Medicare Eligibility in Ohio
For Medicare eligibility in Ohio, you must be a U.S. citizen or permanent U.S. resident. Medicare eligibility generally begins at age 65. However, people younger than 65 can access Medicare if they have qualifying disabilities, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD).
Medicare eligibility and enrollment will be automatic under these circumstances:
- At age 65, you are collecting Social Security benefits or Railroad Retirement Board benefits.
- You are under age 65 and have been receiving disability payments from either Social Security or the Railroad Retirement Board for 24 months.
- You are under age 65, have ALS, and have started receiving Social Security Disability Insurance (SSDI) payments.
People younger than 65 with ESRD are eligible for Medicare, but enrollment is not automatic. You can submit your application to the Social Security Administration.
How Do I Apply for Medicare in Ohio?
A few ways to sign up with the Social Security Administration;
- Sign up online for Medicare
- Over the phone, Call 1-800-772-1213.
- TTY users can call 1-800-325-0778.
- In person at a local Social Security Office.
When can I apply:
- Initial Enrollment Period: seven months from three months before your 65th birthday month until three months after that month
- Special Enrollment Period: delayed enrollment because of current group health insurance through employment
- General Enrollment Period: January 1 – March 31 (late enrollment penalty may apply)
How Do I Pick a Medicare Plan?
Original Medicare is comprised of two main parts:
Medicare Part A (hospital insurance)
Medicare Part B (medical Insurance)
With Original Medicare, you will have out-of-pocket health care expenses and no prescription drug coverage.
Medicare-approved private insurance companies in Ohio offer these options for additional healthcare coverage:
- Medicare Part D: Prescription Drug Plans
- Medicare Part C: Medicare Advantage Plans (may include Part D plan)
- Medigap: Medicare Supplement Insurance
KFF statistics show that 46% of Ohio Medicare beneficiaries enroll in Medicare Advantage and other health plans.
Medicare Advantage plans:
- One plan for Part A, Part B, and usually Part D
- Often extends extra benefits that Original Medicare does not cover, such as dental, vision, and hearing services
- Usually includes prescription drug coverage
- It may require the use of the plan’s provider network
Medigap Insurance (Medicare Supplement plan):
- Offers a suite of plans with varying benefits and premiums
- Covers 100% of Medicare Part A coinsurance and hospital expenses up to one year after Medicare benefits are exhausted
- Covers all or part of Part B coinsurance or copayments
- Covers Part A and Part B deductibles under some plans
- May cover blood purchases and foreign travel not covered by Medicare
- May cover Part B excess charges (not applicable in Ohio, where this practice is illegal)
The Medicaid program is available to low-income Medicare beneficiaries who meet Ohio state criteria. According to KFF, almost 3 million Ohio residents get Medicaid services.
Dually eligible refers to beneficiaries enrolled in both Medicare and Ohio Medicaid. If you are dually eligible, enroll in a Medicaid plan through MyCare Ohio, a managed care program for dually eligible beneficiaries.
Ready to Learn More?
Choosing a plan is not an easy decision. However, educating yourself about the differences between the two types of insurance coverage, comparing different Medicare Health plans and policies, and talking to a licensed insurance agent will help you make the right choice.
The following are resources for Medicare information:
- Get Started with Medicare
- KFF Medicaid’s Role in Ohio
- KFF State Health Facts
- Ohio Department of Insurance