Medicare in Ohio

Medicare beneficiaries can choose to get their healthcare coverage through Medicare Advantage plans, or directly from the federal government via Original Medicare. There are pros and cons to either option, and the right solution is different for each person.

Medicare Advantage plans are offered by private insurers, so plan availability varies from one area to another. There are Medicare Advantage plans in all 88 counties in Ohio,⁷ and the state’s Medicare Advantage market offers more  than many other states.² For 2023, all Ohio Medicare beneficiaries can select from among at least 31 Medicare Advantage plans, and there are 87 plans in Summit County; residents in most Ohio counties have access to 50+ Medicare Advantage plans.

As of April 2018, more than 41% of all Ohio Medicare beneficiaries had Medicare Advantage plans⁸ (nationwide, Medicare Advantage plan enrollment amounted to more than 35% of all beneficiaries at that point).⁹ But Medicare Advantage plan enrollment had increased to more than 54% of the state’s Medicare population by April 2023.¹

The other almost 46% of Ohio Medicare beneficiaries were enrolled in Original Medicare at that point.¹ Nationwide, 51% of Medicare beneficiaries had Original Medicare in April 2023,⁶ so Medicare Advantage is more popular in Ohio than in the country in general.

The Medicare Annual Election Period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription drug plan). People who are already enrolled in Medicare Advantage also have the option to switch to a different Medicare Advantage plan or to Original Medicare during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental healthcare coverage. Nationwide, more than 80% of Original Medicare beneficiaries have a supplemental plan.¹⁰ But for those who don’t, optional Medigap plans (also known as Medicare supplement insurance plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had Original Medicare on its own and experienced a medical claim.

According to America’s Health Insurance Plans (AHIP) analysis, there were 613,352 Ohio Medicare beneficiaries who had Medigap coverage as of 2020.¹¹ In many states, there has been a steady downward trend in Medigap enrollment in recent years as Medicare Advantage plans have gained popularity (Medigap plans cannot be used with Medicare Advantage plans, so fewer people have Medigap plans when Medicare Advantage plan enrollment increases).

Medigap plans are sold by private insurers, but they’re standardized under federal rules (so each plan will provide the same benefits as any other plan labeled with the same letter; Plan G, Plan K, etc.) and regulated by state laws and insurance commissioners. In Ohio, there are 59 insurers offering Medigap plans. The Medicare website has a plan finder tool that will show you prices and plan availability for the various Medigap plans that can be purchased in Ohio.

Federal rules require Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s Open Enrollment Period, which begins when the person is at least 65 years old and enrolled in Medicare Part A and Medicare Part B. But despite the fact that nearly 8 million Medicare beneficiaries are not yet 65 (and are enrolled in Medicare due to a disability) there is no federal requirement that Medigap insurers offer plans to people who are under age 65.

The majority of the states have addressed this with legislation that ensures at least some access to Medigap plans for people under age 65, but Ohio is not among them. Ohio’s Medicare guide notes that Medigap plans are available on a guaranteed-issue basis for six months after they’re at least 65 and enrolled in Medicare Part A and Part B,¹² or when they have a federally-mandated guaranteed-issue right.

As of 2017, the Ohio Department of Insurance published a comprehensive Medigap shopping guide. And although they noted that some insurers in the state did offer Medigap plans to people under 65 (at a higher premium), no insurers submitted under-65 rates to the state for inclusion in the shopping guide. And as of 2023, Medicare’s Medigap plan finder tool indicates that there are no Medigap plans available for Medicare beneficiaries under the age of 65 in Ohio. More than 320,000 Ohio Medicare beneficiaries are under age 65 as of 2023. For this population, the state recommended that they contact Medigap insurers directly (using the phone numbers in the Ohio Medicare premium comparison chart) to see if the insurer will offer them a plan. But it appears that most of them likely will not.

Disabled Medicare beneficiaries have a Medigap open enrollment period when they turn 65. At that point, they can select from among any of the available Medigap plans in their state.

There are several states (including South Carolina, Alaska, Wyoming, Iowa, and Nebraska) that still have operational pre-Affordable Care Act (ACA) high-risk pools that offer coverage to Medicare beneficiaries who are unable to qualify for Medigap plans. The majority of the remaining states require private Medigap insurers to offer at least some plans to disabled enrollees under age 65. But Ohio is among the states that have made no provisions at all to ensure access to supplemental coverage for disabled Medicare beneficiaries. (Note that under federal rules, these beneficiaries do get an open enrollment period for Medigap plans when they turn 65, even if they’ve already been enrolled in Medicare for years due to a disability.)

Under federal rules, disabled Medicare beneficiaries, including those with kidney failure, do have the option to enroll in a Medicare Advantage plan instead of Original Medicare. Medicare Advantage plan monthly premiums are not higher for those under 65. But Medicare Advantage plans may have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $8,300 per year for in-network care, plus the out-of-pocket cost of prescription drugs.¹³

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment (although many of them choose not to do so). And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Original Medicare does not provide coverage for outpatient prescription drugs. More than 80% of Original Medicare beneficiaries have a supplemental plan,¹⁰ and these plans often include prescription coverage.

But Medicare Part D, created under the Medicare Modernization Act of 2003, provides prescription drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Medicare Part D coverage can be purchased as a stand-alone Medicare Part D prescription plan or obtained as part of a Medicare Advantage plan with integrated Medicare Part D benefits. Both options are available for purchase (or plan changes) during the Medicare Annual Election Period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.

There are 24 stand-alone Medicare Part D plans in Ohio for 2023, with premiums that start at $5.10/month.⁴

As of April 2023, more than 2 million beneficiaries of Medicare in Ohio had Part D coverage. More than a million had Part D coverage integrated with a Medicare Advantage plan, and just under 900,000 had stand-alone Part D coverage.¹

Medicare Part D prescription drug plan enrollment follows the same schedule as Medicare Advantage plan enrollment: People can sign up when they’re first eligible for Medicare, or they can enroll during the Medicare Annual Enrollment Period each fall, which runs from October 15 to December 7. Medicare Part D prescription drug plan enrollment and plan changes made during the fall enrollment period take effect the following January.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Ohio includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Need help with filing for Medicare benefits? Got questions about Medicare eligibility in Ohio? You can contact the Ohio Senior Health Insurance Information Program with questions related to Medicare coverage and enrollment in Ohio.

The Ohio Department of Insurance also has a useful resource page all about Medicare in Ohio. The Department of Insurance oversees, licenses, and regulates health insurance companies and the brokers/agents who sell coverage within the state. They can provide assistance to consumers who have questions or complaints about any entity the Department regulates.

The Medicare Rights Center is a nationwide service (call center and website) that can provide assistance, education, and information to Medicare beneficiaries and their caregivers.

Financial help for Ohio Medicare beneficiaries is a helpful overview of how the state Medicaid program can provide financial assistance for Medicare beneficiaries in a variety of circumstances, based on income and resource/asset levels.