Ohio ranks 35th among the states in terms of median household income, and many of its residents are unable to easily afford the average cost of health insurance premiums at $518 per month. Fortunately for some qualified beneficiaries, programs such as Medicare exist to provide more affordable health care coverage.
Ohio Medicare insurance is a federal program, and most of its beneficiaries are people over the age of 65. However, workers with certain disabilities may also qualify for the program. The state of Ohio also offers various programs that assist Medicare beneficiaries.
One way to obtain Medicare coverage is to get Original Medicare, which is comprised of Medicare Part A and Part B. The coverage for Medicare Part A revolves around hospital insurance for services such as inpatient care. For Medicare Part B, the coverage is for medically necessary treatments and durable supplies, as well as for preventive services.
Medicare Part A is normally free, and Medicare Part B comes with a more affordable premium that depends on the income of the beneficiary. Both parts also have deductibles, copays, and coinsurance expenses.
Some Medicare beneficiaries opt to obtain Medigap policies, which refer to the Medicare supplemental plans that can be added to Original Medicare. These plans are available from private health insurance carriers with Medicare approval. They will require a premium, which adds to the cost of Medicare Part B.
In many cases, the supplemental plan will cover Medicare prescription drugs. This is called Medicare Part D, and numerous elderly Medicare beneficiaries rely on this plan to help them afford the many expensive prescription drugs they have to get regularly. Other plans can provide coverage for healthcare services that are not covered by Medicare Part A and Part B, while the supplemental plan can also even cover the cost of Original Medicare deductibles and copayments.
There is also a Medicare Part C, and this refers to the Medicare Advantage Plans available from Medicare-approved private carriers. The Medicare Advantage Plans includes the coverage of Original Medicare plus additional benefits that are not included in Part A and Part B. Often, these plans also come with prescription drug coverage as well.
It is important to compare various Medicare Advantage Plans as they may have different benefits other than the core Original Medicare coverage. The prices for each plan must be considered as well.
In a state like Ohio where the poverty rate is 15.8%, a sizable number of Medicare beneficiaries may have difficulties meeting the expenses of Medicare premiums, deductibles, and copays. But Ohio offers several programs to help cover the Medicare expenses.
The most generous of the Medicare Savings Programs (MSPs) is the program for Qualified Medicare Beneficiaries (QMB). This program covers the premiums for Part A (if applicable) and Part B. It also covers the deductibles, copayments, and coinsurance. To qualify, an individual’s income must be less than $1032 a month. Married couples must have a combined income of less than $1,392 a month.
Another MSP is for Specified Low-Income Medicare Beneficiaries (SLMB), and it pays for the Part B premium. This is for individuals who earn less than $1,234 a month, while a married couple can also qualify with a combined monthly income of no more than $1,666.
The program for Qualified Individuals (QI) also pays for the Part B premium, but the funding for this particular program is often more limited. This is the reason why applications are granted on a “first come, first served” basis.
All of these programs have an asset limit, and for an individual, it is $7,560. Married couples must have assets (not including the house and a car) that do not exceed $11,340 in value.
Qualifying for the MSPs can also qualify beneficiaries for the LIS (Low-Income Subsidy). This is the Extra Help program that can help cover the cost of Medicare Part D. The income level of the beneficiary will determine if the coverage for the Medicare Part D premium is 100% or 25%.
The law requires every state to set up a State Health Insurance Program that offers free and objective counselling for Medicare beneficiaries. In Ohio, this program is called the Ohio Senior Health Insurance Information Program or OSHIIP. Medicare beneficiaries can contact OSHIIP by calling 1-800-686-1578.
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