Ohio is the seventh-most populous State in the US, with over 11.8 million residents. A whopping 2.5 million Ohio residents are enrolled in Medicare plans.
Medicare is the longest-standing health insurance plan in the US, providing medical coverage to all legal US citizens. Medicare plans in Ohio aim to meet the increasing healthcare complexities and needs of senior adults aged 65 and above, those with certain disabilities, and people with last-stage renal disease (ESRD).
This comprehensive health coverage plan is administered by the federal government and funded by the General Revenue and Federal Insurance Contributions Act. The US federal government directly administers Original Medicare, the standard plan.
However, Ohio residents can also enroll in Medicare Advantage plans provided by private health insurance companies. These healthcare plans lower the expenses related to hospital bills and medical care by providing coverage for both inpatient and outpatient care.
Let us learn more about Medicare Advantage plans in Ohio and how they benefit residents.
Medicare Advantage Plans in Ohio
Over 2.8 million residents in Ohio are aged 60 and above, making up one-quarter of the total population. Since Ohio’s life expectancy is 75, medical insurance plans are essential for lowering healthcare bills for older adults.
With growing age, medical needs tend to increase. In 2024, the high inflation has caused a significant increase in hospital and medical bills. In these times, it is challenging to manage healthcare costs associated with routine checkups.
Health insurance plans in Ohio, such as Medicare Advantage plans, mitigate the high costs associated with medical and hospital bills. Consequently, a whopping 2.5 million Ohio residents use Medicare plans to lower healthcare bills.
Beneficiaries enrolled in Original Medicare have the choice to join a Medicare Advantage plan. Recently, Medicare Advantage plans have gained popularity over the standard plans.
As of 2024, Ohio has a more expansive market for Medicare Advantage plans than other States, with 30 plans available in every county. Over 54% of total Medicare beneficiaries are enrolled in Medicare Advantage plans. These astounding demographics are a result of the supplemental benefits Medicare Advantage offers.
Medicare Advantage plans consolidate the benefits of Parts A and B with additional benefits, including coverage for hearing, vision, and dental care.
Some of these plans also provide coverage for health and fitness programs and gym memberships. Thus, Medicare Advantage plans work as bundled coverage for people looking for an all-in-one coverage solution for various medical needs.
As of 2024, Ohio is served by 224 Medicare Advantage plans with an average monthly premium of $16.
Medicare Advantage Networks
The Medicare Advantage plans in Ohio feature networks available in certain areas of the State. Each plan option is based on a ZIP code. These plans have varying copayments, premiums, and deductibles.
However, the standard plans start at $0 premium. Every Medicare-eligible person in Ohio has access to this $0 premium Medicare plan.
Since Medicare Advantage plans consist of networks, they have one restriction—a limited choice of healthcare providers. As Medicare Advantage plans have contracts with certain healthcare professionals and hospitals, you cannot seek treatment outside of the network of choice.
To consult a specialist outside your network, you require pre-authorization or a referral from a healthcare physician within your network.
General Analysis | Ratings of Medicare Plan Providers in Ohio
| Insurance Company | Medicare Rating | A.M. Best Rating | Better Business Bureau (BBB) Rating | J.D. Power ranking |
| Aetna | 4 stars | A+ | A+ | 6th out of 9 |
| Anthem Blue Cross Blue Shield | 4 to 4.5 stars | A+ | A+ | 5th out of 9 |
| Humana | 4 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
Types of Medicare Advantage Plans
The State of Ohio has four types of Medicare Advantage plans. Depending on your healthcare needs, you can enroll in any of the following plans.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Let us look into the details of these Medicare Advantage plans to help you make an informed decision.
Health Maintenance Organizations (HMOs)
An in-network provider, typically called an HMO, is an approved healthcare expert within the plan’s network. In an HMO plan, beneficiaries receive care from a doctor, healthcare physician, or hospital within their network of choice.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network. HMO plans mostly include prescription drug coverage.
Preferred Provider Organizations (PPOs)
PPO allows you to receive medical care from both in-network and out-of-network providers. However, seeking out-of-network care typically costs more than your standard plan. This plan doesn’t restrict you to your primary care doctor.
You also don’t require a referral from your primary care physician to consult physicians outside your network. However, you incur relatively lower costs for medical experts and hospitals within the plan’s network.
Special Needs Plans (SNPs)
SNPs are ideal for beneficiaries with specific diseases who require specialized healthcare. Individuals with chronic conditions, living in nursing homes, or those who have both Medicaid and Medicare receive tailored benefits.
Generally, beneficiaries are limited to the plan’s network of providers. Pre-authorization is required to consult physicians outside the network. SNPs also include prescription drug coverage.
Private Fee-For-Service Plans (PFFS)
PFFS allows you to consult any Medicare-approved provider within Ohio. Hence, you’re not obligated to see a specific healthcare expert. Thus, PFFS plans work the same as Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions. These plans have fewer restrictions.
However, this plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive.
In some PFFS, you have a network of providers where you incur lower costs. However, your plan may not always have prescription drug coverage.
Comparison of the Top-Rated Medicare Advantage Plans in Ohio
As of 2024, the following are Ohio’s best Medicare Advantage plans. Here’s a comparison.
| Medicare Advantage insurance company | Medicare rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| Aetna | 3.9 stars | A | A+ | 6th out of 9 |
| Anthem | 3.9 stars | A | F | 7th out of 9 |
| Humana | 4.2 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 4.2 stars | A | Not rated | 4th out of 9 |
Benefits of Medicare Advantage Plans in Ohio
Medicare Advantage plans provide a range of supplemental benefits with your standard coverage options.
These benefits include coverage for wellness programs, hearing services, dental care, vision care, transportation services, meal accommodation, telehealth services, OTC benefits, chronic condition management, etc. Hence, Medicare Advantage plans work as a bundled coverage option for beneficiaries seeking an all-in-one solution.
Since Ohio has about 200 Medicare Advantage plans, it’s crucial to look into the supplemental benefits your plan of choice offers before enrolling yourself to choose the best available health coverage in your region.
Here are the common benefits offered to Ohio residents with Medicare Advantage plans.
Hospital and Medical Insurance
Medicare Advantage plans in Ohio combine hospital and medical insurance, providing the same coverage as Original Medicare Parts A and B. This ensures that you receive primary coverage with your healthcare services.
Prescription Drug Coverage (Part D)
Most Medicare Advantage plans include prescription drug coverage to lower the out-of-pocket costs of prescription medications. Therefore, in most cases, you don’t require additional prescription drug coverage with a Medicare Advantage plan in Ohio.
Dental Care
Medicare Advantage plans also offer preventive dental services, including routine checkups, scaling, and medically deemed necessary dental procedures.
Vision Care
Comprehensive Medicare Advantage plans also provide coverage for routine eye examinations, eyeglasses, and contact lenses, promoting better eye health.
Hearing Services
Some Medicare Advantage plans offer coverage for hearing exams. These plans typically cover hearing aids and other necessary equipment.
Wellness Programs
Many Medicare Advantage plans include wellness programs, such as gym memberships, fitness classes, and yoga classes, with the primary aim of bettering beneficiaries. Such plans help older adults achieve a healthy lifestyle and combat healthcare problems that arise from a lack of fitness.
Transportation Services
Various Medicare Advantage plans offer assistance with transportation services. These plans ensure you access medical care at facilities more conveniently since you don’t have to worry about transportation to and from a hospital.
Over-the-Counter Benefits
OTC benefits allow beneficiaries to purchase over-the-counter items, non-prescription medications, drugs, and health-related products.
Chronic Condition Management
Chronic condition management includes specialized care for individuals with long-term health problems. Medicare Advantage plans with this benefit are ideal for individuals who require comprehensive healthcare. However, such plans may have a higher premium.
Cost of Medicare Advantage Plans in Ohio
The average monthly premium in 2024 for a Medicare Advantage plan in Ohio is $16. Some Medicare Advantage plans in the State also require you to pay out-of-pocket premiums, deductibles, copayments, and coinsurance.
These additional costs are associated with supplemental benefits and may vary from provider to provider. Therefore, you must familiarize yourself with deductibles, copayments, and coinsurance to avoid higher out-of-pocket premiums.
- Deductibles are expenses that you cover before Medicare provides coverage for health services. Thus, deductibles apply to all Medicare plans, including the standard Original Medicare.
- A copayment is a fixed payment for a doctor’s visit or a prescription drug. This amount is paid after you pay your deductibles, thus covering certain supplemental benefits.
- Coinsurance is a cost-sharing method in which you pay a percentage of the total amount for specific services after paying your deductibles. Your insurance plan covers the rest of the cost.
Medicare Advantage plans usually charge a copayment instead of the 20% coinsurance you pay under Original Medicare.
Also, Medicare Advantage plans significantly vary from provider to provider and plan to plan. Therefore, looking into your plan’s requirements before signing up is best.
Medicare Eligibility and Enrollment in Ohio
What makes you eligible for Medicare in Ohio, and how can you enroll? Medicare has the same eligibility criteria across all the States. You qualify for Medicare if:
- You are 65 years old or above
- You have a medical disability
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral sclerosis (ALS)
You also require approval from the Social Security Administration for your age or disability, as it is an essential prerequisite to qualify for Medicare.
Enrolment Period in Ohio
Medicare has an initial enrolment period (IEP) and a general enrolment period (GEP). The initial enrollment period is 7 months, starting 3 months before your 65th birthday.
However, if you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) every year between January 1st and March 31st.
However, if you have been receiving your Social Security benefits four months before your 65th birthday, you will automatically get enrolled into Medicare. Otherwise, you must apply through mail or by contacting a local Social Security office.
Why Is Medicare Vital for Ohio Residents?
In Ohio, approximately 18% of the population is aged 65 and above. These demographics emphasize the need for healthcare coverage plans for older adults in the region to help them cover hospital costs effectively.
Moreover, the humid summers and extremely cold winters often affect immunocompromised older adults as the weather aggravates certain diseases.
The changing weather conditions also aggravate chronic conditions such as arthritis and cardiovascular disease. Besides this, senior residents are more susceptible to respiratory diseases. These diseases can quickly cause associated health problems. Therefore, senior adults must seek immediate medical assistance.
However, skyrocketing hospital bills make it challenging to have routine checkups. Medicare Advantage plans in Ohio aim to provide comprehensive coverage with supplemental benefits, including preventive care and emergency services to assist older adults in managing their healthcare finances. These plans not only mitigate the costs but also improve the quality of life for senior residents in Ohio.
Resources for Medicare in Ohio
Several organizations across Ohio offer Medicare resources to senior adults. These organizations aim to guide and counsel people looking to enroll in Medicare. Let’s examine the various organizations and their objectives.
| Organization | How you can get help | Website & Contact Info |
| Pro Seniors | Pro Seniors, a nonprofit organization, provides legal aid to Ohio residents. This organization also operates SMP, helping senior adults report Medicare fraud and abuse. Volunteers also help identify fraudulent claims and charges. | Website | (800) 488-6070 |
| Ohio Senior Insurance Information Program (SHIIP) | The Ohio Senior Insurance Information Program (SHIIP) is a statewide program that provides information to senior adults in Ohio. Trained volunteers at SHIIP provide one-on-one counseling and guidance about Medicare benefits and coverage plans. | Website | (800) 686-1578 |
| Ohio Department of Insurance | The Ohio Department of Insurance regulates insurance policies sold in Ohio. This organization advocates for Ohio residents, ensuring they get fair coverage. The experts at this department connect you with agencies related to Medicare and provide you with all the necessary information. | Website | (614) 644-2658 |
| Ohio Area Agencies on Aging | Ohio has about 12 local Agencies on Aging. Every agency provides extensive services to senior adults aged 60 and above residing in Ohio. These agencies guide senior adults about Medicare coverage, options, and plans. They also resolve Medicare-related queries and policies. You can also receive unbiased advice from the counselors as they are not affiliated with any insurance companies. | Website | (866) 243-5678 |
Find an Ideal Coverage Plan in Ohio With Silveredge
Ohio, the seventh-most populous State in the US, has a large number of senior residents. With a quarter of the population aged 60, Ohio has to offer comprehensive healthcare plans to senior residents.
Programs such as Medicare Advantage plans in Ohio significantly lower hospital bills and provide comfort to senior residents. Leveraging the right medical resources can help Ohio residents make cost-efficient, health-centric decisions.
With more than 200 Medicare Advantage plans in the region, it may seem challenging to pick the right plan for you or your loved ones. We suggest that you assess your health status and medical needs before signing up for a medicare plan in your region.
If you have difficulty choosing the right plan, professional help through licensed advisors at Silveredge can help you make an informed decision.
Advisors at Silveredge not only provide insight into Medicare plans but also help you compare different plans in the region. Contact Silveredge today to resolve your Medicare-related queries!
