Medicare Advantage Plans in Ohio

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital coverage) and Part B (medical coverage). Most also include Part D (prescription drug coverage) and may offer extra benefits like dental, vision, hearing, telehealth services, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people qualify for Medicare enrollment at age 65, though some may become eligible earlier due to disability or qualifying medical conditions like ALS or ESRD.

Important enrollment periods include:

• Initial Enrollment
• General Enrollment
• Special Enrollment

Delaying enrollment or failing to qualify for premium-free Part A may result in penalties.

What Types of Medicare Advantage Plans Are Available in Ohio?

Ohio offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and get referrals for specialists.
• Preferred Provider Organizations (PPOs): Allow more provider flexibility but cost more out-of-network; referrals are typically not required.
• Private Fee-for-Service (PFFS): You may visit any provider who agrees to the plan’s payment terms. Some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For people with chronic health conditions like diabetes or cancer.
  • I-SNPs: For people in institutions or who require nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For people eligible for both Medicare and Medicaid, offering low- or no-cost extra benefits.
• Medical Savings Accounts (MSAs): Pair a high-deductible plan with a savings account funded by the insurer for healthcare expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most Medicare Advantage plans include Part D drug coverage. Exceptions include MSAs and some PFFS plans. If your plan doesn’t include drug coverage, you may:

• Enroll in a separate Part D plan (if allowed for your plan type).
• Incur a late enrollment penalty if you delay prescription coverage without creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, it’s important to understand Medicare Advantage costs:

• Premiums: Many plans offer $0 monthly premiums, while others charge varying fees.
• Deductibles, Coinsurance & Copays: Review how much you’ll pay for services like hospital stays or doctor visits.
• Out-of-Pocket Maximums: Limits how much you’ll pay annually for covered services.
• Extra Benefits: Look for perks like dental, vision, hearing, fitness programs, telehealth, and OTC allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: Starts 3 months before your 65th birthday month and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop a Medicare Advantage plan.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Part B for the first time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Allows switching between MA plans or returning to Original Medicare.
• Special Enrollment Periods: Triggered by events such as:
  • Moving outside your plan’s service area
  • Losing employer/union coverage
  • Plan termination
  • Diagnoses that qualify for SNPs

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Simply apply for a new plan during these windows to automatically disenroll from your previous plan.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

⭐ CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in Ohio?

Ohio offers several helpful services:

• Ohio Senior Health Insurance Information Program (OSHIIP): Free Medicare counseling.
• Ohio SMP Program: Educates beneficiaries on detecting and avoiding Medicare fraud.
• Ohio Department of Insurance: Handles Medicare-related complaints.
• Ohio Medicaid: Helps low-income residents with healthcare costs. Visit medicaid.ohio.gov or call 800-324-8680. Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also known as Medigap, help cover out-of-pocket costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles.

• You must be enrolled in Medicare Parts A and B.
• The best time to enroll is during the six-month Medigap Open Enrollment Period, which starts when you enroll in Part B. During this window, coverage is guaranteed regardless of health.
• After that, medical underwriting may apply.
• Medigap does not cover prescription drugs; you’ll need a standalone Part D plan.
• There are 10 standardized plans; Plans F, G, and N are most popular. Medicare Supplement Plan G had the highest enrollment in 2023, with G and N being the fastest-growing options.
• Plan F is no longer available to newly eligible individuals as of 2020.
• Medigap plans offer predictable costs, no referrals, and nationwide coverage.

Learn more about Medicare Supplement plans in Ohio.

Next Steps

If a Medicare Advantage plan in Ohio fits your needs, explore your local options. Compare premiums, provider networks, out-of-pocket costs, and extra benefits—then enroll during your eligibility window.