Review affordable Medigap health insurance plans in Ohio for Seniors receiving Medicare benefits. During Open Enrollment and other eligible periods, you can easily compare quality Supplement coverage from top-rated companies. You also may be able to reduce your out-of-pocket expenses by filling in the gaps that original benefits do not cover. We simplify the comparison, application, and enrollment process, so you can quickly obtain secondary needed coverage. Advantage and Part prescription drug plans are also available.
If you have reached age 65, and are a permanent and legal resident of the US, you are likely eligible for "Part A" hospitalization benefits. Railroad workers, however, enroll through the Railroad Retirement Board. If Social Security checks are already being sent, you will automatically be enrolled in Medicare. However, if you have been receiving SS disability benefits for two years, or have been diagnosed with End-Stage Renal Disease (ESRD), you do not have to wait until age 65.
You may also be eligible if you have not requested Railroad benefits, but qualify. Enrollment is automatic if you are receiving SS benefits before age 65, or you are receiving SS disability income. Other situations include prior employment with the government with Medicare benefits, or if you are receiving kidney dialysis, or have had a kidney transplant.
The Open Enrollment Period (OER) starts the first day of the month in which you reach age 65 and continues for an additional six months, providing a 7-month period. You also must be enrolled in Part B. During this period, you can not be denied or refused a policy because of medical conditions (past, present, or future). You also can not be surcharged or forced to wait for treatment because of a disclosed or undisclosed condition. The Ohio DOI helps regulate carriers and provide consumer information. Medigap options include Advantage and Supplement plans.
What They Cover
Ohio Medigap plans help pay deductibles, coinsurance, and copays that may not be covered by original Medicare. Coverage is provided by private companies, and 10 different types of policies are offered. If you are currently covered under an "Advantage" plan, have group benefits from you or your spouse's employer, or are enrolled in QMB (Qualified Medicare Beneficiary), you may not need an additional policy.
NOTE: Applicants have a 30-day "free look" period that allows the cancellation of the policy with a full refund. The period starts when the policy arrives. Advantage plans often include dental, vision, and hearing benefits, although copays and specific coverage will vary, depending upon the carrier. Different types of plan options include PPO, HMO, PFFS, MSA, HMOPOS, and SNPs.
Unless you are already enrolled in Parts A and B, you can not enroll in a Supplement or Advantage plan. The application process must be initiated by you, since it is not automated. Visiting or contacting your local Ohio SS office will begin the process. After seven months, if you have not applied, a penalty may be assessed. You will also have to wait until the next OE "General Period," which starts in January and ends in March.
Your Part B cost will also increase by 10% for each year that you don't enroll. However, if you or your wife are still working, and have group benefits offered by the employer, you may "opt out" of Part B without incurring a penalty. Once the plan terminates, you should immediately enroll in Part B.
How Are Rates Determined?
Your zip code or county of residence will often impact the price you pay. For example, rates in Toledo and Lucas County will likely differ than rates in Dayton and Montgomery County. Cincinnati and Hamilton County will have a different set of prices. The cost of medical care, treatment and volume of submitted claims, are generally the biggest variables that affect the premium you pay. There are also three types of Medigap pricing:
No-Age-Rated - Age is not a factor in determining the rate. Regardless if you are 65 or 85, prices are the same. A cost-effective option if you retain the plan long-term.However, you can change plans during Open Enrollment periods.
Attained-Age-Rated - The cost of coverage is based on your age at the time you apply. Premiums increase each year, as you get older. Purchasing a policy at age 65 is much less expensive than purchasing coverage at age 70 or 75.
Issue-Age-Rated - The cost of coverage is also based on your age at the time you apply. However, premiums remain fairly stable and don't necessarily increase as you get older.
Plan benefits are "standardized, so when you are comparing similar policies (Plan A or Plan B for example), the same coverage must be offered by each carrier. Of course, each year, that rate may change, while benefits remain the same. During the annual Open Enrollment, you can switch to a different company and/or plan, without answering medical questions.
Once covered for Parts And B, you can apply for Part D (prescription drug) benefits. Insurance companies offer private plans, although many Medicare Advantage plans also include Part D benefits. There may be a penalty if you miss the Part D enrollment deadline. However, if you have alternative benefits, the penalty may not apply. Also, the "donut hole" may require you to pay out-of-pocket expenses on some uncovered prescriptions.
NOTE: If you can not prove that you had "prior credible coverage," the carrier can impose a pre-existing condition clause that increases your rate or excludes benefits for your condition to be paid for a specific period of time. Also, MedSup plans do not offer benefits for vision and dental care, long-term health care, nursing home expenses, prescriptions, private-duty nurses or aids, eyeglasses, or hearing aids.Several of these benefits can be obtained by applying for private policies. Medical qualification may not be needed.
Ohio 2017 Medicare Supplement Plan Monthly Rates
Shown below are estimated current premiums for selected plans at age 65. A complete illustration of rates for all eligible plans from all registered and licensed companies can be provided when your personalized online quote is requested at the top of the page. Your zip code will be needed. Plans E,H,I, and J are no longer offered, although in-force plans can remain active.
$83 - AARP UnitedHealthcare
$89 - State Mutual
$94 - Anthem BC/BS
$94 - Medical Mutual
$94 - Omaha
$95 - State Farm
$102 - Paramount
$103 - United American
$109 - AultCare
$110 - Aetna
$110 - Thrivent
$111 - Summa
$114 - Equitable
$120 - USAA
$123 - Bankers Fidelity Life
$133 - Humana
$136 - Colonial Penn
$138 - Physicians Mutual
$104 - State Mutual
$120 - AARP UnitedHealthcare
$122 - Aetna
$123 - Thrivent
$123 - Globe
$124 - Manhattan Life
$140 - Humana
$161 - Colonial Penn
$171 - United American
$197 - Liberty National
$107 - Central States
$109 - Omaha
$124 - Manhattan Life
$129 - Thrivent
$130 - Physicians Mutual
$148 - Summa
$157 - Gerber Life
$181 - United American
Plan F (High Deductible)
$34 - Globe Life
$38 - Liberty National
$39 - Colonial Penn Life
$40 - Bankers Fidelity Life
$44 - Trivent
$49 - Medical Mutual
$52 - Humana
$69 - Pekin
$127 - USAA
$133 - Central States
$138 - Aetna
$138 - Anthem BC/BS
$139 - Medical Mutual
$149 - AultCare
$150 - AARP UnitedHealthcare
$161 - Equitable
$163 - Summa
$164 - Humana
$189 - Colonial Penn
$194 - Pekin
$201 - Everence
$204 - United American
$54 - AARP UnitedHealthcare
$61 - Colonial Penn Life
$70 - Bankers Fidelity Life
$75 - Humana
$79 - American Republic
$91 - United American
$89 - AARP UnitedHealthcare
$90 - Thrivent
$103 - Everence
$107 - Humana
$109 - American Republic
$114 - Colonial Penn
$128 - United American
$84 - Shenandoah Life
$91 - Central States
$92 - USAA
$96 - Colonial Penn
$97 - Medical Mutual
$99 - Humana
$99 - Aetna
$101 - Anthem BC/BS
$104 - AARP UnitedHealthcare
$119 - Physicians Mutual
$144 - United American
Guaranteed Insurability Regardless Of Open Enrollment Period
Specific situations are available which provide "guaranteed issue rights" at any time throughout the year. You do not have to medically qualify, answer health-related questions, or take a physical. This applies to yourself and all eligible family members. A 63-day period id provided to review, compare, choose, and enroll. Pre-existing conditions (if applicable) are covered and no surcharges or waiting periods can be applied. The following are common guaranteed insurability scenarios:
Benefits through your employer end. This can be through termination, layoff, or retirement.
PACE or Advantage plan is no longer part of the Medicare program, and is not available.
You are misled by your Medigap plan or specific regulations were not followed. Of course, documentation will be required.
Insurance company files for bankruptcy, or your benefits unexpectedly end for reasons beyond your control.
A MedSup plan is terminated by you and you enroll in an Advantage, Select or PACE program. But within the first 12 months, you want to change policies.
You move away from the contract's service area. The move can be to another state, or intra-state, assuming the provider network is different.
Part D Prescription Drug Benefits
You must be enrolled in Parts A or B to purchase Part D benefits. Also, if you don't enroll within a specific time period of becoming eligible, a penalty could be assessed. Although many Advantage plans include prescription drug benefits, Supplement plans do not, and therefore separate coverage must be obtained. However, you may choose to opt out of coverage while enrolling during your initial period.
The dreaded "donut hole" also must be addressed, since it will result in out-of-pocket costs that you will be responsible for. When you have accumulated $3,310 of prescriptions, you will begin to pay 45% coinsurance for brand-name drugs and earn a 42% discount for generic drugs. When a total of $7,062 has been reached, the "donut hole" closes. From that point forward, your out-of-pocket cost is 5% of prescription costs.
Although more costly, several Advantage and Part D contracts issued by insurers will cover most of the gap. However, paying a higher premium may not be cost-effective if your current usage is low enough to avoid the donut hole. You can also request that your primary-care physician and/or specialists recommend cheaper generic drugs, whenever available. Also, if samples or mail order options are available, these can also help reduce out-of-pocket costs.
If you currently have an HSA (Health Savings Account), once you are enrolled in Parts A or B, you are no longer permitted to contribute funds to your HSA. However, you do not lose access to your money, and past contributions may be used to pay for qualified expenses.
Options For Low-Income Households
Medicaid may be available, if you meet their income requirement guidelines. Generally, they will review your expected earned income (yourself and a spouse if applicable), along with your assets, and any guaranteed future income streams. Your Medicaid eligibility can quickly change, if your income substantially increases or decreases.
When Medicaid-eligible, there is no need for a supplemental plan (MedSup or Advantage) since your deductibles, copays, and many other expenses are covered. However, you can choose to decline Medicaid benefits, althoughit is typically unjustified.
The Ohio Public Employees Retirement System Of Ohio (OPERS) provides service for more than 1 million persons. If not covered through a local or alternative state program, you may be receiving retirement and other benefits through OPERS. Your healthcare coverage is also likely provided if you worked more than 20 years and retired under either of two pension options. Persons under age 65 receive benefits from Medical Mutual.
Retired persons eligible for Medicare can select "Connector" coverage that provides an Advantage plan, or a Supplement plan with Part D prescription drug coverage. However, Group Advantage and Part D plans are not offered.
SERS Retirement Benefits
SERS (School Employment Retirement System) is a public pension organization that provides service to nonteaching public school employees. Workers that have had at least 10 years of employment experience, are eligible for healthcare benefits. If you are Medicare-eligible, several Advantage contracts are offered, and your county of residence will determine the plan(s) you are eligible for. Three offered plans are Paramount Elite HMO, Aetna MedicareSM (PPO), and AultCare Prime Time HMO. All three plans include Part D (prescription drugs) benefits. The first two options offer a Silver Sneakers membership.
These plans have no deductible and the maximum out-of-pocket expenses are capped at $3,000. Retired persons are credited with $45.50 each month to help pay the cost of Medicare Part B. Persons not eligible for Medicare may also be able to secure a policy. However, if you have 20 years of employment credited, the cost of coverage is subsidized.
Options For Applicants Under Age 65
If you already have Medicare benefits because of a disability, and have not reached age 65 yet, although several plan options are available, most carriers do not offer coverage. Premiums are generally higher than the cost if you had reached age 65. It's also possible an Advantage plan may be offered in your County, or you may be eligible for Medicaid. However, when you reach age 65, a six-month period of enrollment will be provided, with coverage and application-approval guaranteed.
If you are not disabled and not eligible for Medicaid, you can apply for private plans offered on and off the Exchange. Federal subsidies are based on the size of your household and income of occupants. Many non-compliant options are also available, although benefits may be limited and your application for coverage can be denied. In 2018, several of President Trump's proposed changes will become effective, which could lower rates for many Buckeye State residents.
How Does End-Stage Renal Disease (ESRD) Impact Ohio Medigap Options?
Any underwritten plan will likely be denied, since medical insurability is required. However, for GI (Guarantee Issue) contracts, coverage should be approved, assuming you have reached age 65, have enrolled in Parts A and B, and you have lost secondary coverage. Up to 63 days is provided for you to determine which available plans you would like to purchase. Those plans are A, B, C, F, K, and L. If you wait until after the 63-day window, your application can be rejected.
You may also be able to receive Medicaid benefits, if you qualify. The Ohio Benefit Bank is an additional option that can view your situation, and possibly recommend several alternatives. Many expenses typically paid by a Medigap plan, are covered by Medicaid, including deductibles and copays. There also is a Medicaid information line (available upon request) that can assist you with eligibility issues. You can search for available Medigap plans in your area.