Medicare in Ohio

Medicare in Ohio helps those over 65 and those with specific health conditions get medical coverage.

More than two million Ohio residents are enrolled in some form of Medicare:

• Original Medicare: 1,371,229
• Medicare Advantage: 999,994

Medicare can be challenging to understand, and many Ohio residents have questions about how to apply, who’s eligible, and more.

This page will help you understand if you’re eligible for Medicare, how to sign up, and the different options available under Medicare.

How to Apply for Medicare in Ohio

Most Americans are eligible for Medicare around their 65th birthday. Others are able to apply for Medicare due to a permanent disability or end-stage renal disease. Regardless, you are probably asking yourself, “How do I sign up for Medicare in Ohio?”

Usually, you’ll start receiving information about signing up for Medicare near your 65th birthday. The initial enrollment period is very important — you have more options available and you will avoid late enrollment penalties when you sign up right away.

The good news is that many people automatically receive Medicare Parts A and B when they are first eligible. However, if you want to purchase other coverage, such as Medigap coverage, Medicare Part D, or Medicare Advantage (Part C), you’ll need to do so before the enrollment period ends.

If you don’t get Medicare automatically, you’ll need to apply. You can do this using the options below:

• Contact your local Social Security office
• Call 1-800-772-1213 to enroll over the phone
• If you retired from a railroad, call the Railroad Retirement Board at 1-877-772-5772
• Sign up for Part A online at ssa.gov and Part B using Form CMS-40B

Medicare in Ohio Requirements

Who qualifies for Medicare in Ohio? The purpose of Medicare is to provide coverage for older Americans and those who can’t work due to permanent disability or end-stage renal disease. Generally, these groups of people don’t have access to health insurance from an employer.

Who is eligible for Medicare in Ohio? You need to be a U.S. citizen or permanent resident and have lived in the U.S. for at least five years. Also, at least one of the following must apply:

• Age 65 or older
• You have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s disease
• You have end-stage renal disease (ESRD)
• Under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board

What Does Medicare Cover in Ohio?

If you’re wondering “What does Ohio Medicare pay for?”, you’re not alone. The different parts of Medicare each cover different services, and it’s important to know exactly what you need.

The basis of Original Medicare is Parts A and B. Part A covers in-patient hospital care, while Part B covers outpatient care, doctor’s visits and preventative care.

You can also purchase Medicare Part D, which covers prescription drugs. That way your necessary medication is covered.

Before Medicare pays for your medical care, you’ll pay a deductible. After the deductible, Medicare covers 80% of the cost of care, and you pay 20%. You can choose to purchase a Medigap plan to help you cover these out-of-pocket costs, but it’s important to do so during your initial enrollment period to guarantee acceptance.

Does Medicare Cover Dental in Ohio?

Taking care of dental needs is important, especially to older Americans. So what dental services are covered by Medicare?

Unfortunately, Original Medicare does not include dental coverage. However, if you choose Medicare Part C, known as Medicare Advantage, you get the coverage of Parts A and B along with additional benefits. You may be able to find an Advantage plan with dental coverage.

Can You Have Medicare and Medicaid in Ohio?

Medicare recipients who are lower-income may also qualify for Medicaid in Ohio. People who qualify for both programs are known as dual-eligible.

If you’re dual eligible, you’ll automatically be enrolled in extra help to pay for some of your monthly premiums. When it comes to medical care, Medicare will pay first and then Medicaid will cover what’s left.

To make it easier for dual-eligible citizens in Ohio, the state worked with Medicare to create a Medicare-Medicaid Plan. This plan is known as MyCare Ohio and helps you coordinate your medical care and costs. This program doesn’t cost you anything and offers benefits such as a $0 copayment on Medicare-covered drugs, transportation services, and more.

How Much is Medicare in Ohio?

How much will you pay to get Medicare coverage?

Most Americans get Medicare Part A for free, based on payments into the Medicare system during their working years. If you do have to pay for Part A due to a lack of Medicare taxes, the amount in 2021 is $471 per month. Part A also has a deductible of $1,484 per year, and coinsurance for hospital stays beyond 60 days. Visit this guide if you have more questions about Medicare premiums and deductibles.

In 2021, Medicare Part B costs $148.50 for most Americans. If you have a higher income, you may pay a higher monthly premium. The annual deductible is $203, and then you pay 20% of your medical costs afterward.

If you also purchase a Medicare Part D drug plan, the premium will vary depending on the plan you choose. You’ll also want to compare plans based on how much the copayments are for the prescription drugs you need.

Instead of Original Medicare, which is Parts A and B (and sometimes D), you can choose Medicare Part C, known as Medicare Advantage. The cost of these plans vary. Some don’t charge any more than your normal Part B premium, while others do have an additional cost.

You’ll want to pay attention to the medical network of each Part C plan since out-of-network care may not be covered. You may also receive additional benefits from your Medicare Advantage plan, such as vision, dental, health club discounts, and more.

What is the Income Limit for Medicare in Ohio?

There’s no income limit that disqualifies you from receiving Medicare benefits. However, you may pay a higher premium if you have a higher income. You can also receive additional help paying for your Medicare out-of-pocket costs if you have a lower income.

In 2021, if you have an individual income of over $88,000 or a household income of over $176,000, you’ll pay a higher monthly premium for Medicare Part B and Part D.

If you have a lower income and few assets, you may qualify for a Medicare Savings Program or dual-eligibility for Medicare and Medicaid.

What is the Best Medicare Advantage Plan in Ohio?

Many Medicare beneficiaries are concerned about out-of-pocket expenses or coverage gaps in Original Medicare, so they choose to enroll in Medicare Advantage in Ohio. A Medicare Advantage plan provides all the coverage of Medicare Parts A, B, and D, sometimes without any additional cost beyond your Part B premium.

To choose the best Medicare Advantage plan in Ohio, you’ll want to carefully consider your needs. Choose a plan where the medical network includes the doctors and specialists that you want to see and there is coverage for the medication you need.

Learn More About Medicare and Medicare Advantage in Ohio

As you can see, there’s a lot to know about Medicare in Ohio. This guide has covered some of the most common questions we hear, but you may have more you want to know.

We’re here to help. If you’d like to ask more questions or compare Medicare plans, contact us to talk to a licensed agent today!