Medicare in Ohio: Overview
Medicare is a federal health insurance program enacted in 1965 that is most commonly associated with people age 65 and older. Under certain circumstances individuals younger than 65 who have disabilities or end-stage renal disease also qualify for coverage. Unlike Medicaid, which is jointly funded by the states and the federal government, Medicare is exclusively funded at the federal level.
Nationally, approximately 55 million people have Medicare coverage. Medicare in Ohio covers more than 2 million Ohioans.
Medicare in Ohio: Coverage
Coverage for Medicare in Ohio is no different than Medicare coverage in other states in that the program ensures uniform services are provided in each state. There are several components of the Medicare program, each covering different types of services. Medicare Part A (hospital insurance) includes coverage for inpatient hospital stays and is typically automatically available to all beneficiaries. Enrollees generally do not have to pay a monthly premium for Part A coverage.
Unlike Part A, most beneficiaries pay a monthly premium for Part B (supplementary medical insurance) coverage. Part B is an optional service that helps cover medically-necessary services such as doctors’ services and outpatient care.
Sometimes called Part C, Medicare Advantage Plans are health plan options approved by Medicare and run by private companies – typically managed care companies. Medicare Advantage Plans provide beneficiaries with all of their Part A and Part B coverage - and often prescription drug coverage - and can sometimes do so at a lower cost to the enrollee than traditional Medicare.
Part D is the newest component of the Medicare program and provides optional prescription drug coverage to individuals. Enrollees in part D of the Medicare program typically pay a monthly premium to participate.
Medicare in Ohio: Effect of Federal Reform
Passage of federal healthcare reform legislation makes significant changes to the Medicare program. For example, Medicare Advantage Plans are now prevented from charging more than the traditional Part A and Part B plans for cancer treatment and certain other types of care. Provisions in the new law are also aimed at making Medicare prescription drugs coverage more affordable. These are just a few of the many ways federal reform will impact the Medicare program.
The Medicare program extends healthcare coverage to seniors and certain individuals younger than 65 with disabilities. Its role in the healthcare safety net cannot be overstated as it has played a key role in providing coverage to individuals who might otherwise not be able to afford health insurance.
The Center for Health Affairs works to keep members up-to-date on the latest reimbursement issues, including those involving the Medicare program.
The Center has a lengthy history of effectively advocating for maximum Medicare reimbursement for the region’s hospitals. Wage index is a factor used by the Centers for Medicare and Medicaid Services (CMS) to account for regional differences in the cost of wages in the Medicare reimbursement formula.