How do I enroll in a Medicare plan in Ohio?

The first question you should ask yourself is: what can you afford to pay per month for your Medicare insurance plan? Can you afford the higher monthly premium of a Medicare Supplement or Medigap Plan, which could be around $100-$300 a month depending on your age? Or do you prefer a low-to-zero monthly premium Medicare Advantage Plan – knowing you could be exposed to higher out-of-pocket costs when you need medical care?

While a Medicare Supplement Plan may be more expensive in terms of monthly premium, the costs are more predictable because enrollees know ahead of time how much they will spend for their care each month. Although seniors may enjoy the low-to-no monthly premium of a Medicare Advantage Plan, the out-of-pocket costs throughout the year could be unpredictable if they haven’t budgeted for those expenses.

Can I visit any doctor or hospital I want?

The next question you’ll need to ask yourself is: do you mind being confined inside a network for your medical care or getting permission to see a specific provider to get care? Many Medicare Advantage Plans, especially the little-to-no monthly premium plans, are Health Maintenance Organizations (HMOs) that require you to receive care from providers in the network – which may require referrals from your general physician first.

Some Medicare Advantage Plans may be Preferred Provider Organization (PPO) plans that allow you to see any physician or visit any hospital but offer lower rates if you stay in network. Medicare Supplement Plans, on the other hand, have no network or referral requirements. If your doctor or provider accepts Medicare, then they’re covered by your supplement. Medigap Plans can be helpful for seniors who either want to see the best hospitals and providers around the country, or who travel a lot.

Will my medications be covered?

You are required by law to maintain creditable drug coverage at all times or face a fine; the only question is which type of coverage you prefer. Seniors in Ohio have two choices when it comes to getting their prescriptions: they can either get them through their Medicare Advantage Plan, or if they have a Medicare Supplement, they get their medications through a separate Part D Prescription Plan.

For some seniors, the convenience of having a single affordable Advantage Plan for their prescriptions and medical care outweighs the other benefits of having a supplement. For others, the independence to go anywhere and see any provider as well as have consistent out-of-pocket costs at the expense of a higher monthly premium, outweigh the simplicity having an Advantage Plan – so for them, it’s worth opting into a separate prescription plan when they get a Medicare Supplement.

When can I enroll in a Medicare plan?

There are several enrollment periods that give seniors the opportunity to enroll in certain Medicare Plans. Here are the three most popular enrollment periods.

Initial Enrollment Period: This period starts three months before you turn 65 years old and ends three months after you turn 65. During this 7-month period, you can get any plan (Medicare Supplement or Medicare Advantage plan) you want without needing to prove your current health or your previous coverage.

Annual Enrollment Period: This period runs from October 15 through December 7 every year. During this period, you can enroll in any Medicare Advantage Plan or Part D Prescription Plan. Seniors who have a Supplement don’t have to wait until AEP to change plans – they just have to answer the health questions on the application.

Special Election Period: Are you coming off a group health plan or Medicaid, or do you qualify for assistance paying your premiums? You will be able to elect certain Medicare Supplement Plans without worrying about the health underwriting questions. Of course since there’s no health questions to answer, on a SEP you can select any Medicare Advantage plan if you prefer that to a supplement.

How healthy do I have to be to enroll?

You cannot join a Medicare Advantage Plan outside of the special enrollment periods listed above – but you can join a Medicare Supplement Plan anytime you want, as long as you can pass the health questions on the application.

Each Medicare Supplement company has its own approach to handling specific medical conditions or prescriptions. Some companies may decline an application for a certain condition or medication, whereas another company may accept it. This is where a knowledgeable insurance broker comes in handy, as he can help you shop multiple insurance companies to find the best coverage at the best price – at no additional cost to you!

What’s the process for enrolling in a Medicare plan?

The first step in our process of shopping for your Medicare Plan is figuring out your priorities, so we’ll start by asking you some questions, like: 

• Do you have any doctors you’d like to keep seeing? 
• Which medications are you currently taking? 
• Do you prefer a consistent monthly premium with little to no out-of-pocket costs, or are you looking for a plan with little to no monthly premium even though you may face higher out-of-pocket expenses? 
• Is it important to have access to any hospital network or doctor, or are you ok staying within a clearly defined network near where you live?

Once we understand your priorities, then we use state-of-the-art rating software that collects and combines all the plans, their coverage details and premium costs. Not every software stays up-to-date with every plan sold by every company, so here at our agency, we use multiple quoting tools to research and compile your options, so you can be sure you’re seeing the whole picture.

After we compare your plan options to find your best fit, then we submit an electronic application directly to the insurance company. If you’re applying for a Medigap plan, usually, we wait up to 2 weeks to find out if your application was accepted or declined – if you’re not in a special enrollment period. If you’re applying for a Medicare Advantage plan within the correct enrollment period, you’re application will be process seamlessly and your cards and member info will be sent out immediately after processing.

If your application is declined when applying for a Medicare Supplement plan, you will be refunded any initial premium that you sent in with your application. If your application was accepted, you will receive your new policy and ID cards in the mail within 7-10 business days. After you receive your new policy and ID cards, you can safely cancel your old plan and stop the billing. We’ll check in with you regularly to re-shop your options and keep your rates low.