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, more than 200 plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D donut hole is gone for good, and Ohio runs a free counseling service, OSHIIP, that compares your options with you at no cost.1,2

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 1-800-686-1578.2

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.1

The hospital deductible went up $60 from 2025.1 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. Original Medicare doesn't cover routine dental, vision, or hearing.1,6

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)1
• 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.7

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.6

Ohio is one of the better states for plan choice. About 2.56 million Ohioans are enrolled in Medicare for 2026, and the state offers roughly 212 Medicare Advantage plans, with some Ohio counties among the richest in the country for plan options. Nationally, more than half of eligible Medicare beneficiaries (55% in 2026) are now in a Medicare Advantage plan rather than Original Medicare.8

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. Ohio and Pennsylvania are the two states where the counties offering the most plan options are concentrated, as they have been for the last three years.8 Plan availability and pricing still differ by county, so two people in neighboring counties can see different menus.

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.1,6
• 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.6
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.6
• 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.6,1
• 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 plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost.

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).9
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 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.1 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.6

Ohio offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020.10 Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.1 Every Medigap policy sold in Ohio is guaranteed renewable, so an insurer can't drop you because your health changes.4

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 has to sell you any plan it offers at the standard rate regardless of your health.4

Ohio Has No General Birthday Rule

A few states, like California and Oregon, give every Medigap policyholder a yearly window to switch plans without new health questions, often called a birthday rule. Ohio does not.4 Once your six-month window closes, an insurer in Ohio can generally make you answer health questions before selling you a different Medigap policy. So your first six months on Medicare matter: that's when you have the strongest right to buy.

If You're Under 65 and on Medicare

People qualify for Medicare before 65 through disability, end-stage renal disease, or ALS. If that's you, here's the straight answer: Ohio does not give you a right to buy Medigap. Federal law doesn't require insurance companies to sell Medigap policies to people under 65, and Ohio has not added a requirement of its own. Ohio's Medigap open enrollment period, set by Ohio Administrative Code Rule 3901-8-08, begins only in the first month you are both 65 or older and enrolled in Part B.4 No Ohio law caps an under-65 buyer's premium at a 65-year-old's rate, bars pre-existing-condition exclusions for them, or gives them a yearly window to switch policies.4

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 it is still sitting in the House Insurance Committee: it has not been reported out of committee, has not passed either chamber, and is not law.4 If you find a page telling you Ohio already protects under-65 Medigap buyers, it is describing this bill as though it had passed. It hasn't.

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, and Ohio has 212 of them for 2026, with $0-premium plans available statewide.8 An Advantage plan caps your annual in-network out-of-pocket spending, which is the main protection Medigap would have bought you.6
• 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.4 In Ohio that's the Department of Insurance, whose OSHIIP counselors (1-800-686-1578) will tell you free of charge whether any carrier is currently offering an under-65 policy and what it would cost.2
• 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 must sell you any plan they offer at the standard rate regardless of your health.4 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.5

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 Ohio's standards read $20 lower than Social Security's federal tables for the same tiers, which state QMB at $1,350 and $1,824, SLMB at $1,616 and $2,184, and QI at $1,816 and $2,455: 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 the new federal poverty guidelines are published. So a paycheck or benefit statement slightly above the number in the table is not a disqualification. For QDWI the gap is far wider than $20: Social Security states its QDWI income limits as $5,405 for an individual and $7,299 for a couple, because those figures incorporate earned income disregards in addition to the $20.5

QMB is the most generous, covering your Part B premium and your deductibles and coinsurance, which can mean thousands of dollars saved a year. 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. What Ohio counts and what it excludes is set elsewhere in the Administrative Code, so don't assume any particular asset, a home or a car included, is counted 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 begin paying your premiums until you have enrolled in Part A or Part B through Social Security.5 Ohio's income standards follow the annual federal poverty guidelines, and the 2026 ones took effect March 1, 2026, after HHS updated those guidelines on January 14, 2026. Neither the income nor the resource figure is an absolute cutoff, because states can disregard certain income and resources. 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, pays Part D premiums, deductibles, and copays for people with limited income and resources.12 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)12
• Resource limits: $16,590 for an individual, $33,100 for a married couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses12
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help5

Apply through Social Security at ssa.gov or call 1-800-772-1213.12 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.12

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.13 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. Ohio Medicaid originally selected four plans to run it, but for 2026 the statewide choices open to new members are Anthem Blue Cross and Blue Shield, CareSource, and Molina HealthCare of Ohio. The fourth, Buckeye Health Plan, is not an option for new members in 2026 and is not available in Belmont or Ashtabula counties.13

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 2026.13 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:14

Changes you make during Annual Open Enrollment take effect the following January 1.14 That's when most people review their plan and switch.

Free Medicare Help: Ohio OSHIIP

You don't have to figure this out by yourself, and you don't have to pay a broker to help. Ohio's Ohio Senior Health Insurance Information Program, or OSHIIP, gives free, unbiased Medicare counseling. It has been part of the Ohio Department of Insurance since 1992 and works through hundreds of trained volunteers across the state.2

An OSHIIP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• Work out how Medicare fits with Medicaid if you have both

Call 1-800-686-1578 and you'll reach OSHIIP or a local volunteer counselor.2

Key Medicare Contacts in Ohio

Keep these numbers handy as you compare plans, apply for help, and sort out coverage in Ohio.2

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.