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Medicare in Ohio

Ohio has no provisions to ensure access to Medigap plans for disabled Medicare beneficiaries under age 65

Key takeaways

Medicare enrollment in Ohio

As of September 2020, there were 2,382,039 residents covered by Medicare in Ohio, amounting to more than 20 percent of the state’s population.

For most Americans, Medicare coverage enrollment goes along with turning 65. But Medicare eligibility is also triggered for younger people if they have been receiving disability benefits for 24 months, or have kidney failure or ALS. Nationwide, 15 percent of Medicare beneficiaries — nearly 10 million people — are under age 65. In Ohio, 16 percent of Medicare beneficiaries are under 65.

Disabled beneficiaries make up the largest share of Medicare enrollees in Alabama, Arkansas, Kentucky, and Mississippi, where 22 percent of Medicare beneficiaries are under age 65. But just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.


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Medicare Advantage in Ohio

Medicare beneficiaries can choose to get their healthcare coverage through private Medicare Advantage plans, or directly from the federal government via Original Medicare. There are pros and cons to either option, and the right solution is different for each person.

Medicare Advantage plans are offered by private insurers, so plan availability varies from one area to another. There are Advantage plans for sale in all 88 counties in Ohio, and the state’s Advantage market is more robust than many other states. For 2021, all Ohio Medicare beneficiaries can select from among at least 21 Advantage plans, and there are 99 plans for sale in Summit County.

As of 2018, 37 percent of Ohio Medicare beneficiaries had Medicare Advantage plans (nationwide, Medicare Advantage enrollment amounted to 34 percent of all beneficiaries at that point). But Medicare Advantage enrollment had increased to nearly 47 percent of the state’s Medicare population by the fall of 2020, when 1,113,217 Ohio Medicare beneficiaries had private Medicare coverage (that doesn’t count people with Original Medicare supplemented with private Part D and Medigap plans). The other 1.27 million Ohio Medicare beneficiaries were enrolled in Original Medicare as of mid-2020.

The popularity of Medicare Advantage varies from one state to another. In Minnesota, nearly half of the state’s Medicare enrollment is via  Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (employer-sponsored coverage, in that case, as there are no Medicare Advantage plans available for individuals to purchase in Alaska).

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). People who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Ohio

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental healthcare coverage. Nationwide, more than half of Original Medicare beneficiaries use an employer-sponsored plan or Medicaid for their supplemental coverage. But for those who don’t, optional Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had Original Medicare on its own and experienced a medical claim.

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According to an AHIP analysis, there were 587,953 Ohio Medicare beneficiaries who had Medigap coverage as of 2018. That was down from 613,014 Medigap enrollees in the state in 2016, which mirrors the decrease in Original Medicare enrollment in Ohio, and the corresponding increase in Medicare Advantage enrollment (Medigap coverage cannot be used with Medicare Advantage plans, so fewer people have Medigap plans when Medicare Advantage enrollment increases).

Medigap plans are sold by private insurers, but they’re standardized under federal rules (so each plan will provide the same benefits as any other plan labeled with the same letter; Plan G, Plan K, etc.) and regulated by state laws and insurance commissioners. In Ohio, there are at least 56 insurers offering Medigap plans. The Medicare website has a plan finder tool that will show you prices and plan availability for the various Medigap plans that can be purchased in Ohio.

Federal rules require Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s open enrollment period, which begins when the person is at least 65 years old and enrolled in Medicare Part B. But despite the fact that nearly 10 million Medicare beneficiaries are not yet 65 (and are enrolled in Medicare due to a disability) there is no federal requirement that Medigap insurers offer plans to people who are under age 65.

The majority of the states have addressed this with legislation that ensures at least some access to Medigap plans for people under age 65, but Ohio is not among them. Ohio currently publishes a sample premium comparison guide, but a more robust Medicare shopping guide that was published in 2017 noted that Medigap insurers in Ohio are not required to offer plans to people under age 65. And although they note that some insurers in the state do offer Medigap plans to people under 65 (at a higher premium), no insurers submitted under-65 rates to the state for inclusion in the shopping guide. And Medicare’s Medigap plan finder tool indicated that there were no Medigap plans available for Medicare beneficiaries under the age of 65 in Ohio in 2020. More than 360,000 Ohio Medicare beneficiaries are under age 65. For this population, the state recommended that they contact Medigap insurers directly (using the phone numbers in the Ohio Medicare premium comparison chart) to see if the insurer will offer them a plan. But it appears that most of them likely will not.

Disabled Medicare beneficiaries have a normal Medigap open enrollment period when they turn 65. At that point, they can select from among any of the available Medigap plans, with standard age-65 premiums.

There are several states (including South Carolina, Alaska, Wyoming, Iowa, and Nebraska) still have operational pre-ACA high-risk pools that offer coverage to Medicare beneficiaries who are unable to qualify for Medigap plans. The majority of the remaining states require private Medigap insurers to offer at least some plans to disabled enrollees under age 65. But Ohio is among the states that have made no provisions at all to ensure access to supplemental coverage for disabled Medicare beneficiaries.

Under federal rules, disabled Medicare beneficiaries do have the option to enroll in a Medicare Advantage plan instead of Original Medicare (as of 2021, this includes people who have kidney failure; prior to 2021, these beneficiaries couldn’t enroll in most Medicare Advantage plans). Medicare Advantage premiums are not higher for those under 65. But Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $7,550 per year for in-network care, plus the out-of-pocket cost of prescription drugs.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment (although many of them choose not to do so). And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Medicare Part D in Ohio

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries nationwide have supplemental coverage either through an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare Part D, created under the Medicare Modernization Act of 2003, provides prescription drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Medicare Part D coverage can be purchased as a stand-alone plan or obtained as part of a Medicare Advantage plan with integrated Medicare Part D benefits. Both options are available for purchase (or plan changes) during the annual election period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.

There are 30 stand-alone Medicare Part D plans for sale in Ohio for 2021, with premiums that range from about $7 to $88/month.

As of 2020, More than 1.9 million beneficiaries of Medicare in Ohio had Part D coverage. More than a million had stand-alone Part D coverage and nearly 900,000 had Medicare Advantage plans with integrated Part D coverage.

Medicare Part D enrollment follows the same schedule as Medicare Advan5tage enrollment: People can sign up when they’re first eligible for Medicare, or they can enroll during the annual enrollment period each fall, which runs from October 15 to December 7. Medicare Part D enrollment and plan changes made during the fall enrollment period take effect the following January.

Medicare spending in Ohio

The average per-beneficiary spending for Medicare in Ohio was a little higher than the national average in 2016, at $10,288 (nationwide, the average was $10,096). The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage.

Average per-beneficiary Original Medicare spending was highest in Louisiana, at $11,932, and lowest in Hawaii, at just $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in Ohio?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Ohio includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Medicare in Ohio: Resources for Medicare beneficiaries and their caregivers

Need help with filing for Medicare benefits? Got questions about Medicare eligibility in Ohio? You can contact the Ohio Senior Health Insurance Information Program with questions related to Medicare coverage and enrollment in Ohio.

The Ohio Department of Insurance also has a useful resource page all about Medicare in Ohio. The Department of Insurance oversees, licenses, and regulates health insurance companies and the brokers/agents who sell coverage within the state. They can provide assistance to consumers who have questions or complaints about any entity the Department regulates.

The Medicare Rights Center is a nationwide service (call center and website) that can provide assistance, education, and information to Medicare beneficiaries and their caregivers.

Financial help for Ohio Medicare beneficiaries is a helpful overview of how the state Medicaid program can provide financial assistance for Medicare beneficiaries in a variety of circumstances, based on income and resource/asset levels.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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