Affordable Ohio Health Insurance Plans

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2019 Ohio Medicare Advantage plans are available through multiple companies. Coverage and rates vary, depending on the type of contract you choose, your age, and which part of the Buckeye State you live. Senior Medigap benefits help reduce your out-of-pocket expenses while providing many different types of benefits. Plans (referred to as C or MA plans) are offered through private carriers with emergency benefits included in and outside of the service area. HMO, PPO,PFFS, and SNP plans can be purchased.

Listed below are Advantage contracts offered to individuals that qualify for enrollment. Generally, Seniors that have reached age 65 and have signed up for Part B may be eligible for a policy. A six-month period begins the month you reach age 65, regardless of any medical conditions. A separate Open Enrollment period also begins on October 15th and ends on December 7th each year. Ohio Medigap plans and rates can also be viewed. Supplement plans are also reviewed through our website.

Most plans include prescription drug benefits. For plans that don't include Rx coverage, Part D contracts can be purchased stand-alone with their own formulary lists. Different tiers are provided, with the lowest tiers featuring the cheapest costs, often with copays of $5 and less. Several prescriptions not covered under Part D plans include weight-gain and weight-loss drugs, minerals and vitamins, barbiturates, and testing strips for blood glucose.

Prices, deductibles, copays, and availability can vary depending upon your county of residence. Often, vision, hearing, and dental benefits are included. Enhanced comprehensive dental coverage may also be offered for an extra cost.

 

AARP Medicare Complete Plan 8 - $0 per month premium and $225 deductible. Local HMO with $4,500 maximum out-of-pocket expenses. Inpatient hospital copay is $340 for the first 5 days. Outpatient hospital copay is $340. Pcp and specialist office visit copays are $10 and $45. Urgent Care and ER copays are $30-$40 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $3 (Tier 1 preferred generic), $12 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $0 (Tier 2 generic), $131 (Tier 3 preferred generic), $290 (Tier 4 non-preferred), and 28% (Tier 5 specialty). Optional dental benefits available for an additional $34 per month.

 

AARP Medicare Complete Plan 7 - $0 per month premium and $225 deductible. Local HMO with $4,500 maximum out-of-pocket expenses. Inpatient hospital copay is $340 for the first 5 days. Outpatient hospital copay is $340. Pcp and specialist office visit copays are $10 and $45. Urgent Care and ER copays are $30-$40 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $3 (Tier 1 preferred generic), $12 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $0 (Tier 2 generic), $131 (Tier 3 preferred generic), $290 (Tier 4 non-preferred), and 28% (Tier 5 specialty). Optional dental benefits available for an additional $34 per month. Plan Star rating is 4.0.

 

AARP Medicare Complete Plan 6 - $0 per month premium and $225 deductible. Local HMO with $6,000 maximum out-of-pocket expenses. Inpatient hospital copay is $375 for the first 4 days. Outpatient hospital copay is $375. Pcp and specialist office visit copays are $10 and $45. Urgent Care and ER copays are $30-$40 and $90. Lab services are subject to a $2 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $3 (Tier 1 preferred generic), $12 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $0 (Tier 2 generic), $131 (Tier 3 preferred generic), $290 (Tier 4 non-preferred), and 28% (Tier 5 specialty). Optional dental benefits available for an additional $34 per month.

 

AARP Medicare Complete Plan 5 - $0 per month premium and $225 deductible. Local HMO with $6,000 maximum out-of-pocket expenses. Inpatient hospital copay is $375 for the first 4 days. Outpatient hospital copay is $375. Pcp and specialist office visit copays are $10 and $45. Urgent Care and ER copays are $30-$40 and $90. Lab services are subject to a $2 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $3 (Tier 1 preferred generic), $12 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $0 (Tier 2 generic), $131 (Tier 3 preferred generic), $290 (Tier 4 non-preferred), and 28% (Tier 5 specialty). Optional dental benefits available for an additional $34 per month.

 

AARP Medicare Complete Plan 1 - $18 per month premium and $170 deductible. Local HMO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for the first 4 days. Outpatient hospital copay is $295. Pcp and specialist office visit copays are $5 and $25. Urgent Care and ER copays are $25-$40 and $90. Lab services are subject to a $5 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $8 (Tier 2 generic), $45 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 29% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $6 (Tier 1 preferred generic), $24(Tier 2 generic), $135 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and 29% (Tier 5 specialty). Preventative dental benefits (exams, cleanings, and x-rays) are included with a $0 copay.

 

AARP Medicare Complete Plan 3 - $114 per month premium and $0 deductible. Local HMO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $225 for the first 4 days. Outpatient hospital copay is $225. Pcp and specialist office visit copays are $5 and $30. Urgent Care and ER copays are $30-$40 and $90. Lab services are subject to a $5 copay, and outpatient x-rays are subject to a $14 copay. Outpatient individual and group mental health therapy visits are $40 and $30. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $8 (Tier 2 generic), $45 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $24 (Tier 2 generic), $135 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and 33% (Tier 5 specialty). Preventative dental benefits (exams, cleanings, and x-rays) are included with a $0 copay.

 

Advantra Silver - $0 per month premium and $95 deductible. Local HMO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $315 for the first 5 days. Outpatient hospital copay is $290. Pcp and specialist office visit copays are $0 and $25. Urgent Care and ER copays are $0-$65 and $90. Lab services are subject to a $0-$5 copay, and outpatient x-rays are subject to a $0-$10 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $5 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 31% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $136 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Preventative dental benefits (exams, cleanings, and x-rays) and many other services are included with a $0 copay. Plan Star rating is 3.5.

 

Aetna Medicare Value Plan - $0 per month premium and $95 deductible. Local PPO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $400 for the first 4 days. Outpatient hospital copay is $40-$265. Pcp and specialist office visit copays are $5 and $30. Urgent Care and ER copays are $5-$65 and $90. Lab services are subject to a $0-$10 copay, and outpatient x-rays are subject to a $10 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $5 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $136 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental benefits are available for an additional $10 per month. Comprehensive dental, plus eyewear and hearing aid benefits are available for an additional $19 per month. Plan Star rating is 3.5.

 

Aetna Medicare Choice Plan - $98 per month premium and $0 deductible. Local PPO with $4,100 maximum out-of-pocket expenses. Inpatient hospital copay is $220 for the first 6 days. Outpatient hospital copay is $30-$130. Pcp and specialist office visit copays are $10 and $30. Urgent Care and ER copays are $10-$30 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $20 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $5 (Tier 2 generic), $42 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $136 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental benefits provided with $0 copay.

 

Allwell Medicare - $0 per month premium and $125 deductible. Local PPO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for the first 5 days. Outpatient hospital copay is $325. Pcp and specialist office visit copays are $0 and $45. Urgent Care and ER copays are $45 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $45 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $9 (Tier 2 generic), $37 (Tier 3 preferred generic), $90 (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day mail-order prescription drug copays are $0 (Tier 1 preferred generic), $27 (Tier 2 generic), $111 (Tier 3 preferred generic), $270 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Comprehensive dental benefits provided with $0 copay.

 

Anthem MediBlue Essential - $0 per month premium and $60 deductible. Local HMO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $345 for the first 5 days. Outpatient hospital copay is $0-$295. Pcp and specialist office visit copays are $5 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-100 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 31% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $45 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Preventative dental benefits are available for an additional $14 per month. Comprehensive dental, plus eyewear benefits are available for an additional $26 per month. Plan Star rating is 3.5.

 

Anthem MediBlue Access - $68 per month premium and $50 deductible. Local PPO with $6,200 maximum out-of-pocket expenses. Inpatient hospital copay is $275 for the first 6 days. Outpatient hospital copay is $0 or 20%. Pcp and specialist office visit copays are $10 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-15 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 32% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $45 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Preventative dental benefits are available for an additional $20 per month.

 

Anthem MediBlue Access Basic - $70 per month premium and $200 deductible. Regional PPO with $6,000 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for the first 5 days. Outpatient hospital copay is $0 or 20%. Pcp and specialist office visit copays are $10 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $6 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), 41% (Tier 4 non-preferred), and 29% (Tier 5 specialty). 90-Day prescription drug copays are $18 (Tier 1 preferred generic), $45 (Tier 2 generic), $126 (Tier 3 preferred generic), 41% (Tier 4 non-preferred), and n/a (Tier 5 specialty). Preventative dental benefits are available for an additional $20 per month.   

 

Anthem MediBlue Access Plus - $87 per month premium and $40 deductible. Regional PPO with $4,300 maximum out-of-pocket expenses. Inpatient hospital copay is $250 for the first 6 days. Outpatient hospital copay is $0 or 20%. Pcp and specialist office visit copays are $5 and $30. Urgent Care and ER copays are $25 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 32% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $45 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Three dental options are available at a cost of $20, $28, and $42 per month. Plan Star rating is 3.5. 

 

Anthem MediBlue Access Preferred - $0 per month premium and $0 deductible. Regional HMO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for the first 6 days. Outpatient hospital copay is $0-$285. Pcp and specialist office visit copays are $5 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $10 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $30 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Three dental options are available at a cost of $14, $26, and $38 per month. Plan Star rating is 3.5. 

 

Anthem MediBlue Preferred - $0 per month premium and $0 deductible. Regional HMO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for the first 6 days. Outpatient hospital copay is $0-$285. Pcp and specialist office visit copays are $5 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $10 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $30 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Three dental options are available at a cost of $14, $26, and $38 per month. Plan Star rating is 3.5.  

 

Anthem MediBlue Extra - $32.90 per month premium and $415 deductible. Local HMO with $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $310 for the first 5 days. Outpatient hospital copay is $0-$300. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0-10 copay, and outpatient x-rays are subject to a $50-90 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $7 (Tier 2 generic), $47 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 25% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $21 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Three dental options are available at a cost of $14, $26, and $38 per month. Plan Star rating is 3.5.

 

Anthem MediBlue Acess Core - $15 per month premium. Local HMO with $5,400 maximum out-of-pocket expenses. Inpatient hospital copay is $255 for the first 5 days. Outpatient hospital copay is $0 or 20%. Pcp and specialist office visit copays are $10 and $30. Urgent Care and ER copays are $25 and $90. Lab services are subject to a $0-$15 copay, and outpatient x-rays are subject to a $50-110 copay. Outpatient individual and group mental health therapy visits are $40. Prescription coverage is not included.  Three dental options are available at a cost of $20, $28, and $42 per month. Plan Star rating is 3.0.   

 

Bright Advantage - $0 per month premium and $0 deductible. Local HMO with $4,250 maximum out-of-pocket expenses. Inpatient hospital copay is $285 for the first 5 days. Outpatient hospital copay is $285. Pcp and specialist office visit copays are $0 and $35. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $10 copay, and outpatient x-rays are subject to a $15 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $45 (Tier 2 generic), $126 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and 33% (Tier 5 specialty).  Comprehensive dental option is available at a cost of $15 per month.        

 

CareSource Advantage Zero Premium - $0 per month premium and $250 deductible. Local HMO with $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $350 for the first 5 days. Outpatient hospital coinsurance is $0-20%. Pcp and specialist office visit copays are $9 and $50. Urgent Care and ER copays are $45 and $90. Lab services are subject to a $30 copay, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $6 (Tier 1 preferred generic), $15 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day prescription drug copays are $18 (Tier 1 preferred generic), $45 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Some dental coverage included.

 

CareSource Advantage - $32 per month premium and $0 deductible. Local HMO with $4,600 maximum out-of-pocket expenses. Inpatient hospital copay is $285 for the first 7 days. Outpatient hospital coinsurance is $295. Pcp and specialist office visit copays are $0 and $49. Urgent Care and ER copays are $35 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $25 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $12 (Tier 1 preferred generic), $30 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Some dental coverage included. Plan Star rating is 2.5.

 

CareSource Advantage Plus  - $67 per month premium and $0 deductible. Local HMO with $3,900 maximum out-of-pocket expenses. Inpatient hospital copay is $225 for the first 7 days. Outpatient hospital coinsurance is $225. Pcp and specialist office visit copays are $0 and $30. Urgent Care and ER copays are $25 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $25 copay. Outpatient individual and group mental health therapy visits are $30. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $30 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Some dental coverage included.  

 

Compare Ohio Medicare Advantage plans. View rates and prescription benefits and enroll in a plan that best meets your needs.

 

Humana Gold Plus - $0 per month premium and $150 deductible. Local HMO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $395 for the first 4 days. Outpatient hospital copay is $250. Pcp and specialist office visit copays are $10 and $50. Urgent Care and ER copays are $10-$50 and $90. Lab services are subject to a $0-$35 copay, and outpatient x-rays are subject to a $10-$95 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $7 (Tier 1 preferred generic), $17 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day prescription drug copays are $21 (Tier 1 preferred generic), $51 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Two comprehensive dental options are offered at monthly rates of $28.50 and $33.10. Plan Star rating is 4.0.  

 

Humana Value Plus - $29.20 per month premium and $260 deductible. Local PPO with $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $1,860. Outpatient hospital coinsurance is 20%. Pcp and specialist office visit copays are 20%. Urgent Care and ER copays are 20% and $90. Lab services are subject to a $0 or 20% copay, and outpatient x-rays are subject to 20% coinsurance. Outpatient individual and group mental health therapy visits are subject to 20% coinsurance. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $15 (Tier 2 generic), $47 (Tier 3 preferred generic), $97 (Tier 4 non-preferred), and 28% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $45 (Tier 2 generic), $141 (Tier 3 preferred generic), $291 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Plan Star rating is 4.0.     

 

Humana Cleveland Clinic Preferred - $0 per month premium and $0 deductible. Local HMO with $3,200 maximum out-of-pocket expenses. Inpatient hospital copay is $350 for the first 5 days. Outpatient hospital copay is $250. Pcp and specialist office visit copays are $0 and $35. Urgent Care and ER copays are $0-$35 and $120. Lab services are subject to a $0-$25 copay, and outpatient x-rays are subject to a $0-$95 copay. Outpatient individual and group mental health therapy visits are $35. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $5 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $15 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Two comprehensive dental options are offered at monthly rates of $28.50 and $33.10.            

 

MediGold Southwest OH Essential Care - $0 per month premium and $250 deductible. Local HMO with $4,9500 maximum out-of-pocket expenses. Inpatient hospital copay is $285 for the first 7 days. Outpatient hospital copay is $50-$275. Pcp and specialist office visit copays are $10 and $50. Urgent Care and ER copays are $50 and $90. Lab services are subject to a $10 copay, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $18 (Tier 2 generic), $45 (Tier 3 preferred generic), $95 (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day prescription drug copays are $6 (Tier 1 preferred generic), $54 (Tier 2 generic), $135 (Tier 3 preferred generic), $285 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental coverage is offered for an additional $16 per month. Plan Star rating is 4.0.    

 

MedMutual Advantage Classic - $0 per month premium and $160 deductible. Local HMO with $4,300 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for the first 5 days. Outpatient hospital copay is $375. Pcp and specialist office visit copays are $5 and $45. Urgent Care and ER copays are $45 and $90. Lab services are subject to $0-$10 copays, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $38 (Tier 2 generic), $118 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental, plus eyewear benefits are available for an additional $25 per month. Plan Star rating is 3.5.

 

MedMutual Advantage Choice - $38 per month premium and $55 deductible. Local HMO with $3,950 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for the first 5 days. Outpatient hospital copay is $350. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $40 and $90. Lab services are subject to $0-$10 copays, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $42 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and 32% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $118 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental, plus eyewear benefits are available for an additional $25 per month.   

 

MedMutual Advantage Preferred - $74 per month premium and $55 deductible. Local HMO with $5,700 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for the first 5 days. Outpatient hospital copay is $375. Pcp and specialist office visit copays are $5 and $40. Urgent Care and ER copays are $40 and $90. Lab services are subject to $0-$10 copays, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $42 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and 32% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $118 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental, plus eyewear benefits are available for an additional $25 per month.      

 

MedMutual Advantage Select - $38 per month premium and $160 deductible. Local HMO with $6,500 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for the first 5 days. Outpatient hospital copay is $375. Pcp and specialist office visit copays are $10 and $45. Urgent Care and ER copays are $45 and $90. Lab services are subject to $0-$10 copays, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $15 (Tier 2 generic), $42 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $38 (Tier 2 generic), $118 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental, plus eyewear benefits are available for an additional $25 per month.        

 

MedMutual Advantage Premium - $119 per month premium and $55 deductible. Local HMO with $3,400 maximum out-of-pocket expenses. Inpatient hospital copay is $350 for the first 6 days. Outpatient hospital copay is $295. Pcp and specialist office visit copays are $0 and $30. Urgent Care and ER copays are $30 and $120. Lab services are subject to a $0-$10 copay, and outpatient x-rays are subject to a $50 copay. Outpatient individual and group mental health therapy visits are $30. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $42 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and 32% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $118 (Tier 3 preferred generic), 50% (Tier 4 non-preferred), and n/a (Tier 5 specialty).  Comprehensive dental benefits are included, subject to policy limitations. 

 

MeridianCare Enhanced - $0 per month premium and $0 deductible. Local HMO with $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $372 for the first 5 days. Outpatient hospital copay is $225. Pcp and specialist office visit copays are $5 and $50. Urgent Care and ER copays are $30 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $0 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $4 (Tier 1 preferred generic), $20 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $8 (Tier 1 preferred generic), $60 (Tier 2 generic), $141 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and 33% (Tier 5 specialty). Preventative dental benefits are included.   

 

MeridianCare Essential - $0 per month premium and $0 deductible. Local HMO with $4,400 maximum out-of-pocket expenses. Inpatient hospital copay is $275 for the first 6 days. Outpatient hospital copay is $150. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $0 and $90. Lab services are subject to a $0 copay, and outpatient x-rays are subject to a $0 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $20 (Tier 2 generic), $94 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and 33% (Tier 5 specialty). Preventative dental benefits are included. Plan Star rating is 3.0.

 

Paramount Elite - Standard Medical And Drug - $0 per month premium and $0 deductible. Local HMO with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for the first 5 days. Outpatient hospital copay is $340. Pcp and specialist office visit copays are $10 and $40. Urgent Care and ER copays are $45 and $90. Lab services are subject to a $0-$20 copay, and outpatient x-rays are subject to a $20 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $20 (Tier 2 generic), $45 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $60 (Tier 2 generic), $135 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Two dental options are offered at monthly rates of $18.10 (preventative) and $30 (comprehensive).

 

Paramount Elite - Enhanced Medical And Drug - $85 per month premium and $0 deductible. Local HMO with $3,400 maximum out-of-pocket expenses. Inpatient hospital copay is $200 for the first 5 days. Outpatient hospital copay is $200. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $45 and $100. Lab services are subject to a $0-$10 copay, and outpatient x-rays are subject to a $20 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $2 (Tier 1 preferred generic), $15 (Tier 2 generic), $45 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $6 (Tier 1 preferred generic), $45 (Tier 2 generic), $135 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). 

 

Compare Ohio Premier Health insurance plans in the Dayton area and SW Ohio.      

SummaCare Medicare Topaz - $0 per month premium and $150 deductible. Local HMO with $3,800 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for the first 5 days. Outpatient hospital copay is $300. Pcp and specialist office visit copays are $0 and $45. Urgent Care and ER copays are $45 and $90. Lab services are subject to a $0-$10 copay, and outpatient x-rays are subject to a $75-$130 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 30% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $117.50 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental coverage is offered for an additional $25 per month. Plan Star rating is 4.5.       

 

SummaCare Medicare Ruby - $43 per month premium and $0 deductible. Local HMO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $275 for the first 6 days. Outpatient hospital copay is $250. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $40 and $90. Lab services are subject to a $0-$8 copay, and outpatient x-rays are subject to a $0-$125 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $117.50 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental coverage is offered for an additional $25 per month. Plan Star rating is 4.5.           

 

SummaCare Medicare Sapphire - $76 per month premium and $0 deductible. Local HMO with $3,600 maximum out-of-pocket expenses. Inpatient hospital copay is $275 for the first 6 days. Outpatient hospital copay is $250. Pcp and specialist office visit copays are $0 and $40. Urgent Care and ER copays are $40 and $90. Lab services are subject to a $0-$8 copay, and outpatient x-rays are subject to a $0-$99 copay. Outpatient individual and group mental health therapy visits are $40. 30-Day prescription drug copays are $0 (Tier 1 preferred generic), $10 (Tier 2 generic), $47 (Tier 3 preferred generic), $100 (Tier 4 non-preferred), and 33% (Tier 5 specialty). 90-Day prescription drug copays are $0 (Tier 1 preferred generic), $25 (Tier 2 generic), $117.50 (Tier 3 preferred generic), $300 (Tier 4 non-preferred), and n/a (Tier 5 specialty). Comprehensive dental coverage is offered for an additional $25 per month.   

Several Medicare consumer publications are available for Ohio residents. The shppers guide explains how supplemental plans work with Parts A and B benefits. Although it is not a legal document, regulations, rulings, and legal guidance is provided. The publication includes sections on buying, patient rights, persons with a disability or ESRD, and definitions.