Ohio Health Insurance

Ohio Medicare

The Medicare open enrollment period offers Medicare beneficiaries in all US states an opportunity to review their health plan and switch to a new one that accommodates new needs, such as a change in health status. Health insurance companies such as Anthem Blue Cross Blue Shield, AARP, United Healthcare, Aetna, Humana, and Mutual of Omaha offer various types of HMO and PPO Medicare Supplement or Advantage Plans for Ohio residents. If your needs have changed since you enrolled in a Ohio Medicare plan, this is the time to evaluate your Medicare coverage and look at the options that will work better for you.

Ohio Medicare Enrollment Options

In 2011, Medicare’s open enrollment period is from October 15 to December 7.  This period is your chance to make changes to your Ohio Medicare Advantage, Supplement, Medigap plans or Medicare prescription drug coverage for 2012, which includes:

•    Change from Original Medicare PARTS A 7 B, to a Medicare Advantage, Supplement or Medigap Plan: Original Medicare does not cover everything. To close the gaps in this coverage, you can switch to a Medicare Advantage Plan (HMO or PPO) offered by private insurers approved by Medicare. Cost, additional coverage, and rules are different for different plans.

•    Switch from your current Medicare Advantage Plan back to Medicare Supplement or Medigap Plans.

•    Change from a Medicare Advantage Plan without drug coverage to a Medicare Advantage Plan that offers drug coverage.

•    Change from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that includes drug coverage.

•    Enroll in a Medicare Prescription Drug Plan.

•    Change from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.

•    Give up your Medicare prescription drug coverage completely.

Anthem Senior Advantage Basic (HMO) is available in select Ohio counties. It has a $0 monthly plan premium in addition to your monthly Medicare Part B premium. Unless otherwise noted, out-of-network services not covered. ANTHEM Medicare Advantage plan (HMO) provides you access to several thousands of network doctors nationwide. Similarly, the Ohio Medicare Advantage Plans offered by other health insurance companies offers you more benefits for less money than Original Medicare for most services, and come with predictable out-of-pocket costs

Making the Right Decision during Medicare Enrollment

Open enrollment is the time when Ohio seniors should examine their plans, consider their health status and the various options available to them, and find which one is suited to their needs.  The best way to make the right decision during Medicare open enrollment is to get professional guidance from an independent health insurance agent in Ohio. With vast experience and knowledge in the field, a reliable agent can help you evaluate your Ohio Medicare coverage and make the changes necessary to improve your health insurance and drug coverage.

A Medicare Advantage plan is Part C of Medicare. It is the program that allows Medicare beneficiaries to enroll in a private health plan to receive Medicare cover and also enjoy a few added perks. Medicare Advantage plans are offered by private insurance companies approved by Medicare. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules fixed by Medicare.

Understanding Medicare Advantage

Traditional Medicare is a Fee for Service plan that covers many healthcare services. When you receive your healthcare service, you show you Medicare Card that is issued to you when you enroll in Medicare. This original plan pays for many health services and supplies but does not cover all your healthcare costs like co-pays and deductibles.

Medicare Advantage Plans are health plan options approved by Medicare, but offered through private health insurance companies. If you join one of these plans, you are still in Medicare, but generally get all your Medicare coverage through private companies and use the insurance that the plan provides.

The main differences between Traditional Medicare and Medicare Advantage are as follows:

•    Firstly, co-pays and deductibles are lower with Medicare Advantage than with traditional Medicare.

•    Medicare Advantage plans provide Medicare Part A or Hospital Insurance and Medicare Part B or Medical Insurance. However, Medicare Advantage Plans do not cover hospice care, which is covered by Original Medicare even if you are in a Medicare Advantage Plan.

•    Medicare Advantage plans may also offer extra benefits such as vision, hearing, dental, preventive care services, and health and fitness programs.

•    Medicare Advantage plans have Medicare Part D (Prescription Drug Coverage) built in. With Traditioanl Medicare, Part D has to be purchased separately.

•    Finally, with Traditional Medicare, you can see any doctor or hospital. Many Medicare Advantage plans work with contracted providers – doctors and hospitals with whom they have worked out a long-term contract.

Different types of Medicare Advantage Plans

•    Health Maintenance Organization (HMO) Plans
•    Preferred Provider Organization (PPO) Plans
•    Private Fee-for-Service (PFFS) Plans
•    Special Needs Plans (SNP)

Other Medicare Advantage Plans

•    A HMO Point of Service (HMO POS) Plan that allows you to get some services out-of-network for a higher cost.

•    A Medical Savings Account (MSA) Plan combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. You will then also have to pay out of pocket for care, until the MSA plan deductible is met, after which plan coverage begins. MSA plans may or may not have contracted providers, but MSA plans cannot restrict access to a network of doctors, facilities or suppliers.

When you enroll in a Medicare Advantage plan, you pay a monthly premium to Medicare and also a monthly premium to Medicare Advantage for the added benefits it offers.

Medicare thus offers you the option of getting your health insurance through Traditional Medicare or through private insurance with a Medicare Advantage plan. If you choose a Medicare Advantage plan, you must specifically opt to and give the authorization to receive your healthcare through the plan.

To make the right choice, compare costs and benefits carefully. Professional help is always at hand. So contact a knowledgeable insurance dealer who can explain the details and help you select the best Medicare plan.

Ohio Medicare

Medicare, America’s government health insurance program, was signed into law by President Lyndon B. Johnson on July 30, 1965. It provides health insurance coverage for persons aged 65 and older, for the disabled and for those with permanent kidney failure. Medicare is now assuming even more significance as the baby boomer generation is poised to turn 65, making millions of Americans eligible for Medicare.

Medicare is often confused with Medicaid. They are not the same. Medicare was created in 1965 with the aim to provide health coverage to people on social security. Medicare is also state-run, but meant to help with the hospital and medical coverage of people in poverty or with little resources.

How Medicare Works

Medicare is divided into four parts: A, B, C and D.

Part A – Inpatient care in hospital, skilled nursing facility, hospice, and home health care
Part B – Medically necessary services like outpatient care, doctors’ services and screenings
Part C – Medicare Advantage Plan managed by private insurance companies
Part D – Prescription Drug Coverage

•    Part A covers hospitalization. You become eligible when you sign up for social security. It is free if you have signed up for social security and paid Medicare taxes when you were working. It also covers your spouse.

You are eligible for Part A if:

- You receive or are eligible to receive Social Security benefits; or
- You receive or are eligible to receive railroad retirement benefits; or
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid; or
- You are the dependent parent of a fully insured deceased child.

Most people don’t pay  Part A premium because they paid Medicare taxes while working. This is called “premium-free Part A.”

Medicare Part A works with a fee-for-service plan and you would be charged only if you are hospitalized. It covers hospital stays and emergency care. If a person had an accident and needed to be hospitalized, Medicare Part A would take care of this.

Most Americans are eligible for Part A, but even if you are not, you can purchase it for a premium. You have the option of adding on B, C or D.

•    Part B covers doctor’s office visits, medical services and supplies including preventive screenings. For instance, if you have a fever and need to see a doctor, you would be covered by Part B. Usually, you are automatically enrolled in Part B when you have Part A. Part B is not free and you have to pay a monthly premium for these services.

An individual has the option to cancel Part B coverage by contacting the Medicare Office. However, the cost of Part B is minimal and so it is advisable to keep it.

•    Part C is Medicare Advantage. This is optional Medicare coverage offered by private health insurance companies that are approved by Medicare. If you have Medicare Parts A and B, you can join a Medicare Advantage plan. With a Medicare Advantage plan, you can get the benefits of Parts A, B and D as well as some additional advantages.

Medicare Advantage plans include:

- Medicare managed care plans
- Medicare preferred provider organization (PPO) plans
- Medicare private fee-for-service plans, and
- Medicare specialty plans

Medicare Part C is not free. The health plans that private insurers offer work through hospital, doctor and other service provider networks that they are associated with. So you would get medical services only through these networks. Prescription drug coverage would also have to be paid for.

•    Part D is prescription drug coverage. You are eligible for Part D if you have Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C). When you opt to join a Medicare prescription drug plan, you have to pay an additional monthly premium for the coverage.

To sum it up:

Medicare Part A covers hospital stays and emergency care
Medicare Part B covers doctor office visits and routine health procedures
Medicare Part C is the Medicare Advantage plan run by private insurance companies. It combines the benefits of A and B and also gives the option to add D, if not already included
Medicare Part D is prescription drugs. A fee is usually charged for a drug care service or supply service.

Ohio Medicare

You become eligible for Medicare when you reach age 65. If are nearing eligibility, you need to make your Medicare coverage choice at least three to four months in advance. You have two basic choices: Original Medicare Coverage and Medicare Advantage Plans.

Medicare comprises four parts: A, B, C and D.

Part A covers hospital stays and emergency care

Part B covers doctor visits and routine health procedures

Part C is the Medicare Advantage Plan approved by Medicare and run by private companies

Part D is prescription drug coverage

Original Medicare Coverage

This includes Medicare Part A and Part B and is provided by Medicare.

• You can choose your doctors, hospitals, and other providers, and you or your supplemental coverage pays deductibles and coinsurance. While most people do not have to pay for Part A, everyone must pay a monthly premium for Part B.
• If you want Prescription Drug Coverage (Part D), you must join a Medicare Prescription Drug Plan offered by a Medicare-approved private company.
• Any gaps in insurance can be covered by adding on a supplemental policy like Medigap from a private insurance company.

Medicare Advantage Plans

This comprises plans like a HMO or PPO provided by a private insurer approved by Medicare.

• With most plans, you need to use approved doctors, hospitals, and other providers, and if you don’t, you have to pay more or all of the costs.
• Besides the premium for Part B, you also have to pay a monthly premium and a co-payment or coinsurance for services that are covered. Costs, extra coverage, and rules differ from plan to plan.
• Prescription drug coverage is usually offered by most these plans. If it is not, you can choose to join a Medicare Prescription Drug Plan.
• With a Medicare Advantage Plan, you don’t need and can’t use a Medigap policy.

Besides the above two choices, Medicare also offers other types of plans. These include Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE). Most of the plans provide Part A and Part B coverage, and some also cover Part D.

Your choice of plan can be influenced by health and/or prescription drug coverage that you may have from a former or current employer or union.

What Medicare Does Not Cover

While Medicare offers basic protection against health care costs, it does not cover all your medical expenses or the costs of most long-term care. For that, you need a long term care plan. It would cover nursing home and other charges such as at-home health care, custodial care like help (not from skilled nurses) with dressing, walking, or eating, adult day care, and so on.

Making the Right Choice

To understand all about how Medicare works and make an informed choice, talk to an independent medical insurance agency. You can get comprehensive information on various kinds of plans and how to fill gaps in coverage. Professional guidance is also necessary when it comes to buying long-term health insurance.

Medicare is government sponsored healthcare for seniors aged 65 and older, people who are disabled and people with permanent kidney failure requiring dialysis or a kidney transplant.

It works like private insurance only that it is the government that is the one reimbursing doctors and hospitals, and not private insurance companies. You become eligible when you become 65 or if you are medically disabled before age 65, or have kidney failure requiring a transplant or dialysis.

Medicare Coverage

Medicare benefits come under four heads – A, B, C and D.

• Part A is hospital insurance. It helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. There are certain conditions laid down regarding such care.

• Part B is medical insurance that helps cover medically necessary services. It includes outpatient care and doctors’ services, and also covers some preventive services to maintain your health and to keep certain illnesses from getting worse.

• Part C, the Medicare Advantage plan, is another way to get healthcare benefits. It is managed by private insurance companies approved by Medicare. These plans must cover medically necessary services. They are cost-effective and offer better benefits than Parts A and B together. They can even supplement Parts A and B. Medicare Advantage plans can charge co-pays, deductibles and coinsurance.

• Part D is Prescription Drug Coverage and may help lower drug costs.

When is Medicare Health Insurance Used

If a Medicare beneficiary has an accident and needs to spend time in hospital, Medicare Part A can offset the costs of the catastrophe. If a person eligible for Medicare comes down with a fever or a cold, he would need Medicare Part B to cover his doctor’s visit. Medicare Part D will pay for the medicines he needs to get better.

Medicare Eligibility/Enrolment

• Parts A and B

Most people are automatically eligible for Parts A and B of Medicare.  You automatically get Parts A and B:

-If you get benefits from Social Security or the Railroad Retirement Board (RRB);

-After you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months, if you are under age 65 and disabled;

-The month your disability benefits begin, if you have ALS (Amyotrophic Lateral Sclerosis).

If you have End-Stage Renal Disease, rules are different. For information on this, contact your local Social Security Office or call Social Security

Some people need to sign up for Part A. If you do not get Social Security or RRB benefits (for instance, because you are still working), you will need to sign up for Part A (even though you get it free). You have to get in touch with Social Security 3 months before you turn age 65. If you worked for a railroad, you should contact the RRB to sign up.

If you delay signing up for Part B, you can only get it during the general enrollment period (between January 1 and March 31 each year) and you may have to pay a late enrollment penalty.

• Part C or Medicare Advantage Plans include Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans, Private Fee-for-Service (PFFS) Plans, and Special Needs Plans (SNP). You can join by completing a paper application, or enrolling on the private insurer’s website.

• Part D is not available through the federal government, but only through private insurance companies approved by Medicare. Part D is available through Medicare Prescription Drug plans and Medicare Advantage Plans. If you do not enroll in a Medicare drug plan when you first become eligible, you may have to pay a late premium penalty.

With the nation’s debt crisis looming large, much attention is on cutting Medicare spending. Medicare shoulders the highest expenses in the U.S. healthcare system, and tax dollars pay for most of the annual increase in the cost of care for the elderly and disabled.

The Medicare cut proposal is causing a lot of concern. President Obama and Congressman Paul Ryan are taking opposite approaches to the Medicare dilemma, though their goals are the same – to rein in Medicare costs and to limit the amount of taxpayer money going into Medicare. However, the proposals that both the President and the Republicans are making to tackle long-term Medicare debt have come under fire.

President Obama says he is determined not to leave “seniors at the mercy of private insurance with shrinking benefits to pay for rising cost”. Physicians express the fear that the various committees and federal agencies that President Obama visualizes to set up, to look into the matter, will decrease the services that doctors can order for their patients. The Independent Medical Advisory Board that will kick off by 2018 will decide whether too much is being spent on medical services, and will decide whether one service or treatment is better than another. This has come in for much criticism:

• First, it places the onus of judgment in the hands of a few bureaucrats and vested interests.
• Doctors feel that such judgments on the ‘comparative effectiveness’ of treatments or services are not wise, as they could affect the physician-patient relationship, especially when a patient needs a particular treatment. There is a view that way too much is being spent on seniors aged 65-70. Individuals in this age group are much healthier than they used to be. Some doctors feel that a better alternative to saving money that is being spent on medical services would be to cut Medicare benefits for those in the 65-70 age group so that there is enough to pay for a life saving operation when they reach, say, age 80.

As for Congressman Paul Ryan’s suggestions, doctors think that they could work well for younger people but not the elderly. Paul Ryan recommends that health insurance companies should be brought in for people who have a serious illness. His long-term “budget-cutting plan” proposes a drastic restructuring of Medicare that includes the creation of health insurance exchanges, which he claims would drive down prices through free market competition.

Doctors also came out in criticism of Paul Ryan’s views, especially when it comes to dealing with older patients. As a result, the House GOP plan, to replace Medicare with a voucher-like system, has been rejected. Some of the issues raised are:

• The general feeling was that it does not make sense to give a voucher to an 80 year old with medical problems and tell him to buy private insurance, as it is tough to get private insurance companies to pay for patients who are very old and very sick.
• President Obama points out that this plan will leave old and sick people at the mercy of private health insurance companies.
• Private insurance works better for patients who are young and have less medical issues. It is pointed out that Medical Advantage has not worked well for older patients even in the past.

Suggestions Put Forward to Cut Medicare Spending:

• Medicare access should be cut down. For instance, people shouldn’t be using Medicare or Medicaid to treat issues like a common cold. Treatment should be restricted to high tech solutions that work.

• There is too much money being wasted internally in the Medicare system. This should be dealt with and such waste should be cut.

• Obama care talks about ‘preventive medicine’. Doctors feel that lifestyle changes like diet, and exercise are the crux of preventive measures. Federal medical spending should address such measures to ensure that seniors stay healthy. This would contribute to lowering the nation’s overall health bill.

• Reassessing the retirement age can also help. With greater awareness about health issues and improved medication, today’s senior citizens are quite healthy even at age 65. Reassessing the retirement age can bring down the number of people becoming eligible for Medicare.

• The use of electronic medical records can bring down health care costs and improve the efficiency of hospitals and practices. Computerized medical records will help prevent waste and reduce the time needed to repeat expensive medical procedures and tests. Doctors are now eligible to get more than $40,000 in extra Medicare payments, if they upgrade to electronic records. They would face reduced Medicare payments and even a penalty if they don’t do so by 2015.

To sum up, there is no doubt that Medicare must operate more efficiently, especially as the generation of baby boomers is all set to enter its rolls. Additional revenue must be found. The government should take care to prevent false billings and ensure that Medicare reimbursements are made only for authentic claims.

There is general consensus on an enforceable limit. Such a limit would see a future with less Medicare payments for healthcare service providers like hospitals, doctors, drug companies and others, more out-of-pocket expenses for many senior citizens, and smaller role for tax dollars in Medicare payments.