Medicare Advantage Plans in Ohio

Written by:

Vanessa Jerusalimiec

Reviewed by:

Kai Martinez

Key Takeaways

Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans in Ohio offer coverage to residents over 65.
Younger adults can also enroll in Medicare in OH under special circumstances.
Ohio Medicare Advantage plans provide you with coverage through PPO or HMO networks.
Some Medicare Advantage plans have premiums starting as low as $0, and each plan sets its copayment and coinsurance rates.
The ideal time to enroll in a Medicare Advantage plan is in the months just before your 65th birthday.

For the more than 2.4 million Ohioans who are enrolled in Medicare, Medicare Advantage offers a range of benefits, costs, and provider networks. There are 224 Medicare Advantage plans available in the state, but they vary by ZIP code. By exploring these options, you can find health coverage that’s right for your needs and financial situation.

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Ohio Medicare Advantage Plan Coverage

Medicare Advantage plans, also called Medicare Part C, offer comprehensive healthcare coverage. These are standalone plans offered by private insurance companies. Medicare Advantage plans are a substitute for Original Medicare, the federal Medicare plan.

Every Medicare Advantage plan must provide at least the same coverage as Original Medicare Part A and Part B. This covers hospital and medical bills. But Medicare Advantage plan providers may offer additional benefits, such as dental, vision, hearing, and prescription drug coverage.

OH Medicare Advantage Plan Costs

The costs of Medicare Advantage plans vary because they are offered by private insurance companies that can set their rates. In Ohio, the average monthly premium was $16.63 in 2024. There are plans with $0 per month premiums available throughout the state.

Medicare Advantage plans place caps on out-of-pocket spending, and they often have lower copayment and coinsurance rates than Original Medicare.

Types of Medicare Advantage Plans

Medicare isn’t a one-size-fits-all solution. If you’ve decided to enroll in a Medicare Advantage plan, you have a few options to choose from.

Health Maintenance Organization Plans (HMO) give you excellent healthcare coverage. These plans usually have low monthly premiums. If you enroll in an HMO plan, you’ll work with a primary physician to monitor your health. This means you’ll have someone who knows your healthcare needs. But if you want to see a specialist, you’ll need a referral from your doctor. You may have less flexibility in choosing your specialist, and the provider network may be smaller.
Preferred Provider Organization Plans (PPO) give you access to a more extensive network of care providers. You won’t need to choose a primary physician, and you don’t need to get a referral to see a specialist. You’ll get more flexibility, but this often comes with higher monthly premiums.
Private Fee-for-Service plans (PFFS) provide the most flexibility. These plans don’t have a network of providers. Instead, you can visit any provider in your area and take charge of your health. Before you make an appointment, you’ll need to make sure the provider will accept your insurance plan. The downside of this plan is that it can get pricey. Both premiums and out-of-pocket costs tend to be higher.
Special Needs Plans (SNP) design their coverage around the needs of adults with certain health conditions or financial challenges. Adults with end-stage renal disease (ESRD) or ALS can get specialized coverage from an SNP plan. Benefits, provider coverage, and drug coverage are tailored to match these specific healthcare needs.

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Medicare Advantage Plan Eligibility and Enrollment in Ohio

U.S. citizen or permanent residents over 65 are eligible for Medicare.

Adults under 65 can also qualify for Medicare coverage if they receive Social Security Disability Benefits. This includes adults with a qualifying condition such as ESRD.

When to Enroll in Medicare

The best time to enroll in Medicare Ohio is right around your 65th birthday. When you turn 65, you will have a seven-month Initial Enrollment Period (IEP). This starts three months before the month you turn 65, and ends three months after the month of your birthday. You’ll have lots of time to enroll in Medicare and then find the perfect Medicare Advantage plan.

As an Ohio resident, you can also enroll in a Medicare Advantage plan during the Open Enrollment Period. Also called the Annual Enrollment Period, this enrollment period starts on October 15 and ends on December 7. If you enroll in a Medicare Advantage plan during this period, your coverage kicks in on January 1.

How to Enroll in Medicare

Most people are not automatically enrolled in Medicare. But the enrollment process is easy.

You can apply for Medicare online by creating a Social Security account.
You can enroll over the phone by calling your local Social Security office or the SSA national toll-free number: 1-800-772-1213.
You can apply in person by visiting your local Social Security office.

Enrolling in a Medicare Advantage Plan in Ohio

After you have your Medicare number, the rest is easy. Just call a licensed insurance agent at GoHealth, and find out what plans are available in your area. We’re committed to helping you find the right plan.

Decide on your coverage priorities and compare the benefits, premiums and network options of each plan. You can also check the star rating of the plans to see what other Ohio residents think about the cost and coverage.

Once you pick a plan, a licensed insurance agent will walk you through the enrollment process.

Are There Ohio Medicare Advantage Plans With Prescription Drug Coverage?

Most Medicare Advantage plans include Part D prescription drug coverage.

Each Part D plan has a list of covered medications called the plan formulary. Before you enroll in a Medicare Advantage plan with prescription coverage, take a close look at the formulary. If your meds aren’t covered, keep looking until you find a plan that gives you the coverage you need.

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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