Medicare Plans in Ohio: Coverage and Costs (2026)

If you're turning 65 in Ohio or helping a parent sort out Medicare, you're looking at four parts, 212 Medicare Advantage plans statewide, and costs that reset every January.1 The standard Part B premium for 2026 is $202.90 a month, and the Part D donut hole is gone.2,3 Ohio also runs a free counseling service, OSHIIP, that reviews your plan options with you at no cost.4

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage Plans in Ohio (Part C)
• Medicare Part D: Prescription Drugs
• Medigap Plans in Ohio (Medicare Supplement)
• Help Paying for Medicare in Ohio
• If You Have Both Medicare and Medicaid
• Medicare Enrollment Periods
• Free Medicare Help: Ohio OSHIIP
• Key Medicare Contacts in Ohio
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, check medicare.gov or call Ohio OSHIIP at 1-800-686-1578.7

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government, and it comes in two parts.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.8

The hospital deductible went up $60 from 2025.2 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a SNF. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care.9 Original Medicare doesn't cover routine dental, vision, or hearing.10

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)2
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.11

Medicare Advantage Plans in Ohio (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.10

Ohio is one of the better states for plan choice. About 2.56 million Ohioans are enrolled in Medicare for 2026. Nationally, more than half of eligible Medicare beneficiaries (55% in 2026) are now enrolled in Medicare Advantage plans.1

How Much Choice You Actually Have

Ohio's 212 plans for 2026 are down slightly from 217 in 2025, but the menu is still deep: 100% of Ohioans with Medicare can get a Medicare Advantage plan, and 100% can get one with a $0 monthly premium. As in the last three years, the counties with the most plan options are mostly in Ohio and Pennsylvania. Still, 212 is a statewide count, not any one person's menu: KFF puts the typical beneficiary nationally at 32 Advantage plans with drug coverage.1 Which plans you can join depends on where you live, because you have to live in a plan's service area to enroll.12

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra. Some plans go further and may help pay part or all of your Part B premium.2,10
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in or out of the plan's network.10
• Plans may require prior authorization for certain services, which Original Medicare generally does not.10
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap: CMS says there is no yearly limit on what you pay out of pocket unless you have supplemental coverage such as Medigap, Medicaid, employer, retiree, or union coverage.10,2
• Extras vary widely. Compare the dental, vision, hearing, and over-the-counter benefits, not just the premium.

Use the Medicare Plan Finder at medicare.gov to compare the plans offered where you live side by side, including which ones offer extras like dental, then check the plan's own documents for the details.13

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.3 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026; certain insulins and vaccines are exempt).14
2. Initial coverage: under the standard benefit, you pay 25% coinsurance until your out-of-pocket spending reaches the yearly cap.3
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you owe no cost sharing for covered drugs the rest of the year.3

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025, and the 2026 amount is the one specified in the CY 2026 Rate Announcement.3 The national base beneficiary premium is $38.99 a month, though actual plan premiums vary.2 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap Plans in Ohio (Medicare Supplement)

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare only: a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums, and while you're enrolled in an Advantage plan it's illegal for anyone to sell you one unless you're switching back to Original Medicare. That isn't a permanent lock-out, though. If you join an Advantage plan for the first time and aren't happy with it, a federal trial right lets you buy a Medigap policy and a separate drug plan when you return to Original Medicare within 12 months of joining.10

Ohio offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N.15 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020.16 Plan G is open to people new to Medicare: once you pay the $283 Part B deductible, it covers the rest of Original Medicare's cost sharing, including the Part A deductible and skilled nursing coinsurance, except foreign travel emergency care, which it pays at 80%. A high-deductible Plan G also exists, where you pay up to $2,950 in 2026 before it pays anything, so check which version a quote is for.17 Every Medigap policy sold in Ohio is guaranteed renewable, so an insurer can't drop you because your health changes.5

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must offer you every policy it has for sale and can't price it on your health. Acceptance isn't instant coverage, though: unless you've had six months of continuous creditable coverage, the insurer can exclude a condition treated or diagnosed in the six months before the policy starts, for up to six months.5

Ohio Has No General Birthday Rule

Ohio's Medigap rule has no yearly "birthday rule" window that lets policyholders 65 and older switch plans without new health questions.5 Once your six-month window closes, an insurer in Ohio can generally make you answer health questions before selling you a different Medigap policy. That's why those six months matter.

If You're Under 65 and on Medicare

People qualify for Medicare before 65 through a disability or end-stage renal disease (ESRD). If that's you, Ohio gives you no Medigap open enrollment right before 65. Federal law generally doesn't require insurers to sell Medigap to people under 65, and Ohio's open enrollment period under Ohio Administrative Code Rule 3901-8-08 begins only in the first month you are both 65 or older and enrolled in Part B.5 The rule doesn't cap under-65 premiums at a 65-year-old's rate or give a yearly switching window, and outside guaranteed issue it doesn't bar pre-existing-condition exclusions; insurers may sell but needn't.5

A bill would change that, but it has not passed. House Bill 24 of the 136th General Assembly would require insurers that sell Medigap to people 65 and older to offer it to under-65 Medicare enrollees too. As of July 2026 the bill's own page still showed it introduced in the House and in House committee, and the Revised Code section it would create did not exist. It is not law.5

Most guaranteed-issue rights have no age limit, though. If an employer or state Medicaid plan that supplements Medicare ends or stops providing all those benefits, you can qualify before 65.15 The insurer then can't deny a policy it offers, price it on your health, or exclude pre-existing conditions, though only certain plans qualify.15 Our Ohio Medigap guide has the details.

So what can you actually do before 65?

• Medicare Advantage is the realistic alternative. Every Ohioan with Medicare has access to a Medicare Advantage plan, including one with a $0 monthly premium.1 An Advantage plan caps your annual in-network out-of-pocket spending, which is the main protection Medigap would have bought you.10
• Think hard before dropping employer or retiree coverage. If you have it, it may be doing the job Medigap can't be counted on to do here. Don't drop it expecting to buy a Medigap policy instead.
• Ask before you assume you're locked out. "Not required to sell" is not the same as "forbidden to sell," and Medicare's own guidance is to check with your state insurance department about what rights you have under state law.5 In Ohio that's the Department of Insurance, whose OSHIIP counselors (1-800-686-1578) answer questions free of charge about Medicare coverage for people under 65 with disabilities and educate consumers about Medicare supplement insurance.4,7
• Your real opening arrives at 65. When you turn 65 and are enrolled in Part B, your six-month Medigap Open Enrollment Period starts fresh, and insurers can't refuse you a policy or charge you more because of your health.15 Mark that date.

Help Paying for Medicare in Ohio

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Ohio runs the Medicare Savings Programs under the name Medicare Premium Assistance Programs, through Ohio Medicaid. Your county Department of Job and Family Services decides whether you qualify, and the programs pay some or all of your Medicare premiums and cost-sharing based on income.6

Every one of those figures is a ceiling on countable income, not on gross pay, and Ohio applies its disregards to your income rather than to the published limit. That is why each Ohio figure reads exactly $20 below Social Security's federal table (QMB there is $1,350 and $1,824): the $20 is the monthly SSI general income exclusion. Ohio also deducts the annual Social Security cost-of-living increase from your countable income each January until new poverty guidelines are published. So a benefit statement slightly above the table is not a disqualification. Social Security's QDWI limits ($5,405 individual, $7,299 couple) sit far higher because they also build in earned income disregards.6

QMB is the most generous, covering your premiums, deductibles, and coinsurance.6 Ohio keeps an asset test for these programs, and for QMB, SLMB, and QI the test is on your countable resources, not on everything you own: for 2026 they may not exceed $9,950 for one person and $14,910 for a couple, a limit indexed each year to inflation. QDWI, the fourth tier, uses a different and much lower limit of $4,000 for one person and $6,000 for a couple. Ohio's counting rules sit elsewhere in its Administrative Code, so don't assume a home or car counts against you. Two conditions sit outside the money tests: you have to be qualified for coverage under Medicare Part A, and QI-1 and QDWI applicants must also be otherwise ineligible for medical assistance. Ohio Medicaid cannot pay your premiums until you've enrolled in Part A or Part B through Social Security, and SLMB and QI-1 specifically require Part A; only QMB accepts Part B instead.6 Confirm with Ohio Medicaid or OSHIIP and apply rather than rule yourself out if you land somewhat over.

How to Apply for a Medicare Savings Program in Ohio

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, helps pay Part D premiums, deductibles, and copays for people with limited income and resources. Your deductible drops to $0 and your premium is covered up to a regional benchmark, so a pricier plan costs you the difference.19 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a married couple, the figures for the 48 contiguous states and DC (Alaska and Hawaii are higher). The limit rises if family members you support live with you.19
• Resource limits: $18,090 for an individual, $36,100 for a married couple living together. The lower $16,590 and $33,100 apply only if you tell Social Security none of your resources will go toward burial expenses. Your home and car don't count.19
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help6

Apply through Social Security at ssa.gov or call 1-800-772-1213.19 Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, where residents apply through their local Medicaid office instead.19

If You Have Both Medicare and Medicaid

Many people who have Medicare also qualify for Medicaid, and Ohio has rebuilt how those dual eligibles get care. The state now serves them through Next Generation MyCare, which replaced the older MyCare Ohio demonstration.20 Dual eligibility alone isn't enough: once the program reaches your county, you're in it if you have full Medicaid, Medicare Parts A, B and D, and are 21 or older, unless you're on PACE or a developmental disabilities waiver, or have other hospital-and-doctor coverage.20 A dual-benefit member gets their Medicare and Medicaid benefits from a single plan, which coordinates doctors, drugs, and long-term services and supports under one roof. Of its four plans, only Anthem Blue Cross and Blue Shield, CareSource, and Molina Healthcare of Ohio are open to members statewide; for 2026 Buckeye Health Plan is closed to new members and those coming from another MyCare Ohio plan, though current Buckeye members can stay.20

Next Generation MyCare launched January 1, 2026 in the 29 counties where MyCare Ohio already operated, and it rolls out to the rest of Ohio in phases from April through August 2026.20 If your needs are more intensive, the PACE program is another fully integrated option in parts of Ohio, and an integrated Dual Eligible Special Needs Plan may fit too. For the full picture, see our guide to Next Generation MyCare in Ohio.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. The key dates:21

Changes you make during Annual Open Enrollment take effect the following January 1.21 That's when most people review their plan and switch.

Free Medicare Help: Ohio OSHIIP

The Ohio Senior Health Insurance Information Program, or OSHIIP, gives free, objective Medicare information and one-on-one counseling, and it has been part of the Ohio Department of Insurance since 1992.4 OSHIIP has trained and certified more than 800 volunteers across the state.4

An OSHIIP counselor can help you:

• Understand your choices, from Original Medicare to Medicare Advantage4
• Compare plans, including Medicare Advantage, Part D, and Medicare supplement insurance (Medigap)4
• Learn about financial assistance programs for people with limited income4
• Get help with appeals4

Call the OSHIIP hotline at 1-800-686-1578.7 A local volunteer can meet with you in person or speak with you over the telephone.4

Key Medicare Contacts in Ohio

Keep these Ohio Medicare numbers handy.7,18,19,22

Learn More

Find personalized help comparing your Medicare options in Ohio at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.