If you are approaching or have already reached age 65, you might have begun considering your eligibility for Medicare here in Ohio. Like any insurance program, Medicare comes with certain rules and eligibility requirements you need to understand before enrolling.
Here is what you need to know.
What is Medicare?
Medicare is the federal health insurance program that pays the health care expenses of older adults and others who qualify. Not to be confused with Medicaid, which provides health coverage for specific people with limited income and assets, Medicare is available to most citizens of the United States who have worked and paid their taxes for a certain amount of time. For most people, that means they become eligible for Medicare by the time they turn 65.
What are the Ohio Medicare eligibility requirements?
Medicare coverage in Ohio is typically available to citizens when they turn 65. Disabled people under age 65 and those who have chronic illnesses, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), may also qualify for benefits. If you receive benefits from the Social Security Administration or the Railroad Retirement Board, you’re probably eligible to enroll in Medicare in Ohio.
What are the components of Ohio Medicare?
Medicare programs consist of four parts: A, B, C, and D.
Here is what each part entails:
Medicare Part A
It provides coverage for hospital stays, a limited stay in a skilled nursing care facility, limited home health care services, and hospice care. Most Medicare beneficiaries don’t pay a monthly premium to receive this coverage. However, Part A usually will not pay the entire hospital bill, and you will be responsible for the balance. For more information on Part A, check out our blog post that goes into more detail.
Medicare Part B
It pays for specific non-hospital medical expenses. The costs covered by Part B include doctors’ office visits, X-rays, tests and screenings, and outpatient hospital expenses. Unlike Part A, you will pay a monthly premium for this component of Medicare. You will also be responsible for paying an annual deductible before Part B coverage begins each year. For more information on Part B, check out our blog post that goes into more depth.
Medicare Part C
Known as Medicare Advantage, generally includes every type of Medicare coverage in a single health plan. Private insurance companies offer it as an alternative to the original Medicare plan. Advantage plans must provide all the benefits of Parts A and B (except for hospice care), but they may also include additional services, such as dental, prescription, and eye care. For more information on Part C or Medicare Advantage, check out our blog post that goes into more detail.
Medicare Part D
It’s a prescription drug plan that you access through private insurance companies. Depending on the type of plan you choose, the monthly premiums and your share of the cost of various prescription drugs will vary. These costs could include a deductible, a fixed copayment amount, or a percentage of the full drug cost, known as coinsurance. For more information on Part D prescription drug plans, check out our blog post that goes into more depth.
When can I enroll in Ohio Medicare?
It’s essential to remember when you can sign up for Medicare or join a Medicare plan so that you avoid the late enrollment penalty. Be aware of these three enrollment periods:
Initial Enrollment Period
You are first eligible to sign up for Medicare three months before you turn 65. This Initial Enrollment Period (IEP) lasts for seven months: the three months before you reach 65, the month you turn 65, and the three months that follow. You may enroll in Medicare Parts A, B, C, and D during your Initial Enrollment Period.
Keep in mind that for coverage to begin during the month of your birthday, you must sign up at least one month before you turn 65. If you fail to enroll during that seven-month Initial Enrollment Period, you may be assessed a premium penalty when you enroll later.
General Enrollment Period
If you didn’t enroll for either Part A or Part B during the Initial Enrollment Period, you are still allowed to sign up during the General Enrollment Period (GEP), which starts on January 1st and ends March 31st each year. When you enroll during this period, your coverage begins on July 1st.
Annual Enrollment Periods
You’re not stuck forever with the plan you choose during the initial sign-up period. If your needs change, you may switch to a different plan during the Annual Enrollment Period (AEP), which runs from October 15th through December 7th every year.
During this open enrollment period, you can make changes to your Medicare plan that will become effective on January 1st the following year. These changes could include switching from Original Medicare to a Medicare Advantage plan or vice versa, or changing from one Advantage plan to another.
What are my rights under Ohio Medicare laws?
When you enroll in Medicare, you have specific rights and protections that include:
- Protection against unethical practices
- The right to information that is understandable
- Protection of your privacy
- The right to access the doctors and hospitals you need
This means that no matter how you get your Medicare coverage, you have the right to get clear and simple information about Medicare plans and benefits to help you make informed healthcare decisions. We’re here to help. If you have questions about your eligibility for Medicare in Ohio, give us a call and we’ll be happy to discuss your options.
How do I get started with a Medicare application in Ohio?
If you are already receiving Social Security benefits or retirement payments from the Railroad Retirement Board (RRB), you don’t need to do anything. The Social Security Administration will automatically enroll you in Medicare Parts A and B. They will send you information on the process about three months before your 65th birthday.
If you’re turning 65 within the next three months and are not already receiving benefits from Social Security or the RBB, you won’t be enrolled in Medicare automatically. You need to sign up with Social Security to enroll in Medicare Parts A and B.
To sign up, you will start your application on the Social Security website. If you can’t finish your application in one session, you can save it and complete it later. Other options are to visit your local Ohio Social Security office or call them at 1-800-772-1213 (TTY: 1-800-325-0778).
Approximately two weeks after you sign up, Medicare will send you a “Welcome to Medicare” packet along with your new Medicare card. Read the material in the packet carefully, since it will inform you of other actions you may need to take.
After you sign up for the Medicare program, then you’re free to enroll in any Medicare plan of your choosing up to 3 months before, the month during and three months after initially enrolling into Medicare. If you’ve already signed up for Parts A and B and want to know what your plan options are, above to get a quote.
