Understanding Ohio Medicare: A Comprehensive Guide for New Enrollees

For many Ohio Medicare beneficiaries, where they live may significantly impact their care. This is especially true for those who receive both Medicare and Medicaid through MyCare Ohio, a program designed to offer one point of contact, person-centered services, and a seamless, integrated experience.

Many Ohio Medicare recipients also qualify for help paying their premiums through the state’s Medicare Savings Program. This federally funded program pays the cost-sharing portion of Part B and, in some cases, the Medicare Part A premium.

Ohio’s 12 local Agencies on Aging offer free Medicare counseling. Trained counselors can answer questions about the benefits of different Medicare plans, policy options and how to reduce costs. They can also provide referrals to home health and long-term care providers.

If you’re considering retiring soon, reviewing your options carefully is important. You’ll want to determine whether it makes financial sense to stay with the original Medicare plan or if you should consider a Medicare Advantage plan instead. In addition, it’s important to consider your options for supplemental coverage, including prescription drug add-ons and supplementary policies.

Overview of Ohio’s Medicare System

Medicare Basics:

• Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care.
• Medicare Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Medicare Part C (Medicare Advantage Plans): A type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits.
• Medicare Part D (prescription drug coverage): Adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Ohio residents are eligible for Medicare if they are 65 years or older, certain younger people with disabilities, or people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare provides open enrollment periods annually for current beneficiaries to change or review their plans.

Ohio Medicare Application

There are many ways to apply for Ohio Medicare, including online, in person, by mail, or over the phone. You can also apply through a local agency on aging, like the one in your county. They offer free Medicare counseling and can help you find other services in your area.

Your application must be signed and dated by you or your representative. You must also provide proof of your income, resources (cash, checking, savings, and other assets), pregnancy, if applicable, and any other insurance you may have. You can submit these documents as supporting documentation or upload them into PECOS.

After you’ve submitted your application, you will receive a confirmation page. This will let you know which MAC is processing your application and give you a unique submission tracking number. You will also be able to see real-time information about the status of your application in PECOS. If you’re not sure if you qualify for Medicare, call the Social Security Administration or visit their website to learn more. The Ohio Department of Aging’s Medicare Counseling Hotline connects you to the right local agency for aging in your county.

How to Enroll in Ohio Medicare?

There are several ways to enroll in Ohio Medicare. One way is to sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. If a person signs up during this time, their coverage will start the month after they sign up. Another way to enroll is through a Special Enrollment Period related to Coverage Under Group Health Plans. This SEP allows people who didn’t sign up for Part B when they were first eligible to do so.

Some people also qualify for a Medicare Advantage Plan, which private companies offer and covers more services than original Medicare. These plans typically include drug coverage and extra benefits like vision and dental care. They may have a monthly premium, but their out-of-pocket costs are usually lower than those of original Medicare.

Seniors can get help finding and comparing Medicare plan options through the State Insurance Information Program, Pro Seniors or local Agencies on Aging. Each has trained counselors who can answer questions about Medicare’s benefits, policy options and how to reduce out-of-pocket costs.

MyCare Ohio

MyCare Ohio is a managed care program designed to streamline the delivery of healthcare services for Ohio residents who are eligible for both Medicare and Medicaid. The program integrates the benefits of both systems to simplify access and coordination of services for beneficiaries.

MyCare Ohio provides a coordinated care experience for individuals receiving Medicare and Medicaid benefits, helping manage all aspects of a person’s care. The program is specifically aimed at individuals who are dually eligible for Medicare and Medicaid, providing comprehensive health services including physical health, behavioral health, and long-term care needs. Enrollees can choose from several managed care plans that contract with the state, each offering different networks of doctors, hospitals, and other healthcare providers.

Ohio Senior Health Insurance Information Program (OSHIIP)

What is OSHIIP?

• OSHIIP is a service the Ohio Department of Insurance provides to help Ohio residents better understand their Medicare options. It offers free advice and information tailored to seniors and other Medicare beneficiaries.

OSHIIP provides information on Medicare health coverage for seniors, including Medicare supplements, advantage plans, and prescription drug plans. The program hosts seminars and webinars to educate the public about Medicare choices, changes, and rights. It offers one-on-one counseling to help individuals make informed decisions about insurance. This can include assistance with enrollment, understanding benefits, and resolving conflicts with Medicare services or billing.