Medicare Advantage plans offer the same coverage as Original Medicare through private insurance companies. Many Medicare Advantage plans offer additional benefits not included in Original Medicare.
What You Need to Know
Ohio Medicare Advantage plans are offered through private insurance companies.
Your plan options are determined by the county where you live.
Many Medicare Advantage plans include prescription drug coverage through Medicare Part D.
What Types of Medicare Advantage Plans Are Available?
Medicare Advantage plan providers often contract with a network of doctors and medical facilities to help with negotiating costs. Plan types include:
- Health Maintenance Organization (HMO): Except in emergencies, HMO plans usually only cover medical services performed at an in-network facility. HMO plans are popular, with over 60% of Medicare Advantage enrollees participating in an HMO plan in 2020.1
- Preferred Provider Organization (PPO): PPO plans allow you greater choice in your doctors or medical facilities. However, out-of-pocket costs are generally higher if you choose a doctor outside of your PPO network.
- Special Needs Plans (SNP): These plans cover specific health conditions and situations.
- Chronic Condition SNP (C-SNP): You must have one of the accepted chronic conditions to join, such as certain autoimmune disorders, diabetes or cancer.
- Institutional SNP (I-SNP): This plan is available if you live in an institution like a nursing home or require nursing care at home.
- Dual Eligible SNP (D-SNP): You can choose this plan if you are eligible for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): These plans determine how much the plan will pay doctors and medical facilities, as well as the amount you will need to pay when you get care. You aren’t required to pick a primary care doctor or get referrals for specialists.2
- Medicare Medical Savings Accounts (MSA): These plans combine a high-deductible health insurance plan with a medical savings account (MSA) that you use to pay for out-of-pocket costs.
What Are Prescription Drug Options with Medicare Advantage?
Medicare Part D is coverage for prescription drugs and is offered as part of most Medicare Advantage plans. If you’re currently on medication or think you’ll be in the future, you should consider a plan with prescription drug coverage.
Check out the drug formulary when comparing plans. The formulary is the plan’s list of covered prescription drugs. Researching the drug list before signing up helps you ensure your prescriptions are covered.
A Word of Advice
Check the plan’s formulary before you sign up to make sure your prescription drugs are covered.
How Do You Choose Medicare Advantage Plans?
When choosing a Medicare Advantage plan, consider your out-of-pocket costs and benefits offered by the plan:
- Premiums: Your premium is the amount you pay each month for your plan. Some Medicare Advantage plans are zero-premium, which means you pay no premium except the Medicare Part B premium ($144.60 in 2020). Zero-premium plans aren’t free, however, and may end up costing you more in higher out-of-pocket costs for care.
- Other Costs
- Deductibles: This is the amount you pay out-of-pocket to cover care before your plan starts to pay.
- Coinsurance: This is the percentage of the cost of medical care you’re required to cover.
- Copays: Your copay is the set amount you have to pay for a specific medical service, such as a doctor visit.
- Out-Of-Pocket Maximum: This is the annual maximum you’ll have to pay out-of-pocket for care.
- Plan Benefits
- Vision: Including coverage for eye exams and glasses.
- Dental: Coverage for care like checkups and teeth cleanings.
- Telehealth: Covers remote health services, like a phone consultation or virtual doctor visit.
- Additional Perks: Plans often include benefits such as transportation services or gym membership reimbursement.
Did You Know?
Other benefits in your Medicare Advantage plan can include vision, dental and televisits.
When and How to Enroll in Medicare Advantage?
You must enroll in Medicare Part A and B to be eligible for a Medicare Advantage plan. After enrolling in Original Medicare, you can search for Medicare Advantage plans in your area and complete an application. Plans are offered by service areas in Ohio, which is designated by county.3
- Initial Enrollment Period: This includes the three months before your 65th birthday, the month you turn 65 and the three months after you turn 65.
- Medicare Annual Election Period: You can change your Medicare enrollment each year from October 15 to December 7.
- Medicare Advantage Open Enrollment Period: If you already have a Medicare Advantage plan, you can switch plans each year from January 1 to March 31.
- Special Enrollment Period: Some special circumstances make you eligible to enroll in a Medicare Advantage plan outside of the annual enrollment periods, including:
- Moving outside of your current plan’s service area.
- Gaining coverage from another source, such as an employer or union plan.
- Losing your current coverage, including becoming ineligible for Medicaid.
- Your plan leaves the Medicare program.
- Being diagnosed with a condition that is easier to manage with an SNP.
How Much Do Medicare Advantage Plans Cost in Ohio?
Costs for Medicare Advantage plans in Ohio differ based on your location and the benefits you want from a plan. You’ll need to consider the monthly premium, deductible and out-of-pocket costs (like coinsurance) when comparing plans. Remember that some plans include benefits like dental coverage or transportation services.
If you live in Cleveland you might pay between $0-$225/month for your Medicare Advantage premium. Your out-of-pocket maximum could be as high as $7,550 for in-network services.5
What If You Want to Change Your Medicare Advantage Plan?
You can switch Medicare Advantage plans during Open Enrollment Periods each year. All you need to do to change plans is to apply for a new plan. If accepted, you’re automatically disenrolled from your previous plan when the new plan’s benefits start.
What Are Alternatives to Medicare Advantage?
Medicare Advantage isn’t the only way to get coverage through Medicare. Other options include:
- Program for All-Inclusive Care for the Elderly (PACE): This is a federal program that provides participants with all of their necessary health care services. You must live in the Cleveland area to be eligible for Ohio PACE.6
- Original Medicare: Medicare Part A and Part B coverage with no additional coverage.
- Medicare Supplement: Also known as Medigap policies, these are standardized plans from private insurance providers that help pay the costs not covered by Original Medicare.
- Medicare Supplement with a Part D Plan: Medigap policies don’t normally cover prescription drug costs, but you can purchase a separate Part D plan to help pay for prescriptions.
What Are Medicare Resources in Ohio?
- Ohio Department of Insurance: Provides information on Medicare in Ohio.7
- Ohio Senior Health Insurance Information Program (OSHIIP): Provides free counseling and education on Medicare options.8
- Ohio Department of Medicaid: Provides low and reduced-cost medical coverage for eligible seniors.9
- Ohio Program for All-Inclusive Care for the Elderly (PACE): Provides medical care for eligible seniors in Cleveland.
- McGregor PACE Center for Senior Independence: (216) 791-3580.
Get a better understanding of Medicare Advantage plan costs so you can start comparing plans available in your county.