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
How many Medicare Advantage plans are there 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).
What is the most widely accepted Medicare Advantage Plan? ›AARP/UnitedHealthcare is the most popular Medicare Advantage provider with 28% of all enrollment.
What are the negatives of a Medicare Advantage Plan? ›Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan.
Why do doctors not like Medicare Advantage plans? ›If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
Is Humana Medicare Advantage a good plan? ›The company's average Medicare star rating is 4.3 out of 5, and most of the plan's members are in highly rated plans. Humana is one of the largest providers of Medicare Advantage plans, with more than 5.1 million members enrolled in 2022.
Does getting a Medicare Advantage plan make you lose original Medicare? ›If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
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.
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).
Do Medicare Advantage plans have high premiums? ›The estimated average monthly MA plan premium for 2023 is $18, but this cost may vary significantly. Some plan premiums could be $0, while others could have premiums over $200.
What is the average cost of a Medicare Supplement plan in Ohio? ›In Ohio, 65-year-old consumers pay $106 per month on average for a Medicare Supplement plan, while 75-year-olds pay around $175. The most common plans are F and G, which provide complete coverage (averaging $202.40 and $105.90 per month, respectively).
What states have 5 star Medicare Advantage plans? ›
- Alabama.
- Arkansas.
- California.
- Colorado.
- Florida.
- Georgia.
- Hawaii.
- Idaho.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or whether you have to go to doctors, facilities, or suppliers that belong to the plan's network for non-emergency or non- urgent care).
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.
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.)
Can you switch back and forth between Medicare and Medicare Advantage? ›If you currently have Medicare, you can switch to Medicare Advantage (Part C) from Original Medicare (Parts A & B), or vice versa, during the Medicare Annual Enrollment Period.
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.
Why do agents push Medicare Advantage plans? ›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. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.
Is Medigap or advantage better? ›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.
What Medicare plan do most people choose? ›Most Medicare members have a wealth of options for Medicare Advantage plans in 2022. The majority of people enroll in a PPO or HMO plan, but other plan types may work for you if you have special medical needs, for example. MoneyGeek's top pick overall for Medicare Advantage PPO plans is Blue Cross Blue Shield.
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.
Do you have to pay Medicare Part B premiums with an Advantage plan? ›
In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2023, the standard Part B premium amount is $164.90 (or higher depending on your income). If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service.
What is the best Medicare Advantage plan for 2023? ›- Best Overall: AARP / UnitedHealthcare.
- Best Overall, Runner up: Aetna.
- High Medicare Star Ratings: Blue Cross Blue Shield.
- Great for Nationwide Coverage: Humana.
- Best for Customer Satisfaction: Kaiser Permanente.
- Lowest Cost: Cigna.
The projected average premium for a Medicare Advantage plan in 2023 is $18 per month, but there are other costs to consider, including co-pays and deductibles.
Is AARP and Humana the same? ›AARP makes money by licensing its name to a private insurer that offers a Medicare Advantage plan. Humana is a different private insurer that takes money from the government to provide an Advantage plan.
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.
What changes are coming to Medicare in 2023? ›For 2023, the Part A deductible will be $1,600 per stay, an increase of $44 from 2022. For those people who have not worked long enough to qualify for premium-free Part A, the monthly premium will also rise. The full Part A premium will be $506 a month in 2023, a $7 increase.
Do I need Medicare Part D if I have an Advantage plan? ›Nearly 90% of Medicare Advantage plans include Medicare Part D, but you can also purchase Part D separately if you have a MA plan that does not include it. For the 2022 coverage year, about 48% of the Medicare eligible-population opted for an MA plan.
Is Aetna a good plan for seniors? ›Aetna is a popular choice among seniors who want low-cost, comprehensive Medicare Advantage plans. With low premiums and deductibles, Aetna makes it easy to get quality health insurance without spending a fortune every month.
Does Aetna Medicare Advantage cover prescriptions? ›A Medicare Advantage prescription drug plan (or MAPD) is a plan that includes medical and prescription drug coverage. It is offered from a private insurers such as Aetna®.
Is UnitedHealthcare a good Medicare plan? ›UnitedHealthcare Medicare Advantage plans are rated higher than average. In 2023, the provider's 2023 Medicare Advantage plans received an average rating of 4.28 stars out of 5 from the Centers for Medicare & Medicaid Services, weighted by enrollment.
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.
Does Medicare Advantage pay 100 percent? ›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.
What is true about the Medicare Advantage out-of-pocket maximum? ›The average out-of-pocket limit for Medicare Advantage enrollees is $4,972 for in-network services and $9,245 for both in-network and out-of-network services (PPOs) Since 2011, federal regulation has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B.
What is the out-of-pocket maximum for Medicare Advantage in 2023? ›Medicare Advantage (Part C): In 2023, the out-of-pocket maximum for Part C plans is $8,300 for approved services, but individual plans can set lower limits if they wish. Part D cost sharing does not apply towards your Medicare Advantage plan's MOOP.
How much is AARP Medicare Supplement monthly? ›Membership costs are minimal at only $16 per year. Costs for AARP Medigap insurance vary widely, ranging from about $60 to $300 per month. Getting a price quote based on your situation can help you understand if an AARP policy is the best deal for you.
How much is Medicare Plan G 2023? ›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.
How much will Medicare Supplement cost in 2023? ›What are Medicare premiums in 2023? The Medicare premiums in 2023 are typically $164.90 per month for Part B, $28 for Medicare Advantage, $49 for Part D and $155 for Medicare Supplement.
What are 4 types of Medicare Advantage plans? ›- Health Maintenance Organization (HMO) Plans.
- Preferred Provider Organization (PPO) Plans.
- Private Fee-for-Service (PFFS) Plans.
- Special Needs Plans (SNPs)
| Characteristic | Number of Medicare beneficiaries |
|---|---|
| California | 6,411,106 |
| Florida | 4,680,137 |
| Texas | 4,286,051 |
| New York | 3,672,562 |
Note: Medicare Advantage Plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules. If you travel outside your Medicare Advantage Plan's service area continuously for more than six months, you will automatically be disenrolled from most plans.
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 endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare.
How many different types of Medicare Advantage plans are there? ›Of the 43 Medicare Advantage plans available for individual enrollment to the average Medicare beneficiary in 2023, 35 of the plans include prescription drug coverage (MA-PDs). Total Number of Plans.
What are the 3 plans for Medicare? ›- Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B (Medical Insurance) ...
- Medicare Part D (prescription drug coverage)
There are several different kinds of Medicare Advantage plans. These plans are available from private, Medicare-approved insurance companies, and they're allowed to offer extra benefits beyond Part A and Part B. Some plans include prescription drug coverage, for example.
How many Medicare Advantage should I choose? ›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.
What is the maximum out-of-pocket for Medicare Advantage in 2023? ›Medicare Advantage (Part C): In 2023, the out-of-pocket maximum for Part C plans is $8,300 for approved services, but individual plans can set lower limits if they wish. Part D cost sharing does not apply towards your Medicare Advantage plan's MOOP.
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 difference between AARP and UnitedHealthcare? ›Although AARP is not an insurance company, it offers healthcare insurance plans through United Healthcare. The plans include Medicare Part D prescription drug coverage and Medigap. United Healthcare is a nationwide health insurance company, with reported 2019 revenue of $242.2 billion.
What is the biggest difference between Medicare and Medicare Advantage? ›Medicare Advantage: Coverage. 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).
Is AARP UnitedHealthcare a Medicare Advantage plan? ›
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.
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.
Do most people have Medicare Advantage? ›A new KFF analysis finds that nearly half of eligible Medicare beneficiaries – 28.4 million out of 58.6 million Medicare beneficiaries overall – are now enrolled in Medicare Advantage plans.