At a glance: Medicare health insurance in Ohio
- More than 2.3 million Ohio residents are enrolled in Medicare; 16 percent are under age 65.
- Nearly 42 percent of Ohio Medicare beneficiaries are enrolled in Medicare Advantage plans
- Ohio has a more robust Medicare Advantage market than many other states, with at least 15 plans available in every county, and more than 60 plans available in some areas.
- At least 56 insurers offer Medigap plans in Ohio, but the state does not require Medigap insurers to offer plans to people under age 65 who are enrolled in Medicare due to a disability.
- There are 26 stand-alone Part D prescription plans available in Ohio in 2019, with premiums ranging from about $15 to $97 per month. About 1.8 million Ohio residents have Part D coverage, either under stand-alone plans or as part of their Medicare Advantage coverage.
- Per-enrollee Original Medicare spending in Ohio is a little higher than the national average.
Medicare enrollment in Ohio
As of December 2018, there were 2,306,671 Ohio residents with Medicare coverage. That’s nearly 20 percent of the state’s population, versus a little more than 18 percent of the total US population enrolled in Medicare.
For most Americans, Medicare eligibility begins when they turn 65. But there are nearly 10 million Americans under the age of 65 with Medicare coverage, since eligibility is also triggered once a person has been receiving disability benefits for 24 months, or has kidney failure or ALS. Nationwide, 16 percent of Medicare beneficiaries are under age 65, which is the same as the share of Ohio beneficiaries who are under 65.
Disabled beneficiaries make up the largest share of Medicare enrollees in Alabama, Kentucky, and Mississippi, where 23 percent of Medicare beneficiaries are disabled and under age 65. But just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.
Medicare Advantage in Ohio
Medicare beneficiaries can choose to get their 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. All Ohio Medicare beneficiaries can select from among at least 15 Advantage plans, and there are more than 60 plans for sale in some counties.
As of 2017, 35 percent of Ohio Medicare beneficiaries had Medicare Advantage plans (very similar to the nationwide 33 percent average). But Medicare Advantage enrollment had increased to nearly 42 percent of the state’s Medicare population by the end of 2018, when 963,602 Ohio Medicare beneficiaries had private Medicare coverage (that doesn’t count people with Original Medicare plus private supplemental coverage via Part D and Medigap). The other 1.34 million Ohio Medicare beneficiaries were enrolled in Original Medicare as of the end of 2018.
The popularity of Medicare Advantage varies from one state to another. In Minnesota, 56 percent of the state’s Medicare population is enrolled in Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (and those are via employer-sponsored coverage, 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). Starting in 2019, 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 coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, 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.
According to an AHIP analysis, there were 613,014 Ohio Medicare beneficiaries — about 45 percent of the state’s Original Medicare population — who had Medigap coverage as of 2016 (Medigap coverage cannot be used with Medicare Advantage plans).
Medigap plans are sold by private insurers, but they’re standardized under federal rules and regulated by state laws and insurance commissioners. In Ohio, there are at least 56 insurers offering Medigap plans.
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. 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 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 long as they don’t have kidney failure. Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the 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 $6,700 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 drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Part D can be purchased as a stand-alone plan or obtained as part of a Medicare Advantage plan with integrated 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 26 stand-alone Part D plans for sale in Ohio in 2019, with premiums that range from about $15 to $97/month.
More than 1.8 million Ohio Medicare beneficiaries had Part D coverage as of December 2018. More than a million had stand-alone Part D coverage and about 760,000 had Medicare Advantage plans with Part D coverage.
Medicare spending in Ohio
Original Medicare’s average per-beneficiary spending in Ohio was a little higher than the national average in 2016, at $10,027 (nationwide, the average was $9,533). 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.
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.