Understand Medicare Part C in Ohio
Medicare Advantage Plans offer a few key differences that distinguish them from Parts A and B of the Original Medicare system managed by the federal government. While Part A pays for inpatient care at a hospital and Part B covers services and supplies used to treat or prevent medical conditions, Medicare Advantage Plans come with a few added benefits. Plans are required to offer the same level of care as Original Medicare and may include additional health care benefits, such as prescription drug coverage, routine hearing, vision, and dental exams, and fitness club memberships:
- In 2023, there are 216 Medicare Advantage Plans available in Ohio.
- 100% of the total Medicare population in Ohio has access to a Medicare Advantage Plan with a $0 monthly premium in 2023.
- In 2023, the average monthly premium for a Medicare Advantage Plan in Ohio is $16.03, a decrease from $18.17 in 2022.
- Forty-two Medicare Advantage Plans offer innovative benefits, such as wellness and health care planning, reduced cost-sharing, and rewards and incentives programs in 2023.
Designed to be an all-in-one solution, Medicare Advantage Plans are offered by Medicare-approved private insurance companies. There are several types of Medicare Advantage Plans available, depending on your insurance provider and location. Learn the differences between these plans and how they affect your coverage so that you can make the right choice for your medical situation.
Medicare Advantage Plans in Ohio
Compare ratings of some of Ohio’s Medicare Advantage Plan providers:
| Compare Medicare Advantage Plans in Ohio | ||||
| Insurance company | Medicare rating | A.M. Best rating | BBB rating | J.D. Power ranking |
| Aetna | 4 stars | A | A+ | 6th out of 9 |
| Blue Cross Blue Shield | 4.5 stars | A | A+ | Not rated |
| Humana | 4 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
What Medicare Advantage Plans cover
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
| Medicare Advantage Plan Benefits | ||
| Hospital and skilled nursing facility inpatient care | Home health care | Prescription drug coverage (if included in your plan) |
Medically necessary outpatient services, such as:
| Preventive services, such as:
| Additional benefits (depending on your plan), such as:
|
Types of Medicare Advantage Plans in Ohio
There are four types of plans available in Ohio’s Medicare Advantage program: Health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS), and special needs plan (SNP). Each offers a different level of flexibility in your network of care providers and varies in price. All Medicare Advantage Plans provide the same coverage as Original Medicare, but additional benefits may come with an increased premium.
| HMOs HMOs typically require that you receive all services from in network providers:
| PPOs PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|
| PFFS Plans PFFS plans don’t require a primary care physician or referrals for specialists:
| SNPs SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
|
When to sign up for Medicare Advantage Plans in Ohio
If you want to enroll in a Ohio Medicare Advantage Plan, you need to be enrolled in Medicare Part A and Part B, and you cannot be enrolled in Medigap. Enrollment is available to seniors 65 and older and those with a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) Disability Insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
There are three periods when you can enroll:
- The first is the Initial Coverage Election Period when you first become eligible. This period includes the three months before your 65th birthday, the month of your birthday, and the three months following. If you have a disability, this period will occur three months before or after your 25th month of receiving benefits.
- The Annual Election Period runs from October 15 to December 7. During this period, you can switch from Original Medicare to a Medicare Advantage Plan. If you’re already enrolled in Medicare Advantage, you can switch between plans during this period.
- The Open Enrollment Period takes place between January 1 and March 31. You can switch between Medicare Advantage Plans or go back to Original Medicare during this period.
Medicare provides special enrollment periods for unusual life circumstances, such as losing your job (and health coverage) and moving out of the area your insurance carrier services.
How to Choose a Medicare Advantage Plan in Ohio
Consider these factors as you compare Medicare Advantage Plans available in your area:
| How to compare Medicare Advantage Plans in Ohio | ||
| Monthly premium | This is in addition to your Part B monthly premium. so it affects your monthly cash flow. You pay whether or not you access your benefits. You should have access to at least one zero premium plan with drug coverage in your area. | |
| Provider network | Check to make sure your doctors, hospitals, and pharmacies are in network to keep costs as low as possible. | |
| Out-of-pocket max | This is the most you’ll spend ― not including your premium, deductible, and drug costs ― for Medicare-covered services as long as you follow the plan’s rules for in and out of network coverage. | |
| Deductibles, coinsurance & copays | Also known as cost-sharing, these expenses apply when you access your benefits. Check to see what your plan charges for doctor’s visits, services, treatments, and prescription drugs. | |
| Drug coverage/formulary | See if your drugs are on the plan’s formulary and how much they cost each time you fill a prescription. You may want to talk with your doctor about a generic or alternative version of a drug you need. | |
| Additional benefits | Consider which additional benefits are important to you. Most plans require you to use network providers and may charge extra premiums for more comprehensive coverage. | |
Medicare Advantage Resources in Ohio
If you’re feeling confused by the multitude of plan options available, getting in touch with trained, unbiased counselors can be a good first step. Ohio is home to several organizations that can help you make an informed decision.
| Ohio Department of Aging | Website | 800-266-4346 | The Ohio Department of Aging provides resources for older residents, caregivers and professionals. |
| Ohio Department of Health | Website | 614-466-3543 | The Ohio Department of Health works to prevent disease and promote the health of the state’s residents by ensuring they have access to health care. |
| Ohio Department of Insurance | Website | 614-644-2658 | The Department of Insurance protects consumers by providing education and regulating insurance providers.. |
| Ohio Senior Health Insurance Information Program (OSHIIP) | Website | 800-233-1737 | OSHIIP provides free, objective health information and one-on-one counseling to Medicare beneficiaries. |
| Ohio’s Area Agencies on Aging | Website | 800-626-7277 | Ohio’s Area Agencies on Aging advocate for older adults and serve as planners and funders, while providing education and referral services to Ohio’s seniors. |
Kelly Blackwell
Certified Senior Advisor (CSA)®
As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.
Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.
A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.
As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.
Kelly Blackwell
Certified Senior Advisor (CSA)®
As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.
Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.
A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.
As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.
Learn More From Our Sources
- Medicare | Health Maintenance Organization (HMO) | Last accessed February 2023
- Medicare | How do Medicare Advantage Plans work? | Last accessed February 2023
- Medicare | How Original Medicare works | Last accessed February 2023
- Medicare | Joining a Health or Drug Plan | Last accessed February 2023
- Medicare | Preferred Provider Organization (PPO) | Last accessed February 2023
- Medicare | Private Fee-for-Service (PFFS) Plans | Last accessed February 2023
- Medicare | Special Needs Plans (SNP) | Last accessed February 2023
FAQs
What is the biggest disadvantage of Medicare Advantage? ›
- Limited service providers. If you choose one of the more popular Medicare Advantage plan types, such as an HMO plan, you may be limited in the providers you can see. ...
- Complex plan offerings. ...
- Additional costs for coverage. ...
- State-specific coverage.
AARP/UnitedHealthcare is the most popular Medicare Advantage provider with 28% of all enrollment.
Why are people leaving Medicare Advantage plans? ›Network restrictions are another common reason why beneficiaries leave their Medicare Advantage plans. With Medicare Advantage plans, staying within your policy's network is key to paying the lowest possible costs for health services. Going out of your network could mean high fees or no coverage.
Why are Medicare Advantage plans being pushed so hard? ›Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls.
Are most people happy with Medicare Advantage? ›Medicare Advantage beneficiaries are extremely satisfied with their health care coverage. 98% of beneficiaries say they are satisfied with their Medicare Advantage plan, and 97% express satisfaction with their network of physicians, hospitals and specialists.
What do people not like about the Medicare Advantage plans? ›The biggest disadvantage of Medicare Advantage plans is the closed provider networks, limiting your choice of which doctor or medical facility to use. Medicare Advantage costs are also largely based on how much medical care you need, making it more difficult to budget for health care costs.
How do I choose the right Medicare Advantage plan? ›- costs that fit your budget and needs.
- a list of in-network providers that includes any doctor(s) that you would like to keep.
- coverage for services and medications that you know you'll need.
- Centers for Medicare & Medicaid Services (CMS) star rating.
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
What percent of seniors choose Medicare Advantage? ›Forty-five percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022, a share that is projected to rise to more than 50 percent by 2025.
Can I drop my Medicare Advantage plan and go back to original Medicare? ›Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
Are Medicare Advantage plans good for seniors? ›
For many seniors, Medicare Advantage plans can work well. A 2021 study in the Journal of the American Medical Association found that Advantage enrollees often receive more preventive care than those in traditional Medicare. But if you have chronic conditions or significant health needs, you may want to think twice.
How do I get my $144 back from Medicare? ›Call 1-800-MEDICARE (1-800-633-4227) if you think you may be owed a refund on a Medicare premium. Some Medicare Advantage (Medicare Part C) plans reimburse members for the Medicare Part B premium as one of the benefits of the plan. These plans are sometimes called Medicare buy back plans.
What is the benefit of choosing Medicare Advantage rather than the original Medicare plan? ›Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn't cover—like vision, hearing, and dental services. service area (for non-emergency care). Some plans offer non-emergency coverage out of network, but typically at a higher cost.
Which is better Medigap or a Medicare Advantage plan? ›A Medicare Advantage plan may be a better choice if it has an out-of-pocket maximum that protects you from huge bills. Regular Medicare plus a Medigap insurance plan generally allows you more choice in where you receive your care.
Is Medicare cheaper than Medicare Advantage? ›Medicare Advantage can cost less than Original Medicare. That's because Medicare Advantage plans must have a maximum out-of-pocket limit. In 2023, the maximum for in-network services will be $8,300 and, for in- and out-of-network combined, $12,450. (The limits this year are $7,550 and $11,300.)
What services does an Advantage plan cover that Medicare will not? ›With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine check ups or cleanings). Plans can also cover even more benefits.
Is Humana Medicare Advantage a good plan? ›At the national level, Humana rose to the top in the following categories for its 2023 offerings and performance in the CMS Star ratings: Best company for Medicare Advantage plan overall rating. Best company for member experience. Best company for low-premium plan availability.
Is Aetna a good Medicare Advantage plan? ›Aetna Medicare Star Ratings
For 2022, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.29 out of 5 stars. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars.
Plan G is the best Medigap policy for new enrollees, but it's also one of the more expensive plans, averaging $145 per month for 2023.
Which Medicare plan is most popular? ›By and large, Plan F is the most popular Medicare Supplement plan due to its coverage of more out-of-pocket Medicare costs than any other Medigap plan type.
What is the best site to compare Medicare Advantage plans? ›
The Medicare Plan Finder on Medicare.gov is currently the most comprehensive tool for comparing Medicare Advantage plan benefits, prescription drug coverage and costs.
Which Medicare Advantage plan has the best dental coverage 2023? ›- Best for size of dental network: UnitedHealthcare.
- Best for comprehensive coverage: Cigna & Aetna (tie).
- Best for member satisfaction: Kaiser Permanente.
- Best for low-cost plans: Humana.
Summary: Medicare Advantage plans can be full of extra benefits like prescription drug coverage, dental, hearing, and vision coverage. Another advantage of a Medicare Advantage plan is a mandatory out-of-pocket maximum.
Does Medicare Advantage cover the 20 percent? ›With Original Medicare, you pay 20 percent of the cost, or 20 percent coinsurance, for common health services like office visits or outpatient surgery. Most Medicare Advantage plans use copays instead of coinsurance for these services. That means you pay a fixed cost.
Is AARP Medicare Advantage the same as UnitedHealthcare? ›AARP Medicare Advantage plans are insured by UnitedHealthcare — the largest Medicare Advantage provider in the country — and offer several benefits that aren't available in Original Medicare, such as some coverage for preventive dental care, vision care and hearing exams.
Which state has the most people enrolled in Medicare Advantage? ›| Characteristic | Number of Medicare beneficiaries |
|---|---|
| California | 6,411,106 |
| Florida | 4,680,137 |
| Texas | 4,286,051 |
| New York | 3,672,562 |
Medicare Advantage plans don't pay 100% of your medical costs. Like most health insurance, Medicare Advantage plans have a “cost-sharing” structure for many services. If your plan covers the service, it'll usually pay most of the costs and charge you a copayment or coinsurance amount. A yearly deductible may apply.
Can you switch from Medicare Advantage to original Medicare without penalty? ›If you move away from your Medicare Advantage plan's service area, you can re-enroll in Original Medicare without penalty.
How do you switch from and Medicare Advantage back to Original Medicare? ›- To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be disenrolled automatically from your old plan when your new plan's coverage begins.
- To switch to Original Medicare, contact your current plan, or call us at 1-800-MEDICARE.
No, you can't switch Medicare Advantage plans whenever you want. But you do have options if you're unhappy with your plan. You can jump to another plan or drop your Medicare Advantage plan and change to original Medicare during certain times each year. You may be eligible to change plans at other times, too.
How can Medicare Advantage plans be so cheap? ›
The main reason why Medicare Advantage carriers can offer low to zero-dollar monthly premium plans is that Medicare pays the private companies providing the plans to take on your health risk. But not all Medicare Advantage plans have a low premium cost.
How do I get the $16728 Social Security bonus? ›- Option 1: Increase Your Earnings.
- Option 2: Wait Until Age 70 to Claim Social Security Benefits.
- Option 3: Be Strategic With Spousal Benefits.
- Option 4: Make the Most of COLA Increases.
Social Security benefits and Supplemental Security Income (SSI) payments will increase by 8.7% in 2023. This is the annual cost-of-living adjustment (COLA) required by law.
Does everyone pay $170 for Medicare? ›Although nearly everyone will get free Medicare Part A, the total cost for all components of Medicare will typically be between $170 and $350 per month. These costs are waived or reduced for those who qualify for low-income financial assistance programs.
Is it better to have a Medicare Advantage plan? ›For many seniors, Medicare Advantage plans can work well. A 2021 study in the Journal of the American Medical Association found that Advantage enrollees often receive more preventive care than those in traditional Medicare. But if you have chronic conditions or significant health needs, you may want to think twice.
What is the difference between original Medicare and Medicare Advantage? ›Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).