020). In addition to this, you'll be responsible for 20% coinsurance for all your Part B services.

I always make sure potential clients understand there is no cap on your out-of-pocket expenses with Original Medicare. This is exactly the opposite of how most employer or group health insurance plans work. To protect yourself from high out-of-pocket spending on health care, consider using one of two options: Medicare Supplement insurance or Medicare Advantage plans.

Medicare Advantage Plans in Ohio

Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare. A Medicare Advantage plan is a contract between a private insurance company and the federal Medicare program. You should know that Medicare Advantage plans are required to cover everything covered by Original Medicare.

Medicare Advantage plans combine Part A (hospital insurance), Part B (outpatient insurance), and sometimes Part D (prescription drug coverage). Medicare Advantage coverage usually resembles traditional employer group health insurance.

Medicare Advantage plans generally come in three different types:

  • HMO (Health Maintenance Organization) — These plans require you to work with a network of plan providers. Except in emergencies, the plan will not pay for services performed by non-network doctors. To see a specialist, you need a referral from your primary care physician.

  • PPO (Preferred Provider Organization) — These plans allow you to see any provider, but you will pay less if you use a network (preferred) provider. With PPO plans, you probably won't need referrals, although some specialists in the preferred network may require them.

  • PFFS (Private Fee for Service) — These plans work like Original Medicare. They have preset terms that pay providers fixed amounts for service. Providers may accept the terms of the plan and see you as a patient, or decline the plan terms and not take you as a patient. These plans are relatively rare; HMOs and PPOs are far more common.

Medicare Advantage plans often come with extra benefits beyond Original Medicare. These benefits, which can vary from state to state, are not guaranteed by Medicare, and can change from year to year. These extra benefits may include:

Perhaps the most important feature of Medicare Advantage plans is that they come with fixed out-of-pocket maximum (OOPM) protection. You'll always know the most you could spend with a major illness or hospital stay.

Medicare Advantage plans are a good fit for those who are looking to cap their out-of-pocket spending with little to zero premium cost. You also must be OK using a network of doctors if you're going to choose Medicare Advantage.

Medicare Supplement Plans in Ohio

The other major option my clients choose is Medicare Supplement insurance. These policies are issued by private insurance companies and are designed to fill in the gaps in Original Medicare. They're also known as Medigap plans.

Medigap plans are standardized across 47 of the United States, including Ohio. This means the coverage provided by a Medigap plan in Ohio is the same as one in California. The premiums may vary, but the actual coverage is the same.

The 10 standardized Medicare Supplement plans are: A, B, C, D, F, G, K, L, M and N. There are also high deductible versions of Plan F and G. Each of these Medigap plans covers a different mix of the Part A and Part B gaps. Plan F is the most comprehensive (and most expensive) plan, while Plan A is the least comprehensive and least expensive plan.

Medicare Supplement insurance is a good fit for those who:

  • Can afford the monthly premiums

  • Want coverage that works outside the United States

  • Want maximum flexibility — the choice to see any doctor across the country that takes Medicare patients

Medigap plans don't come with extra benefits like Medicare Advantage plans do, but many insurance companies provide discounts on prescriptions, vision and hearing services. Fitness memberships are often included in Medigap coverage.

Choosing a Medicare Plan in Ohio

Whether you're approaching Medicare age or are considering changing your coverage, make sure you understand the options available to you in Ohio. A great way to learn about the plans available to you is by connecting with a licensed professional. They can help you compare plan benefits and determine which plans are accepted by your doctors.

Joseph Arroyo is a licensed Medicare insurance specialist who lives in Hilton Head, South Carolina. Arroyo is certified to sell Medicare products including Medicare Supplement insurance, Medicare Advantage, and prescription drug plans.