Affordable Ohio Health Insurance Plans

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Last Updated on by Ed Harris

Review affordable Medigap health insurance plans in Ohio for Seniors receiving Medicare benefits. During Open Enrollment and other eligible periods, you can easily compare quality Supplement coverage from top-rated companies. You also may be able to reduce your out-of-pocket expenses by filling in the gaps that original benefits do not cover. We simplify the comparison, application, and enrollment process, so you can quickly obtain secondary needed coverage for standardized A-N policies. Advantage and Part D prescription drug plans are also available.

There are no maximum out-of-pocket expenses, unless you have a Supplement plan. Any physician, specialist, or facility, that accepts Medicare, can be used. If you travel internationally, an additional policy may have to be purchased. The SHIP program can provide free counseling for many coverage-related decisions. The BFCC-QIO (Benefits Coordination And Recovery Center) should be notified if you are not satisfied with specific covered services. In the Buckeye State, Plans N and G are more similar than other states, since providers do not bill Part B excess charges. Cost of coverage is only difference between policies with the same letter offered by different companies.

Note: Medicare Part B premiums increased to $185 for 2025, a 5.9% increase. The annual deductible also increased from $240, and the Part A inpatient deductible (hospital admission) also increased from $1,632. Most Medicare recipients are not required to pay a Part A premium. 2025 Plan D enrollees now have a $2,000 maximum out-of-pocket cost for medications. Also, payment plan billing options are now offered for medications instead of an upfront payment requirement.

 

Eligibility

If you have reached age 65, and are a permanent and legal resident of the US, you are likely eligible for “Part A” hospitalization benefits. Railroad workers, however, enroll through the Railroad Retirement Board. If Social Security checks are already being sent, you will automatically be enrolled in Medicare. However, if you have been receiving SS disability benefits for two years, or have been diagnosed with End-Stage Renal Disease (ESRD), you do not have to wait until age 65.

You may also be eligible if you have not requested Railroad benefits, but qualify. Enrollment is automatic if you are receiving SS benefits before age 65, or you are receiving SS disability income. Other situations include prior employment with the government with Medicare benefits, or if you are receiving kidney dialysis, or have had a kidney transplant. Applicants that have ALS, automatically qualify for Parts A and B when SS benefits commence. Companies are not required to offer plan options to applicants under age 65 that qualify because of a disability.

The Open Enrollment Period (OER) starts the first day of the month in which you reach age 65 and continues for an additional six months, providing a 7-month period. You also must be enrolled in Part B. During this period, you can not be denied or refused a policy because of medical conditions (past, present, or future). A “General Enrollment Period” is available from January 1 to March 31. The effective date of benefits will be July 1, and it’s possible you will have to pay a late enrollment penalty. Regardless of the time of year, we always allow you to view an Ohio Medicare Supplement comparison. 2024 financial ratings can also be reviewed.

Many standardized plans are offered and you may choose the coverage that best fits your medical needs and budget. Plan G in Ohio provides identical benefits as Plan F, with the exception of the Part B deductible that must be paid. Plan G also covers the Part A deductible, Part A hospital costs and coinsurance up to 365 days, Part B excess charges, Part B copays or coinsurance, and skilled nursing facility care coinsurance.

You also can not be surcharged or forced to wait for treatment because of a disclosed or undisclosed condition. The Ohio DOI helps regulate carriers and provide consumer information. Medigap options include Advantage and Supplement plans. Many carriers offer plans to applicants that have reached age 65, but not to applicants under that age. For example, Humana and Cigna do not underwrite under age-65 business in the Buckeye State. Anthem BCBS, Ambetter, SummaCare, Aetna, UnitedHealthcare, and Oscar offer plans in selected counties.

What They Cover

Ohio Medigap plans help pay deductibles, coinsurance, and copays that may not be covered by original Medicare. Coverage is provided by private companies, and 10 different types of policies are offered. If you are currently covered under an “Advantage” plan, have group benefits from you or your spouse’s employer, or are enrolled in QMB (Qualified Medicare Beneficiary), you may not need an additional policy.

NOTE: Applicants have a 30-day “free look” period that allows the cancellation of the policy with a full refund. The period starts when the policy arrives. Advantage plans often include dental, vision, and hearing benefits, although copays and specific coverage will vary, depending upon the carrier. Different types of plan options include PPO, HMO, PFFS, MSA, HMOPOS, and SNPs. PPO contracts will generally allow you to utilize a larger number of providers.

Unless you are already enrolled in Parts A and B, you can not enroll in a Supplement or Advantage plan. The application process must be initiated by you, since it is not automated. Visiting or contacting your local Ohio SS office will begin the process. After seven months, if you have not applied, a penalty may be assessed. You will also have to wait until the next OE “General Period,” which starts in January and ends in March.

Your Part B cost will also increase by 10% for each year that you don’t enroll. However, if you or your wife are still working, and have group benefits offered by the employer, you may “opt out” of Part B without incurring a penalty. Once the plan terminates, you should immediately enroll in Part B.

How Are Rates Determined?

Your zip code or county of residence will often impact the price you pay. For example, rates in Toledo and Lucas County will likely differ than rates in Dayton and Montgomery County. Cincinnati and Hamilton County will have a different set of prices. The cost of medical care, treatment and volume of submitted claims, are generally the biggest variables that affect the premium you pay. There are also three types of Medigap pricing:

No-Age-Rated – Age is not a factor in determining the rate. Regardless if you are 65 or 85, prices are the same. A cost-effective option if you retain the plan long-term. However, you can change plans during Open Enrollment periods.

Attained-Age-Rated – The cost of coverage is based on your age at the time you apply. Premiums increase each year, as you get older. Purchasing a policy at age 65 is much less expensive than purchasing coverage at age 70 or 75.

Issue-Age-Rated – The cost of coverage is also based on your age at the time you apply. However, premiums remain fairly stable and don’t necessarily increase as you get older.

The average cost of a Medicare Supplement plan in Ohio will vary between $40 and $285. Plan G (HD) and Plan F (HD) are the least expensive options. The type of pricing (see above) may also impact the cost of coverage.

Plan Benefits 

Plan benefits are “standardized, so when you are comparing similar policies (Plan A or Plan B for example), the same coverage must be offered by each carrier. Of course, each year, that rate may change, while benefits remain the same. During the annual Open Enrollment, you can switch to a different company and/or plan, without answering medical questions. Many consumers receive benefits from prior employer. The most popular plans are F, G, and N.

Once covered for Parts And B, you can apply for Part D (prescription drug) benefits. Insurance companies offer private plans, although many Medicare Advantage plans also include Part D benefits. There may be a penalty if you miss the Part D enrollment deadline. However, if you have alternative benefits, the penalty may not apply. For 2025, the donut hole has been eliminated. Instead, a new three phase benefit has been created – deductible phase, initial coverage phase, and catastrophic phase.

NOTE: If you can not prove that you had “prior credible coverage,” the carrier can impose a pre-existing condition clause that increases your rate or excludes benefits for your condition to be paid for a specific period of time. Also, MedSup plans do not offer benefits for vision and dental care, long-term health care, nursing home expenses, prescriptions, private-duty nurses or aids, eyeglasses, or hearing aids. Several of these benefits can be obtained by applying for private policies. Medical qualification may not be needed.The initial coverage phase has no limit.

The Manufacturer Discount Program replaces the Coverage Gap Discount Program. Thus, the manufacturer will pay a discount of approximately 10% for brand name drugs. The discount is 20% for the catastrophic phase. Also, the base monthly beneficiary premium is $36.78, an increase of $2.08 from 2024.

 

Ohio 2025 Medicare Supplement Plan Monthly Rates

Shown below are estimated current premiums for selected plans for a non-smoking female at age 65. Smoker and male rates may be higher. A complete illustration of rates for all eligible plans from all registered and licensed companies can be provided when your personalized online quote is requested at the top of the page. Your zip code will be needed. Plans E, H, I, and J are no longer offered, although in-force plans can remain active. Starting last year, plans C and F were no longer offered as new business, although existing plans can be renewed, since the plans are “grandfathered.” Note: All Medicare members must pay the Part B deductible.

Other information available is the average increase (or decrease) in premium the last five years, contact information of carrier, and if you are subject to a  pre-existing condition clause, the number of months before policy will pay for those conditions. The financial rating and contact information of each company is also available.

Hamilton, Butler, Clermont, Clinton, Brown, Adams, Highland, and Warren Counties

Plan A

$84 – AARP UnitedHealthcare

$97 – Omaha Supplemental Insurance

$100 – Allstate

$100 – Manhattan Life

$102 – Paramount

$107 – Medical Mutual

$108 – AFLAC

$108 – Medico

$109 – Physicians Select

$109 – Cigna

$112 – Continental Life

$114 – Humana

$114 – New Era Life

$114 – Elips Life

$116 – Ace Property And Casualty

$117 – American Benefit Life

$120 – American Home Life

$121 – Bankers Fidelity

$127 – Manhattan Life

$140 – Heartland National Life

$141 – Anthem BCBS

$192 – GPM Health

$221 – Guarantee Trust Life

Plan B

$114 – AARP-UnitedHealthcare

$121 – Continental Life

$132 – United States Fire

$231 – United American

$262 – Assured Life

Plan C

$153 – AARP-UnitedHealthcare

$161 – Heartland National

$173 – Medical Mutual

$245 – United American

$269 – GPM Health

$358 – Assured Life

Plan F

$120 – Manhattan Life

$122 – Omaha Supplemental

$123 – Ace Property And Casualty

$123 – Allstate

$126 – Humana

$127 – AFLAC

$128 – Medico

$129 – American Benefit Life

$131 – AARP-UnitedHealthcare

$131 – American Home Life

$133 – Cigna

$135 – Elips Life

$135 – United States Fire

$138 – SBLI USA Life

$140 – Continental Life

$141 – Paramount

$154 – Capitol Life

$158 – Bankers Fidelity

$162 – Manhattan Life

$165 – New Era Life

$174 – Medical Mutual

$178 – Anthem BCBS

$272 – GPM Health

$280 – Guarantee Trust Life

$291 – United American

$359 – Assured Life

Plan F (High Deductible)

$45 – Humana

$48 – Medico

$73 – Medical Mutual

Plan G

$95 – AARP-UnitedHealthcare

$102 – Continental Life

$101 – Mutual Of Omaha

$102 – Elips Life

$103 – Ace Property And Casualty

$104 – AFLAC

$104 – Allstate

$104 – United States Fire

$105 – Accendo

$106 – Cigna

$107 – Mutual Of Omaha

$108 – SBLI USA Life

$108 – New Era Life

$113 – Humana

$113 – Medico

$114 – Manhattan Life

$115 – Capitol Life

$116 – Anthem BCBS

$116 – Heartland National

$121 – Paramount

$123 – Bankers Fidelity

$123 – Medical Mutual

$138 – Union Security

$139 – Great Southern Life

$168 – GPM Health

$184 – United American

$191 – Guarantee Trust Life

$247 – Assured Life

Plan G (High Deductible)

$33 – United American

$33 – New Era Life

$35 – Medico

$37 – Cigna

$38 – Bankers Fidelity

$38 – United States Fire

$41 – Mutual Of Omaha

$41 – Ace Property And Casualty

$40 – Humana

$41 – Elips Life

$43 – Continental Life

Plan N

$72 – Omaha Supplemental Insurance

$75 – Cigna

$75 – AARP-UnitedHealthcare

$77 – American Benefit Life

$78 – SBLI USA Life

$79 – Accendo

$79 – Mutual Of Omaha

$79 – AFLAC

$79 – United States Fire

$79 – Ace Property And Casualty

$79 – Elips Life

$80 – Allstate

$80 – Continental Life

$81 – Elips Life

$82 – Medico

$83 – Manhattan Life

$84 – Humana

$86 – New Era Life

$88 – Heartland National LIfe

$88 – Capitol Life

$94 – Bankers Fidelity

$96 – Union Security

$99 – GPM Health

$103 – Assured Life

$113 – Paramount

$115 – Anthem BCBS

$120 – Medical Mutual

$152 – Guarantee Trust Life

$173 – United American

 

Franklin, Licking, Madison, Ross, Pickaway, Fairfield, Madison, Fayette, and Delaware Counties

Plan A

$70 – AARP-UnitedHealthcare

$83 – Mutual Of Omaha

$95 – Omaha Supplemental Insurance

$95 – Ace Property And Casualty

$96 – AFLAC

$96 – American Benefit Life

$96 – Elips Life

$97 – United States Fire

$98 – Allstate

$98 – Accendo

$98 – American Home Life

$99 – Continental Life

$101 – New Era Life

$101 – Medico

$101 – Allstate

$101 – Medical Mutual

$101 – Humana

$101 – SBLI USA Life

$102 – Paramount

$103 – Cigna

$106 – Capitol Life

$107 – Heartland National Life

$107 – Manhattan Life

$112 – Bankers Fidelity

$116 – United American

$117 – Anthem BCBS

$120 – Union Security

$150 – GPM Health

$184 – Guarantee Trust Life

$160 – Oxford Life

$225 – Assured Life

Plan B

$103 – Continental Life

$105 – AARP-UnitedHealthcare

$117 – United States Fire

$210 – United American

$229 – Assured Life

Plan C

$122 – New Era Life

$128 – Heartland National Life

$131 – AARP-UnitedHealthcare

$138 – Paramount

$160 – Medical Mutual

$184 – GPM Health

$195 – Oxford Life

$223 – United American

$312 – Assured Life

Plan F

$108 – SBLI USA LIfe

$115 – Ace Property And Casualty

$117 – Allstate

$117 – Cigna

$118 – AFLAC

$119 – Omaha Supplemental Insurance

$119 – American Home Life

$120 – American Benefit Life

$128 – AARP-UnitedHealthcare

$132 – Manhattan Life

$134 – Continental Life

$140 – Paramount

$141 – Bankers Fidelity

$143 – Capitol Life

$145 – Accendo

$159 – Union Security

$165 – Medical Mutual

$165 – New Era Life

$167 – Anthem

$196 – Humana

$213 – GPM Health

$233 – Guarantee Trust Life

$266 – United American

$335 – Assured Life

Plan F (High Deductible)

$30 – United American

$34 – New Era Life

$36 – Great Southern Life

$36 – Medico

$39 – National Health

$45 – Humana

$45 – Cigna

$68 – Medical Mutual

Plan G

$92 – AARP-UnitedHealthcare

$94 – Elips Life

$97 – Mutual Of Omaha

$98 – United States Fire

$98 – Continental Life

$98 – SBLI USA Life

$99 – Heartland National Life

$99 – Medico

$99 – Manhattan Life

$100 – National Health

$101 – Capitol Life

$101 – Accendo Life

$102 – New Era Life

$103 – Oxford Life

$104 – Anthem BCBS

$112 – Bankers Fidelity

$113 – Humana

$115 – Great Southern Life

$116 – Union Security

$120 – Sentinel Security

$122 – Medical Mutual

$125 – Paramount

$132 – GPM Health

$133 – Cigna

$160 – Guarantee Trust Life

$176 – United American

$231 – Assured Life

Plan N

$71 – SBLI USA Life

$73 – AARP-UnitedHealthcare

$75 – Elips Life

$75 – Manhattan Life

$75 – Mutual Of Omaha

$77 – United States Fire

$76 – Accendo

$76 – Capitol Life

$76 – National Health

$77 – Medico

$77 – Heartland National

$77 – Continental Life

$77 – United States Fire

$80 – Union Security

$82 – New Era Life

$82 – Central States

$85 – Great Southern Life

$85 – Bankers Fidelity

$86 – GPM Health

$89 – Humana

$97 – Assured Life

$102 – Sentinel Security

$105 – Cigna

$106 – Anthem BCBS

$114 – Paramount

$117 – Medical Mutual

$127 – Guarantee Trust Life

$173 – United American

$181 – Oxford Life

Cuyahoga, Ashtabula, Lorain, Mahoning, Columbiana, and Lake Counties

Plan A

$69 – AARP-UnitedHealthcare

$92 – Mutual Of Omaha

$97 – Humana

$99 – Medical Mutual

$100 – Accendo

$100 – Continental Life

$102 – Medico

$106 – New Era Life

$106 – Paramount

$107 – Elips Life

$107 – National Health

$108 – SBLI USA Life

$108 – United States Fire

$110 – Heartland National

$111 – Manhattan Life

$113 – Capitol Life

$117 – Bankers Fidelity

$123 – Great Southern Life

$125 – Central States

$125 – Union Security

$126 – Anthem BCBS

$128 – United American

$145 – Cigna

$148 – Sentinel Security

$150 – GPM Health

$169 – Guarantee Trust Life

$187 – Oxford Life

$230 – Assured Life

Plan B

$107 – AARP-UnitedHealthcare

$119 – Continental Life

$130 – United States Fire

$232 – United American

$249 – Assured Life

Plan C

$131 – New Era Life

$136 – AARP-UnitedHealthcare

$138 – Paramount

$146 – Heartland National

$160 – Medical Mutual

$211 – GPM Health

$211 – Oxford Life

$246 – United American

$340 – Assured Life

Plan F

$115 – SBLI UA Life

$122 – AARP-UnitedHealthcare

$123 – Elips Life

$124 – Medico

$126 – Mutual Of Omaha

$127 – Central States

$133 – Manhattan Life

$133 – United States Fire

$137 – Continental Life

$137 – Capitol Life

$139 – National Health

$140 – Accendo

$143 – Humana

$145 – Great Southern Life

$145 – Paramount

$148 – Bankers Fidelity

$157 – New Era Life

$161 – Medical Mutual

$165 – Union Security

$179 – Anthem BCBS

$189 – Cigna

$189 – Sentinel Security

$213 – GPM Health

$215 – Guarantee Trust Life

$280 – United American

$342 – Assured Life

Plan F (High Deductible)

$33 – United American

$37 – Medico

$37 – New Era Life

$41 – Great Southern Life

$43 – National Health

$47 – Humana

$50 – Cigna

$65 – Medical Mutual

Plan G

$100 – AARP-UnitedHealthcare

$103 – Medico

$107 – Mutual Of Omaha

$108 – Elips Life

$109 – SBLI USA Life

$109 – National Health

$109 – Continental Life

$109 – United States Fire

$112 – Manhattan Life

$112 – Accendo

$113 – Heartland National Life

$114 – Capitol Life

$114 – New Era Life

$117 – Oxford Life

$118 – Medical Mutual

$121 – Humana

$123 – Bankers Fidelity

$124 – Anthem BCBS

$124 – Paramount

$129 – Great Southern Life

$132 – Union Security

$126 – Great Southern Life

$142 – Cigna

$158 – GPM Health

$176 – Guarantee Trust Life

$194 – United American

$251 – Assured Life

Plan G (High Deducible)

$33 – United American

$35 – Medico

$37 – New Era Life

$39 – Cigna

$40 – Bankers Fidelity

$40 – United States Fire

$42 – Mutual Of Omaha

$43 – Humana

$44 – Elips Life

$46 – Continental Life

Plan N

$77 – AARP-UnitedHealthcare

$78 – Cigna

$79 – SBLI USA Life

$80 – Medico

$83 – Mutual Of Omaha

$83 – National Health

$83 – United States Fire

$84 – Accendo

$84 – Manhattan Life

$85 – Elips Life

$85 – Continental Life

$91 – Union Security

$91 – New Era Life

$92 -Heartland National Life

$93 – Capitol Life

$93 – Bankers Fidelity

$95 – Great Southern Life

$95 – Humana

$96 – Central States

$98 – GPM Health

$105 – Assured Life

$113 – Medical Mutual

$114 – Paramount

$123 – Anthem BCBS

$118 – Medico

$184 – United American

$186 – Oxford Life

Montgomery, Preble, Darke, Clark, Champaign, Clinton, Shelby, Greene, and Miami Counties

Plan A

$69 – AARP-UnitedHealthcare

$92 – Mutual Of Omaha

$97 – Continental Life

$100 – Accendo

$104 – US Fire

$106 – New Era Life

$106 – Manhattan Life

$108 – Capitol Life

$111 – Lumico Life

$113 – Humana

$116 – Union Security

$119 – Central States

$120 – Anthem

$121 – Great Southern Life

$123 – National Health

$128 – United American

$134 – Cigna

$137 – Medico

$174 – Oxford Life

Plan C

$122 – New Era Life

$131 – AARP-UnitedHealthcare

$135 – Heartland National

$138 – Paramount

$153 – Medical Mutual

$176 – GPM Health

$185 – Oxford Life

$214 – United American

$292 – Assured Life

Plan F

$115 – Central States

$118 – Manhattan Life

$120 – Mutual Of Omaha

$120 – Accendo

$124 – Lumico Life

$124 – Capitol Life

$126 – Continental Life

$126 – Humana

$132 – AARP-UnitedHealthcare

$136 – Great Southern Life

$141 – New Era Life

$145 – Paramount

$145 – Union Security

$148 – Sentinel Security Life

$149 – National Health

$154 – Medical Mutual

$162 – Anthem BCBS

$177 – GPM Health

$205 – Medico

$243 – United American

Plan F (High Deductible)

$30 – United American

$34 – New Era Life

$39 – Great Southern Life

$46 – Medico

$47 – National Health

$64 – Medical Mutual

Plan G

$99 – Mutual Of Omaha

$100 – Continental Life

$101 – Manhattan Life

$101 – AARP-UnitedHealthcare

$102 – New Era Life

$104 – Capitol Life

$104 – Heartland National

$105 – Accendo

$105 – Oxford Life

$105 – Lumico Life

$107 – Humana

$108 – Anthem BCBS

$117 – Medical Mutual

$117 – Union Security

$118 – Sentinel Security Life

$120 – Great Southern Life

$123 – National Life

$125 – Paramount

$135 – Medico

$169 – United American

Plan G (High Deductible)

$30 – United American

$31 – New Era Life

$38 – United States Fire

$39 – Mutual Of Omaha

$40 – Humana

$43 – Continental Life

Plan N

$78 – Manhattan Life

$79 – Accendo

$79 – Mutual Of Omaha

$79 – Capitol Life

$80 – Continental Life

$80 – Union Security

$82 – United States Fire

$82 – New Era Life

$82 – Central States

$84 – Heartland National

$84 – Humana

$84 – Lumico Life

$90 – Great Southern Life

$92 – AARP-UnitedHealthcare

$103 – Anthem BCBS

$104 – Cigna

$112 – Medical Mutual

$171 – Oxford Life

Summit, Trumball, Wayne, Ashland, Medina, Mahoning, Columbiana, and Portage Counties

Plan A

$69 – AARP-UnitedHealthcare

$87 – Mutual Of Omaha

$90 – Continental Life

$93 – Accendo

$95 – Medical Mutual

$95 – New Era Life

$99 – United States Fire

$100 – Manhattan Life

$101 – Heartland National

$103 – Capitol Life

$105 – Lumico Life

$106 – Humana

$106 – Paramount

$110 – Union Security

$112 – Anthem BCBS

$113 – Central States

$115 – Great Southern Life

$116 – United American

$116 – Sentinel Security

$127 – Cigna

$130 – Medico

Plan B

$105 – AARP-UnitedHealthcare

$114 – Continental Life

$125 – United States Fire

$223 – United American

$224 – Assured Life

Plan C

$131 – AARP-UnitedHealthcare

$131 – New Era Life

$138 – Paramount

$146 – Heartland National

$184 – GPM Health

$237 – United American

$306 – Assured Life

Plan F

$121 – Central States

$126 – Manhattan Life

$126 – Humana

$126 – Mutual Of Omaha

$128 – Accendo

$131 – Capitol Life

$131 – Lumico Life

$132 – AARP-UnitedHealthcare

$133 – United States Fire

$134 – Continental Life

$145 – Paramount

$153 – Union Security

$156 – National Health

$157 – New Era Life

$173 – Sentinel Security

$175 – Cigna

$179 – Anthem

$211 – Medico

Plan F (High Deductible)

$33 – United American

$37 – Medico

$37 – New Era Life

$41 – Great Southern Life

$45 – Humana

$44 – Medico

$47 – Cigna

$49 – National Health

$65 – Medical Mutual

Plan G

$101 – AARP-UnitedHealthcare

$103 – Medico

$105 – Mutual Of Omaha

$107 – Humana

$107 – Manhattan Life

$107 – Continental Life

$108 – Elips Life

$109 – United States Fire

$112 – Accendo

$113 – Heartland National Life

$114 – Capitol Life

$114 – New Era Life

$115 – Bankers Fidelity

$117 – Oxford Life

$117 – Medical Mutual

$118 – Anthem BCBS

$122 – Union Security

$124 – Paramount

$126 – Great Southern Life

$128 – National Health

$133 – Humana

$134 – Cigna

$187 – United American

 

Plan G (High Deductible)

$33 – United American

$34 – New Era Life

$35 – Medico

$40 – Bankers Fidelity

$40 – Humana

$40 – United States Fire

$42 – Mutual Of Omaha

$43 – Elips Life

$46 – Continental Life

 

Plan N

$80 – Medico

$83 – Medical Mutual

$84 – Elips Life

$84 – Humana

$84 – Accendo

$84 – Union Security

$84 – Manhattan Life

$85 – Continental Life

$86 – Capitol Life

$86 – United States Fire

$86 – New Era Life

$86 – Heartland National

$90 – Central States

$92 – AARP-UnitedHealthcare

$93 – Bankers Fidelity

$95 – Great Southern Life

$95 – Assured Life

$98 – GPM Health

$105 – National Health

$110 – Cigna

$114 – Paramount

$121 – Anthem BCBS

$184 – United American

$196 – Oxford Life

Guaranteed Insurability Regardless Of Open Enrollment Period

Specific situations are available which provide “guaranteed issue rights” at any time throughout the year. You do not have to medically qualify, answer health-related questions, or take a physical. This applies to yourself and all eligible family members. A 63-day period id provided to review, compare, choose, and enroll. Pre-existing conditions (if applicable) are covered and no surcharges or waiting periods can be applied. The following are common guaranteed insurability scenarios:

Benefits through your employer end. This can be through termination, layoff, or retirement.

PACE or Advantage plan is no longer part of the Medicare program, and is not available.

You are misled by your Medigap plan or specific regulations were not followed. Of course, documentation will be required.

Insurance company files for bankruptcy, or your benefits unexpectedly end for reasons beyond your control.

A MedSup plan is terminated by you and you enroll in an Advantage, Select or PACE program. But within the first 12 months, you want to change policies.

You move away from the contract’s service area. The move can be to another state, or intra-state, assuming the provider network is different.

 

Part D Prescription Drug Benefits

You must be enrolled in Parts A or B to purchase Part D benefits. Also, if you don’t enroll within a specific time period of becoming eligible, a penalty could be assessed. Although many Advantage plans include prescription drug benefits, Supplement plans do not, and therefore separate coverage must be obtained. However, you may choose to opt out of coverage while enrolling during your initial period. You are also not required to obtain PDP Plan coverage.

Each plan has a formulary drug list of covered medications. Prescriptions are separated into “tiers,” which can impact your copay and out-of-pocket cost. Typically, the lower the tier, the lower the cost. However, each carrier determines which drugs are assigned to their own tiers. The formularies can also change each year although notification is sent in writing.

The dreaded “donut hole” also must be addressed, since it will result in out-of-pocket costs that you will be responsible for. When you have accumulated $3,310 of prescriptions, you will begin to pay 45% coinsurance for brand-name drugs and earn a 42% discount for generic drugs. When a total of $7,062 has been reached, the “donut hole” closes. From that point forward, your out-of-pocket cost is 5% of prescription costs.

Although more costly, several Advantage and Part D contracts issued by insurers will cover most of the gap. However, paying a higher premium may not be cost-effective if your current usage is low enough to avoid the donut hole. You can also request that your primary-care physician and/or specialists recommend cheaper generic drugs, whenever available. Also, if samples or mail order options are available, these can also help reduce out-of-pocket costs. Selected free drug discount plans sometimes are reputable resources to lower out-of-pocket costs.

If you have group benefits through an employer, or union coverage, enrolling in an alternative plan could cause you to lose prior coverage for yourself and additional dependents. There are also specific times you can drop your current plan if you are not going to select another plan.

Your HSA

If you currently have an HSA (Health Savings Account), once you are enrolled in Parts A or B, you are no longer permitted to contribute funds to your HSA. However, you do not lose access to your money, and past contributions may be used to pay for qualified expenses. Future legislation may provide more flexibility regarding how and when the money is spent.

Options For Low-Income Households

Medicaid may be available, if you meet their income requirement guidelines. Generally, they will review your expected earned income (yourself and a spouse if applicable), along with your assets, and any guaranteed future income streams. Your Medicaid eligibility can quickly change, if your income substantially increases or decreases. If you are under age 65, you can choose to purchase private single or family medical coverage, although a subsidy will not be offered. Therefore, the rate will likely be substantially higher than the cost of Medicaid.

When Medicaid-eligible, there is no need for a supplemental plan (MedSup or Advantage) since your deductibles, copays, and many other expenses are covered. However, you can choose to decline Medicaid benefits, although it is typically unjustified. Molina and CareSource offer both low-income and Marketplace plan options. Federal subsidies are only available to applicants under age 65.

OPERS

The Ohio Public Employees Retirement System Of Ohio (OPERS) provides service for more than 1 million persons. If not covered through a local or alternative state program, you may be receiving retirement and other benefits through OPERS. Your healthcare coverage is also likely provided if you worked more than 20 years and retired under either of two pension options. Persons under age 65 receive benefits from Medical Mutual.

Retired persons eligible for Medicare can select “Connector” coverage that provides an Advantage plan, or a Supplement plan with Part D prescription drug coverage. However, Group Advantage and Part D plans are not offered.

SERS Retirement Benefits

SERS (School Employment Retirement System) is a public pension organization that provides service to nonteaching public school employees. Workers that have had at least 10 years of employment experience, are eligible for healthcare benefits. If you are Medicare-eligible, several Advantage contracts are offered, and your county of residence will determine the plan(s) you are eligible for. Three offered plans are Paramount Elite HMO, Aetna MedicareSM (PPO), and AultCare Prime Time HMO. All three plans include Part D (prescription drugs) benefits. The first two options offer a Silver Sneakers membership.

These plans have no deductible and the maximum out-of-pocket expenses are capped at $3,000. Retired persons are credited with $45.50 each month to help pay the cost of Medicare Part B. Persons not eligible for Medicare may also be able to secure a policy. However, if you have 20 years of employment credited, the cost of coverage is subsidized.

Options For Applicants Under Age 65

If you already have Medicare benefits because of a disability, and have not reached age 65 yet, although several plan options are available, most carriers do not offer coverage. Premiums are generally higher than the cost if you had reached age 65. It’s also possible an Advantage plan may be offered in your County, or you may be eligible for Medicaid. However, when you reach age 65, a six-month period of enrollment will be provided, with coverage and application-approval guaranteed.

If you are not disabled and not eligible for Medicaid, you can apply for private plans offered on and off the Exchange. Federal subsidies are based on the size of your household and income of occupants. Many non-compliant options are also available, although benefits may be limited and your application for coverage can be denied. In 2018, several of President Trump’s proposed changes will become effective, which could lower rates for many Buckeye State residents.

How Does End-Stage Renal Disease (ESRD) Impact Ohio Medigap Options?

Any underwritten plan will likely be denied, since medical insurability is required. However, for GI (Guarantee Issue) contracts, coverage should be approved, assuming you have reached age 65, have enrolled in Parts A and B, and you have lost secondary coverage. Up to 63 days is provided for you to determine which available plans you would like to purchase. Those plans are A, B, C, F, K, and L. If you wait until after the 63-day window, your application can be rejected.

You may also be able to receive Medicaid benefits, if you qualify. The Ohio Benefit Bank is an additional option that can view your situation, and possibly recommend several alternatives. Many expenses typically paid by a Medigap plan, are covered by Medicaid, including deductibles and copays. There also is a Medicaid information line (available upon request) that can assist you with eligibility issues. We make it easy to search for available Medigap plans in your area.