Medicare Advantage in Ohio
Medicare Advantage in another way to access your Medicare benefits. Medicare HMO’s first started in the 1970’s, and in 1997, it became Medicare + Choice and in 2003 it was named Medicare Advantage or Part C. In 2017, almost 19 million Medicare beneficiaries are currently enrolled in Part C plans. They have grown in popularity over the years because of the maximum out of pocket protection, the extra benefits and the convenience to name a few things. There are a few Medicare Advantage plan types available, HMO, PPO, PFFS and SNP plans. Each plan type is designed to offer choices on cost, networks and extra benefits. More than likely in Pennsylvania, you will find MA plan for every budget.
By the numbers for 2017*:
- Total number of Medicare beneficiaries in the US: 55,504,005
- Total number of Medicare beneficiaries in Ohio: 2,154,337
Medicare Advantage (Part C) statistics:
- Total number of Medicare beneficiaries enrolled in Medicare Advantage in the US: 18,478,199
- Total number of Medicare beneficiaries enrolled in Medicare Advantage in Ohio :786,115
- Total Number of Medicare Advantage Plans in US: 2317 total
- Total Number of Medicare Advantage Plans in Ohio: 111 total
Part D (stand-alone prescription drug plan) statistics:
- Total number of Medicare beneficiaries enrolled in a stand-alone PDP in the US: 25,078,872
- Total number of Medicare beneficiaries enrolled in a stand-alone PDP in Ohio: 1,034,978
- Total Number of stand-alone PDP Plans in Ohio: 23 plans
- Average Premium for stand-alone PDP in US: $53.14/per month
- Average Premium for stand-alone PDP in Ohio: $52.00/per month
How do Medicare Advantage Plans in Ohio work?
Medicare Advantage plans at least must cover all the benefits that Medicare Part A and Part B cover plus extras. The Medicare Advantage plan is in place of your Original Medicare benefits, you still have Original Medicare, however your Medicare Advantage plan administers your benefits. Medicare Advantage plans combine your medical, hospital and typically your prescription coverage all in one plan. In addition, MA plans usually offer routine vision, hearing, and dental benefits. Medicare Advantage plans offer many great benefits but there are a couple factors to look for.
Two of the most important questions to consider when shopping for a Medicare Advantage plan in Pennsylvania are:
- Is my doctor/hospital In Network? Do a lot of doctors take Medicare Advantage?
Most Medicare Advantage plans typically have a network of providers that provide your health care services. There are different types of plans, some have in and out of network benefits, and some do not have networks at all.
Since Ohio has such a large population of Medicare beneficiaries, many healthcare providers accept Medicare Advantage plans.
HMO’s have a network and require that you have a primary care physician that acts like your quarterback., you will need a referral to see a specialist. HMO’s will cover emergency services outside of their network in the event of an emergency.
PPO’s also have a network for medical services and offer out of network benefits for an increased cost. In Network services will have less out of pocket costs. However, the flexibility to see providers in and out of network make PPO Medicare Advantage plans popular.
PFFS plans do not have provider networks. PFFS plans are typically found in rural areas in Ohio. Each time you see a provider when enrolled into a PFFS plan, the provider needs to agree to the plan’s terms of service and to accept payment. Providers have the option to decide on case by case basis if they will accept a PFFS plan.
Special Needs Plans (SNP’s) are Medicare Advantage Plans for people that have chronic conditions, reside in an institution or have both Medicare and Medicaid. Most always, SNP’s have networks and require you to designate a primary care physician to manage your healthcare.
Coverance Insurance Solutions have access to the top Medicare Advantage carriers in Ohio. Our licensed agents can research to see which Medicare Advantage plan your physician accepts.
- If my medication covered? Medicare Advantage Prescription coverage
Most Medicare Advantage plans have Part D included for ease and convenience. If you MA plan doesn’t have Part D, depending on the plan type, you may or may not be able to add a stand-alone Part D plan. Let’s examine further.
- If you purchase HMO Medicare Advantage plan without Part D you will not be able to purchase a stand-alone Part D plan, as per Medicare rules.
- If you purchase an PPO without Part D, as per CMS rules you will not be able to purchase a stand-alone Part D plan.
- For a PFFS plan without Part D, you can purchase a stand-alone Part D plan, as per CMS rules.
Medicare Advantage Prescription Drugs plans follow the same parameters for Part D plans:
- Deductible – the MAPD plan you choose may or may not have a prescription deductible.
- Coverage limit – the amount of coverage for medications. This amount includes what you pay as a copay or coinsurance + what the plan pays for each medication. Every time you fill a prescription the total cost of the medication (your copay/coinsurance + what the plan pays) gets deducted from the coverage limit. Once the balance is zero, you enter the…
- Coverage Gap or donut hole where you pay the total cost of each medication
- Catastrophic coverage – once your total out of pocket costs (TrOOP – all copays, coinsurance amounts) reaches a certain amount you enter the Catastrophic coverage portion where you have small copays or coinsurance on your medications for the remainder of the calendar year.
Most all Part D and MAPD plans have these same prescription benefit design. They can vary on premium, deductible, formulary and coverage during in the Coverage Gap. It pays to shop around.
Once we have found the plan that meets your needs there is one last thing.
Enrolling into a California Medicare Advantage Plan
To be eligible to enroll, you need to have Medicare Part A & B, continue to pay your Part B premium, live in the service area and not have ESRD (end stage renal disease). Most Medicare Advantage Plans have enrollment periods.
Initial Enrollment Period – the 7 month window around your 65th birthday. You can enroll a in MA or MAPD 3 months before you turn 65, the month of your birthday, and 3 months after. If you are under 65 and disabled, this 7-month window opens around your 25th month collecting Social Security Disability benefits.
Special Enrollment Period -Certain circumstances can open a special enrollment period, such as moving outside the plan’s service area, being Dual Eligible for Medicare and Medicaid, receiving prescription assistance from the federal government, and several others. You may have a SEP and not realize it. Our trained agents can assist to see if you qualify for an SEP.
Annual Election Period – AEP runs every year from October 15th – December 7th. This is time to add, drop or change your Medicare Advantage plan for the next year. Every October 1st Medicare Advantage Plans release the next year plan benefits. It pays to compare your current plan with the new plans to make sure you are maximizing your Medicare benefits.
Open Enrollment Period (OEP) – OEP, starting in 2019, will run from January 1st – March 31st. It gives you one chance to make a like to like plan switch.
Medicare Advantage plans offer many extras that aren’t covered under Original Medicare.
Here are a few benefits that might be covered by your Medicare Advantage Plan:
- Routine Vision and eyeglasses
- Routing Hearing services
- Fitness memberships
- Transportation services
- Routine Dental services
- Over the counter product credit
- Portion of your Part B premium
There are many perks to enrolling into a Medicare Advantage Plan. Finding a Medicare Advantage plan in Ohio that your physician accepts and covers your medications is no small feat, it takes time, patience and technology, and at Coverance Insurance Solutions, we have all three.