Did you know that about 2 million people are already using an Original Medicare Health Plan in Ohio?
As in any other state, they have their own choices to make in terms of the multiple Medicare Health Plan options available in Ohio. You may know the state for the popular Rock and Roll Hall of Fame or perhaps the Cleveland Clinic (a leading name in the health education and research arena) but you must also know that it is home to over 2.3 million Medicare beneficiaries according to the 2019 data from the Centers for Medicare and Medicaid Services.
Below are some additional interesting statistics that you should know:
Please note that all sponsors of Medicare Advantage Plans and Medicare Prescription Drug Plans must sign a contract with Medicare before they start offering Medicare health insurance plans, be it Medicare HMO or Medicare Part D Prescription Drug Plan, to Ohio residents.
It’s also important to understand that not all health plans may be available across the state. Whether or not a particular plan is available in your service area will depend on the contract terms between that plan and Medicare. On an annual basis, the sponsors are required to renew their contract with Medicare to continue offering the health plans to the residents. This also means that the availability of a certain plan in your specific service area is subject to change depending on the renewal of the contract.
Knowing and understanding your options is the key to choosing the ideal Original Medicare Health Plan in Ohio. Whether your disability has qualified you for a health plan or you’re going to turn 65 soon, being equipped with the right information will help you maximize your insurance coverage and cut down unexpected healthcare costs.
Let’s dive in to find out what each Medicare health plan has in store for you:
You may know Part A of the Original Medicare Plan as the ‘hospital insurance’ part. As it suggests, this scheme covers general hospital expenses. Think of basic services, such as nurse care and daily meals, and medical supplies, including medication, that are required during hospital care. This plan also covers the costs of an inpatient care, expert nursing facility, and sometimes even a hospice setup.In some critical cases, you may also get coverage for home healthcare services. That being said, be informed that the services offered by this plan may come with some charges, including coinsurance, copayments, and deductibles.
You may think of Part B as the ‘medical insurance’ part of the scheme. This plan covers out-of-hospital medical expenses, including that of ambulance services, lab tests, doctor visits, special medical supplies, and therapy sessions. This plan may cover home healthcare services in some scenarios.
Please note that Ohio beneficiaries take both Part A and B to get hospital and medical coverage together. Some patients may not find these plans fulfilling, as they don’t cover basic checkups for eyes and teeth, prescription medications, and custodial care.
Medicare Advantage Plans are those offered by private insurance companies in collaboration with Medicare. This alternative health plan offers the aforementioned benefits of the Original Medicare Health Plans (Part A and B) along with additional perks. These privileges include routine vision, dental, and hearing checkups as well as prescription drug coverage and health and fitness sessions.
Medigap is a complementary plan that covers the medical costs that are not included in the standard Medicare plans as well as out-of-pocket healthcare costs. In simple words, it provides coverage for copayments, coinsurance, and deductibles along with supplemental benefits.
As long as patients require medication coverage for hospital treatment, most of the Medicare health insurance plans work well. However, when it comes to prolonged prescription treatment, they have to enroll in a Medicare Prescription Drug Plan (Part D). This plan covers the cost of prescription medications as per the advice of a healthcare provider. Please note that the list of drugs covered under this plan may vary from one service area to another.
That being said, beneficiaries have the option to apply for a stand-alone plan that aligns with their Original Medicare Health Plan in Ohio. They may also use it to extend their Medicare Advantage Plans.
All in all, what you must understand is that different Medicare health plans cover different aspects of healthcare. The idea is to get yourself enrolled in a plan that meets your specific health needs and requirements while reducing your expenses.
The good news is that Original Medicare Health Plans in Ohio are accessible for all U.S. citizens. On top of that, all legal residents who have been living in the state for at least five continuous years also qualify.
Apart from this, you must know about the following eligibility requirements for an Original Medicare Health Plan in Ohio.
Please note that the eligibility requirements for Part C and D are the same. You can simply apply for them after getting yourself enrolled in the Original Medicare Health Plan in Ohio. Just make sure that your health plan and required services are available in your zip code or else, you won’t receive the benefits on your current plan.
As discussed earlier, Medicare offers advantage and supplemental health insurance plans for beneficiaries who are interested in getting additional coverage. Authorized by private insurance firms working in coordination with Medicare, these plans offer the standard healthcare benefits along with extra perks.
Please note that these plans require you to pay a certain amount for individual deductibles, copayments, and coinsurance. On the bright side, the premium is much lower than the Original Medicare Plans.
Below are the two common types of Medicare Advantage Plans in Ohio.
The Health Maintenance Organization (HMO) offers a network of healthcare providers and professionals to the beneficiaries. All the healthcare bodies are associated with the insurance company. By using the services offered by them, beneficiaries can get discounted rates and insured medical services.
It is crucial to note that beneficiaries can only use the services of the healthcare providers that are a part of the HMO network in order to avail the benefits. Moreover, when consulting with a specialist, they will have to get a referral from your primary care provider. If they visit an alternative hospital, they will have to pay the fee in full.
Beneficiaries who are looking for extra flexibility with their health plans opt for the Preferred Provider Organization (PPO). They can not only receive treatment from the healthcare providers in the network but also external facilities. For out-of-network services, they just have to pay extra.
Beneficiaries can go for the Private Fee-For-Service (PFFS) plan to be free to choose a healthcare provider of their own choice. Please note that the provider you choose will have to adhere to the guidelines of your insurance company if you want the company to pay your treatment costs.
Apart from this, Ohio residents with chronic health conditions and disabilities can opt for the Special Needs Plan (SNP). This hybrid plan is made for those who require specific healthcare services from their health insurance.
Ohio residents have multiple opportunities for healthcare plan applications. Upon receiving their social security, they automatically get enrolled in the Original Medicare Health Plan in Ohio. If they haven’t received it, they can simply contact the social security headquarters in the state to achieve all the benefits.
You must also know that some employers also offer Part A in their health insurance plans for old-age employees.
You should take notes of the following three enrollment periods:
Beginning three months before the 65th birthday of a citizen, the initial enrollment period lasts for 7 months. For example, if you turn 65 in May 2020, you have the time from February to August 2020 to send your applications.
Beneficiaries who fail to apply during the initial enrollment period due to spousal insurance or employee-based group plan get a special date after the expiration of their previous coverage. From then, this enrollment period lasts for 8 months.
The general enrollment period runs from January to March on an annual basis. Eligible residents can apply to receive coverage from the first day of July in the same year.
Note: Residents who fail to sign up for Part B during their initial enrollment may be charged a penalty of 10% premium based on the delay, which usually lasts throughout the Medicare coverage.
Choosing the right Original Medicare Health Plan in Ohio is not an easy decision. You need to determine your specific healthcare needs and requirements as well as understand the nitty-gritty of each plan. Our expert team at O’Neal Insurance Group can assist you throughout and provide you with professional insights and necessary resources. We’ll make sure that you get the perfect Original Medicare Health Plan in Ohio.
The best thing is that the initial consultation session with our experts is FREE.