Requests for Consultations on Ohio Medicare Supplement – Ohio Medigap insurance, Ohio Medicare Advantage and Ohio Medicare Part D Prescription drug plans are answered the same day if received by 3:00 PM ET, or for faster service, call us toll free at 1-888-225-2323 or Local (614) 863-4770 between the hours of (9AM – 6PM ET. Mon – Fri.

This website and all the information contained herein is for general informational purposes only. Nothing contained herein is representative of any specific insurance company or policy. Requests made on this site are for the services of a licensed agent from Health Insurance for Ohio to assist in locating appropriate coverage only and are not for details on a specific insurance company or policy.

2009 Medicare Part A & Part B

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2009:

Medicare Premiums for 2009:

Part A: (Hospital Insurance) Premium

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.

The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

$96.40 per month*

Medicare Deductible and Coinsurance Amounts for 2009:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

A total of $1,068 for a hospital stay of 1-60 days.

$267 per day for days 61-90 of a hospital stay.

$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).

All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

$133.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)

Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2009 is available in the September 19, 2008 Fact Sheet titled, "CMS Announces Medicare Premiums, Deductibles for 2009" on the www.cms.gov website.

*Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $96.40 per month.  For additional details, see our FAQ titled: " Medicare Part B Monthly Premiums in 2009"

Most people will pay the standard monthly Part B premium of $96.40 in 2009. Some people will pay a higher premium based on their modified adjusted gross income.

Your monthly premium will be higher if you file an individual tax return and your annual income is more than $85,000, or if you are married (file a joint tax return) and your annual income is more than $170,000.

If you meet these criteria, Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago).  For example, the income reported on your 2007 tax return will be used to determine your monthly Part B premium in 2009. If your income has decreased since 2007, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria.

At the end of each year, Social Security will send you a letter if your Part B premium will increase based on the level of your income and to tell you what you can do if you disagree. For more information about Part B premiums based on income, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

The chart below shows the Part B monthly premium amounts based on income.
These amounts change each year. There may be a late-enrollment penalty.

You Pay	If Your Yearly Income is
	Single	Married Couple
$96.40	$85,000 or less	$170,000 or less
$134.90	$85,001-$107,000	$170,001-$214,000
$192.70	$107,001-$160,000	$214,001-$320,000
$250.50	$160,001-$213,000	$320,001-$426,000
$308.30	Above $213,000	Above $426,000

You Pay	If You Are Married but You File a Separate Tax Return From Your Spouse and Your Yearly Income is
$96.40	$85,000 or less
$250.50	$85,001-$128,000
$308.30	Above $128,000

 

Medigap (Supplemental Insurance)Policies

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.

Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.

You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits.

It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.

You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

For additional information on Medigap policies, including why you would want to buy a Medigap policy and information about what Medigap policies cover, please read our publication, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Standard Ohio Medicare Supplement Plans Chart

CORE BENEFITS

A

B

C

D

E

F

G

H*

I*

J*

K**

L***

Hospital coinsurance: Days 61 to 91

●

●

●

●

●

●

●

●

●

●

●

●

Hospital coinsurance: Days 91 to 150

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●

●

●

●

●

●

●

●

●

●

●

Hospital Payment in full: 365 additional days

●

●

●

●

●

●

●

●

●

●

●

●

Part A and Part B blood deductible: First three pints of blood

●

●

●

●

●

●

●

●

●

●

50%

75%

Part B 20% coinsurance: Physician and other services

●

●

●

●

●

●

●

●

●

●

50%

75%

 

ADDITIONAL BENEFITS

A

B

C

D

E

F

G

H*

I*

J*

K**

L***

SNF coinsurance: Days 21 to 100 - $119 per day in 2006

●

●

●

●

●

●

●

●

50%

75%

Part A Hospital Deductible: $952 in 2006

●

●

●

●

●

●

●

●

●

50%

75%

Part B Annual Deductible: $124 in 2006

●

●

●

Part B Excess Charges: Coverage for up to 115% percent of Medicare's approved charge (Medigap policy will either pay 80% or 100% of excess charge)

100%

80%

100%

100%

Foreign Travel Emergency: $250 deductible, 80% of the cost of emergency care during the first two months of the trip, $50,000 lifetime limit

●

●

●

●

●

●

●

●

At-Home Recovery: Maximum benefit of $1,600 annually

●

●

●

●

 
*Effective 1/1/06, plans H, I, and J can no longer be sold with prescription drug benefits.  Beneficiaries who purchased these plans before 1/1/06 are allowed to renew them and to retain the plans’ prescription drug benefits.

** Plan K covers 100% of cost sharing for Medicare Part B preventive services and 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year once an individual has reached the out-of-pocket limit on annual expenditures of $4,000 in 2006.

** Plan L covers 100% of cost sharing for Medicare Part B preventive services and 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year once an individual has reached the out-of-pocket limit on annual expenditures of $2,000 in 2006.

2008 MEDIGAP DEDUCTIBLE AMOUNT FOR HIGH DEDUCTIBLE POLICY OPTIONS

CMS released the 2008 deductible amount for Medigap high deductible plans F & J; effective January 1, 2008, the annual deductible amount for those two plans is $1,900. The high deductible amount for Medigap plans F and J is updated each year and is based on the August CPI-U figures released by the Bureau of Labor Statistics. The full text of the announcement is available on the CMS website at: http://www.cms.hhs.gov/Medigap/.  This figure represents the out-of-pocket expense, excluding premiums, that a beneficiary must incur before the policy begins paying any benefits.   Under the high deductible option, policies pay 100% of covered out-of-pocket expenses once the deductible has been satisfied in a year.  Note, the high deductible option for benefit packages F or J was added by Section 4032 of the Balanced Budget Act of 1997, Sec. 1882(p) of the Social Security Act, 42 U.S.C. 1395ss(p).

Medicare Supplement Guaranteed Issue Events Chart

Guaranteed issue right situation… Your Medicare Advantage Plan is leaving the Medicare Program, stops giving care in your area, or you move out of the plan’s service area.	You have the right to buy … Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company. For this right you must switch to the Original Medicare Plan.	When you apply for a Medigap policy… You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
You are in the Original Medicare Plan and have an employer group health plan or union coverage that pays after Medicare pays, and that coverage is ending. This includes retiree or COBRA coverage. Note: in this situation state laws may vary.	Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.If you have COBRA coverage you can either buy a Medigap policy or wait until the COBRA coverage ends.	You must apply 63 calendar days after the latest of these three dates. · date the coverage ends, · date on the notice that coverage is ending (if you get one), or · date on claim denial, if this is the only way you know that your coverage is ending.
You are in the Original Medicare Plan and have a Medicare SELECT policy. You move out of the Medicare SELECT plan’s service area.You can keep your Medigap policy or you may want to switch to another Medigap policy.	Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in your state or the state you are moving to.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
Trial Right: You joined a Medicare Advantage Plan or PACE when you are first eligible for Medicare Part A at age 65 and within the first year of joining, you decide you want to switch to the Original Medicare Plan.	ANY Medigap policy that is sold in your state by any insurance company.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends. Note: Your rights may last for an extra 12 months under certain situations.
Trial Right: You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan less than a year and want to switch back.	The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare Select policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage.If your former Medigap policy isn’t available, you can also buy a Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.	Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.	You must apply 63 calendar days from the date your coverage ends.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or misled you.	Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.	You must apply 63 calendar days from the date your coverage ends.

Frequently asked questions by Ohio Beneficiaries

Where can I find a comprehensive source of information on Medicare options in Ohio?

The Ohio Department of Insurance has published a consumer guide, Medicare Supplement Insurance, Medicare Options and Part D. Click here to read a copy.

What is the difference between Medicare and Medicaid?

Medicare is federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant. Medicaid is a medical assistance program for low-income people. It is jointly funded by the federal government and the states, and its benefits vary from state to state. Most health care costs are covered if you qualify for both Medicare and Medicaid.

What are my Medicare coverage options?

Medicare patients have two options in receiving their Medicare benefits: either through Original Medicare or a Medicare Advantage plan. Your out-of-pocket costs vary depending on your plan, coverage and the services you use.

Original Medicare contains what is called Part A (hospital) and Part B (medical) coverage. You can choose to purchase additional insurance such as Medicare supplement insurance (also known as MedSup or Medigap) and Part D prescription drug coverage. Medicare supplement insurance and prescription drug coverage each require a monthly premium in addition to your Part B premium.

Medicare Advantage plans are options approved by Medicare but run by private companies. They are part of the Medicare Program. With Medicare Advantage plans you generally get all your Medicare-covered health care through that plan. Coverage can include prescription drug coverage. You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs. You may have to use the plan's doctors and hospitals to get services. You don't need to buy a Medigap policy. These plans may require a monthly premium in addition to your Part B premium.

Am I eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Most people on Medicare pay a premium for Part A. However, you can get Part A at age 65 without having to pay premiums if:

You already get retirement benefits from Social Security or the Railroad Retirement Board.
You are eligible to get Social Security or Railroad benefits but you haven't yet filed for them.
You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if you have:

Received Social Security or Railroad Retirement Board disability benefits for 24 months.
End-Stage Renal Disease and meet certain requirements.

While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it.

How do I enroll in Medicare?

For some, enrollment is automatic. If you begin receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic. Everyone else must apply through the Social Security Administration.

Those turning age 65 have a total of seven months to enroll. Your Medicare enrollment period starts three months before the month of your 65th birthday. Your enrollment period ends three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage should start on the first day of your birth month.

If you don't enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B.

Where can I sign up for Medicaid?

Contact your county Department of Job and Family Services for the proper paperwork to apply for this program. You can visit www.jfs.ohio.gov/ohp for helpful information.

Who can help me understand Medicare?

The Ohio Senior Health Insurance Information Program (OSHIIP) is a program of the Ohio Department of Insurance. Since 1992, OSHIIP’s trained staff and network of more than 1,300 volunteers throughout the state have been educating consumers about Medicare and other senior insurance topics such as long-term care insurance. You can call the toll-free OSHIIP hotline at 1-800-686-1578 to talk with a trained representative. You can also read our consumer guide, Medicare Supplemental Insurance, Medicare Options and Part D. Click here to find an OSHIIP volunteer in your area.

Why do I need Medicare supplement insurance?

Original Medicare does not pay all medical expenses. A Medicare supplement policy, also known as MedSup or Medigap insurance, fills most of Medicare’s coverage gaps. You can choose from many standardized plans that cover various costs.

How do I determine the quality of a Medicare supplement policy?

By law, the Ohio Department of Insurance cannot rate policies. However, rating services such as A.M. Best Company, Fitch Investors’ Service, Standard & Poor, Moody’s Investor Service, or Consumer Reports Magazine provide financial and policy holder rating information. Consumers should also call 1-800-MEDICARE (1-800-633-4227) with questions and visit www.medicare.gov.

Are there Medicare Advantage plans in my county?

Each year, private companies offering Medicare Advantage plans must apply to the federal government and meet requirements in order to offer their plans in your area. Some companies choose not to re-apply. That's why it's important to review your options every fall.
Click here for a county-by-county listing.

Does Medicare cover diabetic supplies?

Medicare covers test strips, lancets, the machine used to test blood sugar levels and outpatient self-management education. It also covers replacement batteries and calibration solution for the machines that require it. Medicare also covers diabetic shoes. Check out Medicare’s publication on diabetic coverage.

Does Medicare cover care in a nursing home?

Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days and a certain amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing.

Does Medicare cover home health care?

Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent..

Will Medicare pay for outpatient prescriptions, hearing aids, dentures, eyeglasses, etc.?

Original Medicare (Part A and Part B) covers very little with regards to prescription medication. Medicare Part D, which was introduced in 2006, is Medicare’s prescription drug benefit. This benefit is available through stand-alone plans or through most Medicare Advantage plans.

Original Medicare also does not cover hearing aids, dental procedures or routine eye exams. Some Medicare Advantage plans will provide some coverage for these extra benefits.

Does Medicare pay for physical therapy?

Yes, Medicare Part B pays 80 percent of the approved amount for outpatient physical therapy up to a maximum. Medicare Part A may also cover physical therapy during inpatient stays.

Can my doctor insist that I pay up front for services before Medicare pays?

Yes, but only if your doctor doesn't accept assignment. If your doctor doesn't accept assignment, he or she cannot charge you more than the Medicare approved amount. If your doctor participates with Medicare, he or she can collect the deductible and copayment.

Who qualifies for Medicaid?

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. See above for enrollment and program information.

Where can I find a comprehensive source of information on Medicare options in Ohio? The Ohio Department of Insurance has published a consumer guide, Medicare Supplement Insurance, Medicare Options and Part D. Click here to read a copy. What is the difference between Medicare and Medicaid? Medicare is federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant. Medicaid is a medical assistance program for low-income people. It is jointly funded by the federal government and the states, and its benefits vary from state to state. Most health care costs are covered if you qualify for both Medicare and Medicaid. What are my Medicare coverage options? Medicare patients have two options in receiving their Medicare benefits: either through Original Medicare or a Medicare Advantage plan. Your out-of-pocket costs vary depending on your plan, coverage and the services you use. Original Medicare contains what is called Part A (hospital) and Part B (medical) coverage. You can choose to purchase additional insurance such as Medicare supplement insurance (also known as MedSup or Medigap) and Part D prescription drug coverage. Medicare supplement insurance and prescription drug coverage each require a monthly premium in addition to your Part B premium. Medicare Advantage plans are options approved by Medicare but run by private companies. They are part of the Medicare Program. With Medicare Advantage plans you generally get all your Medicare-covered health care through that plan. Coverage can include prescription drug coverage. You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs. You may have to use the plan's doctors and hospitals to get services. You don't need to buy a Medigap policy. These plans may require a monthly premium in addition to your Part B premium. Am I eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Most people on Medicare pay a premium for Part A. However, you can get Part A at age 65 without having to pay premiums if: You already get retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to get Social Security or Railroad benefits but you haven't yet filed for them. You or your spouse had Medicare-covered government employment. If you are under 65, you can get Part A without having to pay premiums if you have: Received Social Security or Railroad Retirement Board disability benefits for 24 months. End-Stage Renal Disease and meet certain requirements. While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it. How do I enroll in Medicare? For some, enrollment is automatic. If you begin receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic. Everyone else must apply through the Social Security Administration. Those turning age 65 have a total of seven months to enroll. Your Medicare enrollment period starts three months before the month of your 65th birthday. Your enrollment period ends three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage should start on the first day of your birth month. If you don't enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B. Where can I sign up for Medicaid? Contact your county Department of Job and Family Services for the proper paperwork to apply for this program. You can visit www.jfs.ohio.gov/ohp for helpful information. Who can help me understand Medicare? The Ohio Senior Health Insurance Information Program (OSHIIP) is a program of the Ohio Department of Insurance. Since 1992, OSHIIP’s trained staff and network of more than 1,300 volunteers throughout the state have been educating consumers about Medicare and other senior insurance topics such as long-term care insurance. You can call the toll-free OSHIIP hotline at 1-800-686-1578 to talk with a trained representative. You can also read our consumer guide, Medicare Supplemental Insurance, Medicare Options and Part D. Click here to find an OSHIIP volunteer in your area. Why do I need Medicare supplement insurance? Original Medicare does not pay all medical expenses. A Medicare supplement policy, also known as MedSup or Medigap insurance, fills most of Medicare’s coverage gaps. You can choose from many standardized plans that cover various costs. How do I determine the quality of a Medicare supplement policy? By law, the Ohio Department of Insurance cannot rate policies. However, rating services such as A.M. Best Company, Fitch Investors’ Service, Standard & Poor, Moody’s Investor Service, or Consumer Reports Magazine provide financial and policy holder rating information. Consumers should also call 1-800-MEDICARE (1-800-633-4227) with questions and visit www.medicare.gov. Are there Medicare Advantage plans in my county? Each year, private companies offering Medicare Advantage plans must apply to the federal government and meet requirements in order to offer their plans in your area. Some companies choose not to re-apply. That's why it's important to review your options every fall. Click here for a county-by-county listing. Does Medicare cover diabetic supplies? Medicare covers test strips, lancets, the machine used to test blood sugar levels and outpatient self-management education. It also covers replacement batteries and calibration solution for the machines that require it. Medicare also covers diabetic shoes. Check out Medicare’s publication on diabetic coverage. Does Medicare cover care in a nursing home? Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days and a certain amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing. Does Medicare cover home health care? Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent.. Will Medicare pay for outpatient prescriptions, hearing aids, dentures, eyeglasses, etc.? Original Medicare (Part A and Part B) covers very little with regards to prescription medication. Medicare Part D, which was introduced in 2006, is Medicare’s prescription drug benefit. This benefit is available through stand-alone plans or through most Medicare Advantage plans. Original Medicare also does not cover hearing aids, dental procedures or routine eye exams. Some Medicare Advantage plans will provide some coverage for these extra benefits. Does Medicare pay for physical therapy? Yes, Medicare Part B pays 80 percent of the approved amount for outpatient physical therapy up to a maximum. Medicare Part A may also cover physical therapy during inpatient stays. Can my doctor insist that I pay up front for services before Medicare pays? Yes, but only if your doctor doesn't accept assignment. If your doctor doesn't accept assignment, he or she cannot charge you more than the Medicare approved amount. If your doctor participates with Medicare, he or she can collect the deductible and copayment. Who qualifies for Medicaid? Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. See above for enrollment and program information. Do I need long-term care insurance? That’s a decision only you can make. You should consider your assets, life expectancy, current health, lifestyle, family health history and family support. Please call OSHIIP at 1-800-686-1578 if you have specific questions or read our consumer's guide to long-term care insurance.

Where can I find a comprehensive source of information on Medicare options in Ohio? The Ohio Department of Insurance has published a consumer guide, Medicare Supplement Insurance, Medicare Options and Part D. Click here to read a copy. What is the difference between Medicare and Medicaid? Medicare is federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant. Medicaid is a medical assistance program for low-income people. It is jointly funded by the federal government and the states, and its benefits vary from state to state. Most health care costs are covered if you qualify for both Medicare and Medicaid. What are my Medicare coverage options? Medicare patients have two options in receiving their Medicare benefits: either through Original Medicare or a Medicare Advantage plan. Your out-of-pocket costs vary depending on your plan, coverage and the services you use. Original Medicare contains what is called Part A (hospital) and Part B (medical) coverage. You can choose to purchase additional insurance such as Medicare supplement insurance (also known as MedSup or Medigap) and Part D prescription drug coverage. Medicare supplement insurance and prescription drug coverage each require a monthly premium in addition to your Part B premium. Medicare Advantage plans are options approved by Medicare but run by private companies. They are part of the Medicare Program. With Medicare Advantage plans you generally get all your Medicare-covered health care through that plan. Coverage can include prescription drug coverage. You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs. You may have to use the plan's doctors and hospitals to get services. You don't need to buy a Medigap policy. These plans may require a monthly premium in addition to your Part B premium. Am I eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Most people on Medicare pay a premium for Part A. However, you can get Part A at age 65 without having to pay premiums if: You already get retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to get Social Security or Railroad benefits but you haven't yet filed for them. You or your spouse had Medicare-covered government employment. If you are under 65, you can get Part A without having to pay premiums if you have: Received Social Security or Railroad Retirement Board disability benefits for 24 months. End-Stage Renal Disease and meet certain requirements. While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it. How do I enroll in Medicare? For some, enrollment is automatic. If you begin receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic. Everyone else must apply through the Social Security Administration. Those turning age 65 have a total of seven months to enroll. Your Medicare enrollment period starts three months before the month of your 65th birthday. Your enrollment period ends three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage should start on the first day of your birth month. If you don't enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B. Where can I sign up for Medicaid? Contact your county Department of Job and Family Services for the proper paperwork to apply for this program. You can visit www.jfs.ohio.gov/ohp for helpful information. Who can help me understand Medicare? The Ohio Senior Health Insurance Information Program (OSHIIP) is a program of the Ohio Department of Insurance. Since 1992, OSHIIP’s trained staff and network of more than 1,300 volunteers throughout the state have been educating consumers about Medicare and other senior insurance topics such as long-term care insurance. You can call the toll-free OSHIIP hotline at 1-800-686-1578 to talk with a trained representative. You can also read our consumer guide, Medicare Supplemental Insurance, Medicare Options and Part D. Click here to find an OSHIIP volunteer in your area. Why do I need Medicare supplement insurance? Original Medicare does not pay all medical expenses. A Medicare supplement policy, also known as MedSup or Medigap insurance, fills most of Medicare’s coverage gaps. You can choose from many standardized plans that cover various costs. How do I determine the quality of a Medicare supplement policy? By law, the Ohio Department of Insurance cannot rate policies. However, rating services such as A.M. Best Company, Fitch Investors’ Service, Standard & Poor, Moody’s Investor Service, or Consumer Reports Magazine provide financial and policy holder rating information. Consumers should also call 1-800-MEDICARE (1-800-633-4227) with questions and visit www.medicare.gov. Are there Medicare Advantage plans in my county? Each year, private companies offering Medicare Advantage plans must apply to the federal government and meet requirements in order to offer their plans in your area. Some companies choose not to re-apply. That's why it's important to review your options every fall. Click here for a county-by-county listing. Does Medicare cover diabetic supplies? Medicare covers test strips, lancets, the machine used to test blood sugar levels and outpatient self-management education. It also covers replacement batteries and calibration solution for the machines that require it. Medicare also covers diabetic shoes. Check out Medicare’s publication on diabetic coverage. Does Medicare cover care in a nursing home? Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days and a certain amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing. Does Medicare cover home health care? Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent.. Will Medicare pay for outpatient prescriptions, hearing aids, dentures, eyeglasses, etc.? Original Medicare (Part A and Part B) covers very little with regards to prescription medication. Medicare Part D, which was introduced in 2006, is Medicare’s prescription drug benefit. This benefit is available through stand-alone plans or through most Medicare Advantage plans. Original Medicare also does not cover hearing aids, dental procedures or routine eye exams. Some Medicare Advantage plans will provide some coverage for these extra benefits. Does Medicare pay for physical therapy? Yes, Medicare Part B pays 80 percent of the approved amount for outpatient physical therapy up to a maximum. Medicare Part A may also cover physical therapy during inpatient stays. Can my doctor insist that I pay up front for services before Medicare pays? Yes, but only if your doctor doesn't accept assignment. If your doctor doesn't accept assignment, he or she cannot charge you more than the Medicare approved amount. If your doctor participates with Medicare, he or she can collect the deductible and copayment. Who qualifies for Medicaid? Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. See above for enrollment and program information. Do I need long-term care insurance? That’s a decision only you can make. You should consider your assets, life expectancy, current health, lifestyle, family health history and family support. Please call OSHIIP at 1-800-686-1578 if you have specific questions or read our consumer's guide to long-term care insurance.