With more plans available than ever before, Medicare Advantage (MA) has nearly doubled in popularity since 2010. Also known as Medicare Part C, the program now has nearly 31 million enrollees, which is over one-half of all eligible Medicare beneficiaries. This page explains Medicare Advantage plans in Ohio and how the program works.
What is Medicare Advantage in Ohio?
Medicare Advantage plans must provide the same level of coverage as you would get with Original Medicare.
There are two parts to Original Medicare. Medicare Part A covers inpatient services such as you'd receive in a hospital or skilled nursing facility (SNF). Medicare Part B covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more.
Original Medicare does not include prescription drug coverage. For that, you need Medicare Part D.
One reason Medicare Advantage keeps growing in popularity is that most plans cover additional services as well. The most common extra benefits are:
- Fitness programs like SilverSneakers
- Prescription drug coverage
- Routine vision and dental care
- Hearing aids
Having an Ohio Medicare Advantage plan does not exempt you from paying the Medicare Part B premium.
Ohio Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Original Medicare and Part D benefits.
Also known as all-in-one plans, many beneficiaries find they save money with an MA-PD, particularly if it also includes dental and/or vision coverage.
How do you qualify for Medicare Advantage in Ohio?
If you have Medicare Parts A and B, you qualify for Medicare Advantage in Ohio.
American citizens and permanent legal residents age 65 and older are eligible for Medicare. If you began collecting Social Security benefits at least 4 months before your 65th birthday, you will be automatically enrolled in Parts A and B. Everyone else must apply for Medicare.
You can qualify for Medicare before turning 65 if you collect disability benefits from either Social Security or the Railroad Retirement Board (RRB) for 24 months. Anyone who qualifies for Medicare due to a disability is automatically enrolled in both Parts A and B during month 25.
Finally, you may also be eligible for Medicare before turning 65 if you have either amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) or end-stage renal disease (ESRD).
When can you sign up for a Medicare Advantage plan in Ohio?
Medicare limits enrollment to specific times.
Your Initial Enrollment Period (IEP) begins 3 months before your Medicare eligibility month and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits occurs in January, your IEP lasts from October 1 through April 30.
If you did not sign up for Medicare Part A and/or Part B during your IEP, you may do so during the General Enrollment Period, which lasts from January 1 through March 31. After General Enrollment ends, you may then sign up for a Medicare Advantage plan between April 1 and June 30.
You can also join an MA plan from October 15 through December 7, which is when the Medicare Annual Enrollment Period (AEP) occurs.
If you already have Part C, the Medicare Advantage Open Enrollment Period lets you either switch to a new MA plan or return to Original Medicare. If making that change means you'll lose your prescription drug coverage, you may also enroll in a standalone Medicare Part D plan. You have from January 1 to March 31 to act.
You may also join a Medicare plan during a Special Enrollment Period (SEP) if you experience certain life changes. There are dozens of ways to qualify. Find the full list on Medicare.gov.
Types of Medicare Advantages plans in Ohio
There are four common types of Medicare Advantage plans in Ohio.
More than half of all Ohio MA plans are health maintenance organizations. HMO plans have a provider network, which may include nearly any entity that provides healthcare services. You may be responsible for 100% of the costs if you receive non-emergency care from an out-of-network provider. HMOs also require members to choose a primary doctor and get a referral before seeing a specialist.
Preferred provider organizations (PPO) also use a provider network, but members can go to an out-of-network provider for a higher copay. PPO plans do not require members to choose a primary care doctor or get a referral to see a specialist.
A private fee-for-service (PFFS) plan sets cost limits for covered services. Some use a provider network but do allow members to receive out-of-network care for a higher price. With a PFFS plan, you don't have to choose a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people who meet certain criteria. SNP plan guidelines may include:
- Having a chronic condition (e.g. chronic heart failure, diabetes, HIV/AIDS, dementia, or ESRD)
- Living in an institution (such as a nursing home) or requiring at-home care
- Being dual eligible (i.e. qualifying for both Medicare and Medicaid)
SNPs also require their members to choose a primary care doctor who coordinates the patient's care and provides specialist referrals.
How to choose a Medicare Advantage plan in Ohio
When comparing Medicare Advantage plans in Ohio, consider the following:
- Costs: May include a yearly deductible, monthly premium, and copays or coinsurance.
- Coverage: Benefits vary from plan to plan, so make sure you're comparing apples to apples. If it's an MA-PD plan, don't forget to check the drug formulary.
- Network: If you have complicated or preexisting conditions, you may want a plan whose network includes your providers.
- Ratings: Medicare uses a 5-point rating system and releases its findings each fall before Annual Enrollment.
Our Find a Plan tool makes comparing Ohio Medicare Advantage plans easy. Just enter your location information and coverage start date to review Medicare plans in your area.
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