Medicare, the longest-standing health insurance plan in the United States, provides medical coverage to all legal U.S. citizens. The federal government partially funds Medicare through taxes. This extensive healthcare program helps lower hospital bills and medical expenses for U.S. citizens, including more than 2.4 million residents in Ohio alone.
Eligibility for Medicare plans includes all legal U.S. citizens aged 65 and above, individuals with certain disabilities, and those suffering from end-stage renal disease (ESRD).
Medicare plans offer comprehensive healthcare benefits covering a range of services, including inpatient and outpatient medical care. Through these services, Medicare effectively lowers out-of-pocket healthcare bills, ensuring enrollees receive optimal care without worrying about expenses.
Ohio residents can enroll in Medicare plans through their local Social Security office or the Medicare.gov online portal. These Medicare plans vary from State to State.
If you are an Ohio resident, it is best to look into the available plans in your region to make a cost-efficient decision that suits all your needs. Let us look into the various plans available for Ohio residents and what benefits they offer.
Medicare in Ohio
In 2024, nearly 2.5 million Ohio residents have access to Medicare plans, representing nearly 21% of the State’s population. For most senior residents in Ohio, Medicare has become essential for affording the increasing expenses associated with old-age healthcare.
Medicare plans in Ohio significantly lower healthcare bills by providing extensive coverage for inpatient and outpatient care. Some plans, such as Medicare Advantage, also offer supplemental benefits like wellness programs to aid senior residents in navigating peacefully through the hurdles of old age.
Besides that, a surprising 13% of Ohio Medicare beneficiaries are under the age of 65. These beneficiaries qualify for Medicare due to some disability or end-stage renal disease. Hence, a total of 21% of Ohio residents are enrolled in Medicare.
If you also wish to access Medicare benefits, you can look into the eligibility criteria and the available plans in your region. Let us look into the various Medicare plans in Ohio and what they offer to residents.
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 |
Medicare in Ohio by the Numbers
According to the 2024 demographics, the total number of Medicare beneficiaries in each plan is as follows.
| Total number of people enrolled in Medicare | Medicare Advantage plans | Medicare Supplement Plan (Medigap) | Medicare Part D (Prescription Drug Coverage) |
| 2.5 million beneficiaries | Over 54% of Ohio Medicare beneficiaries are enrolled in Medicare Advantage plans. | 600,000 Ohio Medicare beneficiaries have Medigap coverage. | More than a million Ohio residents have integrated Part D coverage through Medicare Advantage plans. Nearly 900,000 beneficiaries have stand-alone Part D coverage. |
Type of Medicare Plans in Ohio
Medicare offers two primary types of plans to Ohio residents: Original Medicare and Medicare Advantage plans.
Beneficiaries can also access Medicare supplement plans and Part D coverage. These supplemental plans can be added to primary coverage for additional benefits, such as comprehensive drug coverage.
Before choosing a Medicare plan, you must research the options available in your region to ensure you choose the right plan.
If you fulfill the eligibility criteria, you can enroll yourself into any of the following Medicare plans in Ohio.
- Original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- Medicare Part D (Prescription Drug Coverage)
- Medicare Supplement Plan (Medigap)
Let us discuss each plan in detail.
Original Medicare (Part A and Part B)
Original Medicare, the standard Medicare plan offered in Ohio in a fee-for-service plan comprising Parts A and B. This basic Medicare plan is designed to significantly lower healthcare bills associated with inpatient and outpatient care.
Medicare beneficiaries can enroll in Original Medicare to access its benefits and protect their finances from the impact of skyrocketing medical bills. According to the latest CMS data, about 2,269,020 people are enrolled in Medicare Part A and B in Ohio.
Medicare Part A, also known as hospital insurance, focuses on providing coverage for inpatient care, such as hospital stays, skilled nursing facilities, hospice, and home healthcare. Therefore, Medicare Part A provides extensive coverage for your hospital needs, including medications, meals, and access to semi-private rooms.
Part A hospital insurance covers 80% of your medical costs, while you’re responsible for covering the remaining 20% as deductibles and copays. Part A premium is free, but if you haven’t been paying Medicare tax, it may cost up to $506 per month.
In contrast, Medicare part B also known as medical insurance focuses on outpatient care such as doctors’ visits, emergency care, lab tests, diagnostic tests, medical supplies, equipment, and preventive care.
Medicare Part B also covers screening for tumors, cancer, and related medical issues deemed medically necessary. But Part B premium is income-based, varying from person to person.
Original Medicare enrollment requires you to pay deductibles along with the cost incurred from inpatient and outpatient care. If you’re looking for a flexible coverage plan that has a wide network of healthcare providers across the State, Original Medicare is an ideal coverage option for you.
Medicare Advantage (Part C)
Another popular health coverage plan is a Medicare Advantage plan, also known as Part C, provided by private health insurance companies.
Recently, Medicare Advantage plans have gained popularity. In 2024, Ohio had a more expansive market for Medicare Advantage plans than other States, with 30 plans available in every county.
Over 54% of Medicare beneficiaries are enrolled in Medicare Advantage plans. The total number of beneficiaries enrolled in Medicare Advantage increased from 1,061,016 to 1,147,579 year over year. These astounding demographics are a result of the supplemental benefits Medicare Advantage offers.
Medicare Advantage plans consolidate the benefits of Part 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.
However, Medicare Advantage plans come with one limitation—a restricted choice of healthcare providers as it only collaborates with specific healthcare providers and hospitals.
Medicare beneficiaries enrolled in Advantage plans cannot seek medical treatment from healthcare providers outside of their network. To consult a specialist outside your network, you require pre-authorization or a referral from a healthcare physician within your network.
However, Medicare Advantage plans are an excellent coverage choice for Ohio residents looking for a bundled coverage option within their area. In Ohio, Medicare Advantage plans cost an average of $16 per month.
Types of Medicare Advantage Plans in Ohio
There are different Medicare Advantage plans available in Ohio. These insurance plans include the following.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Ratings of Ohio Medicare Advantage Plans
| 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 |
Medicare Part D (Prescription Drug Coverage)
Medicare Prescription Drug Coverage, also known as Part D, is designed to cover the cost of prescription medications.
As of 2024, Ohio has 24 stand-alone Prescription Drug Coverage options, with over 2 million beneficiaries having access to stand-alone plans. The premium for Part D starts at $5.10 per month.
If you have Original Medicare, you are eligible for Medicare Part D. However, you must know that all Medicare enrollees are offered Part D.
If you do not enroll on time, you may have to pay a late-enrollment penalty. Therefore, it’s best to enroll when you become eligible for Medicare. This will not only save you from a late enrolment penalty but also help cut down costs for over-the-counter medications.
Medicare Supplement Plan (Medigap)
Medicare Supplement plans, also called Medigap, are optional plans providing coverage for what’s not covered under Original Medicare Part A and B. Medigap provides additional health insurance to lower your out-of-pocket costs.
In Ohio, 12 standardized Medigap plans are sold by private health insurance companies. These are denoted by different alphabets (A, B, C, D, F, G, K, L, M, and N).
Plan G is the most popular Medicare Supplement plan in Ohio, with 41% of Medigap enrollees. A Plan G for a 65-year-old nonsmoking person ranges from $100 to $368 per month.
Medigap plan F is the second most popular supplement plan in Ohio. However, you can only enroll in Medigap plan F if you were eligible for Medicare before 2020. Plan F is a high-deductible plan costing $53 per month.
You must also know that Medigap in Ohio is not offered to people under age 65 who are enrolled in Medicare due to a disability. Consequently, you must look into your provider’s supplement plan before enrolling to know the details.
Cost of Medicare Plans in Ohio 2024
The cost for Medicare plans in Ohio varies due to numerous factors such as income-based premiums, assets, resources, extra coverage, and whether you’re enrolled in Original Medicare. Therefore, you must look into various cost-determining factors before opting for a plan.
Some of these factors also include whether you have been paying your Medicare taxes. However, the cost of Medicare Advantage plans solely depends on the provider, coverage, and supplemental benefits each plan offers.
In Ohio, the average monthly premium for the Medicare Advantage plan is $16 in 2024. Let us look into the estimated costs for Medicare plans in Ohio in 2024.
| Original Medicare | Medicare Advantage | Medigap | Part D |
| Part A premium: $0 to $506 per month. Deductible: $1,600 for each benefit period. Part B premium: $164.90 monthly and up (income-based) Deductible:$233 for each plan period. | Average monthly premium in 2024 for a Medicare Advantage plan in Ohio is $16. | Plan G cost for a non-smoking person aged 65 is $100 to $368 per month. Plan F cost for eligible beneficiaries is $53 per month. | The lowest monthly premium starts at $5.10. |
Eligibility and Enrollment for Medicare in Ohio
What determines the eligibility criteria for Medicare in Ohio? The eligibility criteria for Medicare are consistent across all the States. You are eligible 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)
If you have a disability or end-stage renal disease, you must have approval from the Social Security Administration for your disability status.
Enrolment Period for Medicare Plans in Ohio
You can join, switch plans, or drop your coverage plans from October 15 to December 7 each year. This is known as your open enrollment period.
Besides open enrollment, Medicare has two enrollment periods. These are your initial enrolment period (IEP) and a general enrolment period (GEP).
The initial enrollment period is 7 months, starting 3 months before your 65th birthday and ending 3 months after you turn 65. You can enroll during this period if you haven’t had Medicare before.
If you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) between January 1 and March 31 every year. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
During this period, you can also make changes to your current Medicare plans. For example, if you have Original Medicare and you want to switch to a Medicare Advantage plan, you can do so during this period.
Applying for Medicare in Ohio
Applying for Medicare is straightforward for Ohio residents. You can apply online, by mail, or in person at the nearest Social Security office. You can also register through the Medicare.gov online portal.
If you have been paying your Medicare taxes, you automatically get enrolled in Original Medicare. In this case, you receive your Medicare ID in the mail.
Enrollment periods are crucial for first-time applicants, as you can only apply during the open enrollment or general enrollment periods. You can also streamline your application process by contacting licensed advisors at Silveredge.
Additional Resources for Medicare in Ohio
Numerous organizations across Ohio offer Medicare resources to senior adults. These organizations aim to provide guidance and counseling to 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 |
Securing Your Health in the State of Ohio With Silveredge
Growing healthcare needs and medical complications highlight the importance of having access to health insurance coverage plans. Programs such as Medicare are excellent at lowering out-of-pocket hospital bills.
Enrolling in Medicare can not only save you from skyrocketing hospital bills but also provide you with a robust long-term plan in place. But before you choose a Medicare plan, it’s best to look into the available options in your region.
Silveredge is dedicated to providing counseling and guidance about Medicare plans. Our licensed advisors can assist you in securing a Medicare plan that meets your healthcare needs and also safeguards your well-being. Reach out to Silveredge today for a secure and healthy future!
