Understanding Medicare in Northeast Ohio
Northeast Ohio’s population continues to age and decline. According to the 2020 census, all of the major cities in the region, including Cleveland, Youngstown, Akron, and Canton, all lost inhabitants. The number of Ohio residents over 65 will soon overtake the number of Ohio residents age 18 or under. And as Ohio’s population ages, more members of the baby boomer generation are retiring and enrolling in Medicare for their healthcare and prescription drug coverage.
Medicare is the federal program created in 1965 to citizens over the age of 65 in the United States have medical coverage and can enjoy health and wellness during their retirement years. Medicare also covers some people under 65 if they have a disability, such as ALS (Lou Gehrig’s Disease).
Medicare differs from Medicaid in that Medicaid is jointly funded by state and federal governments to provide healthcare to those with low incomes. Medicare is solely funded by the United States government.
Continue reading to find out about Ohio Medicare, whether it differs from federal Medicare, its different aspects, and how the Medicare enrollment process works.
Is Medicare in Ohio Different?
Medical coverage through Medicare is the same in all 50 states, including Ohio. Changes to Medicare at the federal level impact all of the United States equally. About 2 million Ohioans are covered under Medicare, and almost 55 million Americans in total are covered.
How to Enroll in Medicare
The initial enrollment period for Medicare is the 7 month period (beginning 3 months before the month of the enrollee’s 65th birthday, it also includes the month of the birthday, and the 3 months after the enrollee turns 65).
For those individuals who still have other medical coverage at age 65 (because they are still working or have spousal coverage), there is a special enrollment period. Those in this particular situation can sign up for Medicare after they turn 65 or during the 8 month period that begins the month after employment or medical coverage ends, whichever comes first.
What are the Parts of Medicare?
Medicare has undergone revisions over the years. Current Medicare options are now divided into four Parts: A, B, C, and D. Each one is concerned with different aspects of medical coverage and some parts are optional.
Medicare Part A
Medicare Part A is for inpatient hospital coverage, hospice care, or inpatient care in a non-medical healthcare facility, and is typically available to all Medicare beneficiaries. Generally, enrollees do not pay a monthly premium for Medicare Part A coverage.
Medicare Part B
Medicare Part B, on the other hand, usually requires individuals to pay a monthly premium. Part B covers medically necessary doctors’ services, durable medical equipment, and outpatient care. Enrollees can turn down Part B coverage when they first become eligible, but if the enrollee later decides to sign up for Part B later, coverage could be delayed.
Medicare Part C
Medicare Part C is another name for Medicare Advantage Plans. These are health plan options that have been approved by Medicare and by law must offer the same coverage that Medicare does. Medicare advantage plans are usually operated by managed care companies instead of insurance companies. They offer both Part A and Part B coverage, and some offer prescription drug plans, as well. Even if they have a pre-existing condition, Medicare enrollees are still able to join Medicare Advantage plans.
Many of these Part C plans also offer additional benefits such as gym memberships, as well as hearing, dental, and vision services. Enrollees may also be able to customize their Part C plan based upon their particular needs.
Medicare Part D
Finally, there is Medicare Part D. Part D is Medicare’s newest part and helps pay for prescription drugs. It’s optional, but immediate enrollment in Medicare Part D is recommended in order to avoid a late signup penalty. The enrollee must already be enrolled in Medicare Parts A and B to add Part D coverage, or get Part D through a Medicare Advantage Plan. All premiums, deductibles, and copays are the responsibility of the enrollee.
Extra Protection With Medigap
Medigap insurance, also known as Medicare Supplement Insurance, is an optional health insurance plan that can be purchased to cover costs not covered by Medicare. Private insurance providers (like UnitedHealthcare, SummaCare and Medical Mutual) offer these plans to cover the cost of medical services that aren’t covered by Medicare.
Medigap insurance usually doesn’t cover costs associated with nursing home care, vision or dental services, or hearing aids.
All Medigap policies are controlled by both state and federal laws that have been put in place to protect the buyer. Insurance companies that offer Medicare supplement plans must clearly identify them, and these plans must all offer the same basic benefits. Depending on the insurance provider, sometimes Medicare supplement plans may offer additional benefits to the buyer.
In order to purchase Medicare Supplement Insurance, the buyer must already be enrolled in Medicare parts A and B. They will pay a premium to the insurance company in addition to the premium for Medicare Part B. Some states offer a type of Medigap coverage called Medicare SELECT, which requires the buyer to choose hospitals and doctors that are within its provider network.
The optimal time to buy a Medigap policy is during the Medigap Open Enrollment Period, which is a 6-month window that begins on the first day of the month that the buyer is 65 years of age AND enrolled in Medicare Part B. If a Medigap policy isn’t selected during this time, it may cost more in the future.
Medicare Protects Northeast Ohio’s 64+ Year Old Citizens
Medicare has been safeguarding the health of elderly individuals for over 50 years. Not only across Ohio, but the entire United States. Navigating through all of the fine details of Medicare can be a challenge, but trusted insurance agents like Reliable Consulting Group can help get through this confusing time. Contact us today and let us make your business better!
