It seems like we’re all constantly on the hunt for the best health insurance option. If Medicare is an option for you, there are a few things that you should know. Benzinga has put together this guide to the best Medicare in Ohio to help.
The Best Medicare in Ohio:
What is Medicare?
Medicare is a federal health insurance program that is available to individuals who meet its qualifications. You may qualify for Medicare if:
- You are 65 or older
- You have a disability
- You need dialysis or a transplant due to end-stage renal disease
Before enrolling in Medicare, you should know that it is different from the health insurance policies you’ve probably held in the past. There are a few parts of Medicare that may be available to you:
Part A: This is your hospital insurance. It covers inpatient hospital stays, hospice care and care in a skilled nursing facility. You may also be able to use this part of Medicare to cover the costs of home health care.
Part B: This is your medical coverage. It can be used for outpatient care such as doctor visits, medical supplies, preventive care and other medical services.
Part C: This part of Medicare is actually a different plan entirely. It is an alternative to Original Medicare, also called Medicare Advantage plans. These plans are offered by private insurance companies and combine both Parts A and B of Original Medicare coverage.
Part D: This is your prescription drug coverage. It is generally offered as a supplemental plan that can be added to the other parts of Original Medicare. It may also be included in some Medicare Advantage plans.
Legalities of Medicare in Ohio
Medicare is a health insurance program that is both offered and regulated by the federal government. If you enroll in an Original Medicare plan, you can receive coverage for visits with any doctor that accepts Medicare insurance.
Medicare Advantage plans are not regulated by the federal government. These plans are offered by private insurance companies that are approved by the Medicare program. However, the provider of your Medicare Advantage plan will control the plan that you enroll in. These private insurance companies can restrict the providers that are covered by your plan. They may also require you to receive a referral from your primary care doctor before you can receive coverage for a specialist visit.
Some Medicare Advantage plans include Medicare Part D plans. However, you may be required to use generic drug treatments to receive coverage under these plans.
You may also choose to look into Medicare supplemental insurance. These plans are also known as Medigap coverage, and they are designed to fill gaps in your Medicare coverage. If you have a Medicare Advantage plan, you will be unable to also carry this supplemental Medicare insurance.
Types of Medicare Advantage Plans
If you decide to enroll in a Medicare Advantage plan, you’ll have a few different plan types to choose from. Each plan type offers its own unique set of benefits. Here’s a quick overview of the 2 most common plan types you will probably see.
HMO: Health maintenance organization (HMO) plans include both Part A and Part B of Original Medicare. Some plans may also include Medicare Part D, as well as vision, dental and hearing benefits. Each provider offering an HMO plan will have its own network of participating providers. HMO plans only offer coverage for visits with the doctors and facilities that are within its network. These plans may also require you to receive a referral from your primary care doctor before it will cover a visit with a specialist.
PPO: Preferred provider organization (PPO) plans also include both Part A and Part B of Original Medicare coverage. Some of these plans include Part D coverage and additional benefits such as vision, dental and hearing coverage. The provider of your PPO plan will also have its own network of participating providers.
However, you are not restricted to visits with participating doctors to receive coverage. If you visit a provider that is out-of-network, you may be able to receive coverage, but you should expect to pay more for your visit. Typically, PPO plans do not require you to receive a referral from your primary care doctor if you wish to receive coverage for a specialist visit.
No matter which plan type you choose, there are a few terms you should become familiar with to best understand your coverage.
Deductible: Each health insurance plan has a deductible. The deductible is the amount that you will need to pay out-of-pocket for your covered medical services before your insurance provider pays for your medical costs.
Coinsurance: After you meet your deductible, you will probably have to pay some portion of the costs for your medical services. Some insurance plans will require a coinsurance payment. Coinsurance payments are a percentage of each medical bill that you will need to pay out-of-pocket. Your health insurance provider will cover the remaining cost.
Copay: Some plans may require a copay instead of coinsurance payments. A copay is a set amount of money that you will pay for each covered medical service after you have met your deductible. Like coinsurance payments, your health insurance provider will cover the remaining portion of your bill.
Premium: Your health insurance plan also comes with a premium. Your premium is the amount that you will need to pay to keep your health insurance policy active. Most premiums are due on a monthly basis.
Out-of-pocket maximum: Your out-of-pocket maximum is the maximum amount of money that you will need to pay out-of-pocket for your covered medical services. If you reach your out-of-pocket maximum, your health insurance provider will pay 100% of your covered medical costs for the rest of your plan year.
How to Sign Up for Medicare in Ohio
There are a few ways you can sign up for Medicare Part A and Part B coverage in Ohio:
- Enroll online.
- Call Social Security Monday through Friday from 7 a.m. to 7 p.m. at 800-772-1213.
- Visit a Social Security office near you to sign up in person.
If you’re interested in a Medicare Advantage plan, you will start by reviewing the plans available in your area online. Be sure to enter your ZIP code to find the most accurate information.
If you’ve found a Medicare Advantage plan that you’d like to enroll in, you can:
- Visit the insurance company’s website to enroll online.
- Contact the insurance company to request a paper enrollment form.
- Call 800-MEDICARE (800-633-4227).
Average Cost of Medicare Advantage Plans in Ohio
If you decide to enroll in a Medicare Advantage plan, you should know that the cost of your plan will depend on a number of factors. You should evaluate the options available in your county to decide which one can give you the best coverage for your needs. Here are a few examples of available plans in Ohio.
Best Medicare Insurance Providers in Ohio
If you decide to enroll in Medicare, you’ll probably be wondering who the best Medicare insurance providers in Ohio are. Here are a few of our favorites.
1. Best Overall in Ohio: Humana
Humana is a provider that has offered Medicare Advantage plans for as long as the federal Medicare program has been around. This means that it has had plenty of time to build up a strong and reputable source of doctors and facilities to participate in its network.
Humana Medicare Advantage plans are available in most states, so if you travel you can feel confident that there is a participating doctor available near you. It also offers health plan deductibles as low as $0, allowing you to take advantage of your coverage right from the start.
2. Most Affordable in Ohio: Anthem Blue Cross and Blue Shield
In Ohio, Anthem Blue Cross and Blue Shield offers affordable Medicare Advantage plans at every level. Its health plan deductibles can be as low as $0. Each health plan also comes with a separate drug deductible for your prescription drug coverage. Anthem offers drug deductibles as low as $0. It also offers an out-of-pocket maximum of $4,900. Depending on the prescription drugs you use, your premium could be as low as $0.
3. Best for Travel Coverage: UnitedHealthcare
UnitedHealthcare is a great option if you like to travel. These Medicare Advantage plans include travel coverage. This may eliminate your need for additional travel insurance. It also offers video doctor visits, which you can use to help you in the case of a common medical need.
Many of its plans also offer a nurse hotline to answer any questions you have about your health. The nurse hotline can offer advice over the phone, or advise you to visit a medical clinic if the issue is more severe.
4. Best for Exclusive Benefits: MediGold
MediGold offers Medicare Advantage plans to many Ohio residents. With every plan, you can receive a free SilverSneakers membership. This allows you access to more than 16,000 fitness centers across the nation. You may also be eligible to receive an over-the-counter quarterly allowance to help you cover the cost of non-prescription medical essentials. Some MediGold Medicare Advantage plans also include preventive dental services as well as hearing aids.
5. Best for Primary Care Coverage: Allwell
In some cases, you may need to visit your primary care doctor frequently throughout the year. If this sounds like your situation, Allwell may be the right plan for you. Allwell plans offer health plan deductibles as low as $0. It also offers primary doctor copays as low as $0, eliminating your need to shell out money each time you visit your doctor.
What Medicare Option is Right for Me?
When it comes to your health needs, only you can make the right decision. We encourage you to use this guide to familiarize yourself with the options that are available to you. Remember, while Original Medicare is nationwide, Medicare Advantage plans are available by county.
If you decide to look into Medicare Advantage plans, be sure to research each provider. You’ll want to make sure you are comfortable with the customer service each provider can offer you. For example, if you’re not comfortable handling matters online or over the phone, look for a provider with a local office so you can speak to someone in person.
Once you’ve found the plan that offers the right amount of coverage, you can enroll and start using the benefits offered by your plan.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.