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Ohio Medicare Advantage Plans – Best 5 in 2022

The rates of people who have enrolled in Medicare Part A and Part B but have chosen to switch to one of the best Medicare Advantage plans in Ohio for 2022 has increased. In fact, almost 40,000 more beneficiaries chose an Ohio Medicare Advantage plan last year. If you need a way to manage the coinsurance, copays, and deductibles from Original Medicare without draining your savings account, you also might decide Medicare Advantage gives you the best option.

What is Medicare Advantage in Ohio?

Medicare Advantage in Ohio is layered coverage which includes the following:

– Medicare Part A
– Medicare Part B
– Medicare Part D

Part A and Part B make up Original Medicare, and Medicare Advantage is known as Part C. Part C is one plan that covers hospital insurance(Medicare Part A), medical insurance (Medicare Part B), and prescription drug coverage (Medicare Part D).

Medicare Advantage Plan in Ohio has topped Original Medicare and has become the more popular in coverage options. Insurance carriers provide Part C plans and benefits that are connected to a service area of certain hospitals, health care facilities, and specific network providers.

Medicare Advantage health insurance plans will also have additional benefits like vision, hearing, dental, gym memberships (SilverSneakers), meal delivery, medical appointment transportation, and over the counter prescription allowance.

Note: If you have End-stage Renal Disease or a disability, you will qualify for Medicare coverage in Ohio. You can be younger than 65 years old.

What is the Best Medicare Advantage plan in Ohio in 2022?

Best for network freedom: Medicare Advantage PPO

PPO Plans Benefits:

Larger network and noreferrals

– $0 to $100 per month for PPO premiums

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

HMO Benefits:

HMO Premiums are generally $0 cost monthly premium

– Lower out of pocket because it uses the HMO referral network

Best for low income or health conditions: Medicare Advantage D-SNP

If you should have low income or health conditions, then a Special needs plan (SNP) is best. It will help with the costs of the following:

  • Part B premium
  • Copays/Coinsurance
  • Deductibles
  • Monthly premiums

Note: You can have Medicare and Medicaid to help with costs.

What Medicare Advantage plans are available in Ohio?

Local HMO plans: 83

Local PPO plans: 32

Regional PPO plans: 6

What’s changing with Medicare Advantage in Ohio in 2022?

The Centers for Medicare and Medicaid Services has released contract changes that will take effect for 2022. These changes will affect the Part C Program, the Medicare Prescription Drug Benefit, and the Medicare Cost Plan Program.

Enhancements to the Part C and D Programs Beneficiary Real-Time Benefit Tool (RTBT)

The Real-time benefit tool will give enrollees access to real-time benefit information regarding cost-sharing and shopping for lower-cost alternative drug formulations or therapies for wellness. This helps when a doctor suggests a drug, the tool allows you to look up the copay and check similar, more cost-effective options.

Permitting a Second, “Preferred,” Specialty Tier in Medicare Part D

Part D plans will have more tools for negotiation with manufacturers to help lower out of pocket costs. In turn, this will exchange and place products on a preferred specialty tier.

Medicare Advantage (MA) and Part D Prescription Drug Program Quality Rating System

This rating system measures and codifies routine updates for star ratings. The system will provide technical clarification for the scores calculated for Medicare contracts.

Establishing Pharmacy Performance Measures Reporting Requirements

Medicare Part D plans will have to disclose pharmacy performance measures to CMS. CMS will then be able to understand better how measures are applied. A reporting of pharmacy performance measures publicly will also occur to gain more transparency.

Implementing Several Opioid Provisions of the SUPPORT Act

The SUPPORT act will implement several provisions. SUPPORT stands for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment. The act also has it set to expand drug management programs. This will give the ability for Part D to review opioid utilization statistics with providers.

Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements

Reductions in cost-sharing will now be an allowable supplemental benefit.

How much does Medicare Advantage cost in Ohio?

Most states have an HMO plan that offers a $0 per month premium as well as a PPO with $0 monthly premiums. However, it is becoming more standard to see PPOs with premiums.

Plan availability varies from county to county. In Ohio, the average Medicare plan with a prescription drug plan is $45 a month. The Part D drug deductible is about $114.

When can you enroll in a Ohio Medicare Advantage plan?

During specific times of the year, you can enroll in Medicare Advantage plans.

Initial Enrollment Period

Eligibility for Initial enrollment happens at 65.

At 65, you are eligible to join the health plans Medicare Part A and Part B.

Open Enrollment Period – AKA Annual Election Period

October 15th until December 7th is the period of time when you can join, drop, or make changes to an Ohio Medicare Advantage Plan. Coverage for Part C starts January 1st, provided that the plan is complete and turned in by December 7th.

Medicare Advantage Open Enrollment Period

You can switch plans or join Original Medicare or a Medicare Supplement plan from January 1st until March 31rst.

Special Enrollment Periods – Special Circumstances

When special circumstances in life arise, you may need to change your Medicare Advantage and Medicare prescription drug coverage plan. Events that would warrant changes would be an address change, your plan changes with Medicare, losing current coverage, or having the ability to have coverage with your employer (VA/Tricare/PACE).

Other special considerations may also include:

You being eligible for both Medicare and Medicaid
Eligibility for Extra Help
State Pharmaceutical Assistance Program enrollment
dropping of a Medigap plan
Special needs or a disability

5-star Special Enrollment Period

From December 8th until November 30th, the five star rating enrollment period can be used once. Plans are rated with satisfaction surveys which help compare plans based on their quality and performance. The five star rating is the highest rating to be given. To learn more about this rating, visit here.

Special Enrollment Periods if you get “Extra Help”

Special enrollment applies to you if you receive extra help, which is defined as qualifying for extra help, eligibility for Medicare or Medicaid, or enrollment into the State Pharmaceutical Assistance Program.

When can I make changes to my Medicare Advantage plan?

Medicare Advantage Open Enrollment Period:

You can switch plans or join Original Medicare or a Medicare Supplement plan from January 1rst until March 31rst.

Are Medicare Advantage plans in Ohio “bad”?

Like most insurance, there are times that a Medicare Advantage plan might not be the right fit for an individual.  However, they continue to grow in popularity, and many have found options that work great for their situation.  For Medicare Advantage, enrollment has increased in the past ten years. Ohio has a penetration rate of 43% as of 2021. It is noted that half of all Part C Medicare beneficiaries with a 5-day hospital stay incur higher costs than those in Original Medicare.

1. Number of lives enrollment in Medicare Advantage in New York: 1.1 million

2. Number enrolled by plan specifically the 3 plans below:

Local HMO: 470,645

Local PPO: 343,915

Regional PPO: 43,038

3. Percentage of Medicare beneficiaries enrolled in Medicare advantage in Ohio: 43%

4. Number of lives enrollment in Medicare Advantage nationwide: 24.1 million

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide: 39%

Common Questions on Medicare Advantage in Ohio

Are there disadvantages to Medicare Advantage?

1. Network limits.

Since Medicare Advantage plans are with insurance carriers, they are limited to networks that limit choices for doctors, facilities, and hospitals. HMO plans have limited provider lists and will require a referral from a primary care physician.

2. Costs are hard to predict.

An Ohio Medicare Advantage plan is popular because it has significantly lower premiums when compared to a Medicare Supplement plan; however, over time, you will still experience more out of pocket costs from copayments, coinsurance, etc. These costs add up every time you use the plan. Over time it could be hard financially.

3. More Involvement.

A Medicare beneficiary will have to stay on top of their plan info as they use it. Confirmation of network limits, coverage options, paying bills and copays, and knowing plan changes will be imperative.

4. Less Long Term stability.

An Ohio Medicare Advantage Plan will renew every year, and it will face changes in various things, including:

Drugs covered
Network limits

Basically, what will be in place this year may change the following year. Medigap plan benefits are standardized and do not change.

What are the four types of Medicare Advantage policies available in Ohio?

The four types of Medicare Part C plans are:

  • HMO – Health Maintenance Organization
  • PPO – Preferred Provider Organization
  • PFFS – Private Fee for Service
  • SNPs – Special Needs Plans

Which companies are the top three Medicare Advantage plan providers?

Blue Cross Blue Shield – 15%
Humana – 18%
United Healthcare – 26%

What are Medicare SNPs?

An SNP or Special Needs Plan is a type of Ohio Medicare Advantage Plan that is limited to those with a syndrome, disease, or specific characteristics. Plans are set up and based on healthcare providers, drug formulations, and benefit choices.

Do Medicare Advantage plans include prescription drug coverage?

Usually, Medicare Advantage plans include prescription drug plans (MAPD). These combo plans are built with prescription drug coverage built into them.

Do Medicare Advantage plans cover the SilverSneakers program in OH?

This popular benefit is often included with Medicare Advantage plans in Ohio. If fitness and gym membership benefits in Ohio are important to you, speak with your insurance agent to see if your Part C plan has the program. These extra benefits can vary from plan to plan, even if the same insurance company offers them.

Related Topics

Ohio State Links

Ohio Medicare Resources

Get more information about Original Medicare from these authority resources:

Ready to learn more?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In Ohio, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.