The Medicare & Medicaid Center

Medicare, the United States Government Program, is a type of health insurance. It is generally provided automatically to citizens and permanent residents who are at least 65 years old.  Furthermore, people younger than 65 years old can receive Medicare government benefits for certain disabilities.

Medicare coverage can and will vary by your location.  Below are some highlights of Ohio Medicare coverage.

Ohio Medicare Doctor Office Visits

Ohio Medicare generally covers all medically required services provided by your doctor. These services can be provided in a hospital, the doctor’s office, a nursing home, or other location. 

Gynecological (GYN) exams and routine physical examinations are not covered by Ohio Medicare.  The Ohio Medicare topic on Pelvic Exams and Pap Tests provides further details.

Part B of Ohio Medicare is responsible for reimbursement of doctor visits.  The amount Ohio residents pay for a doctor visit is 20% of the amount approved by Medicare.  Ohio Medicare often covers 100% of laboratory service fees. 

Note that a resident covered by Ohio Medicare must first pay a $124 deductible (2006 amount) before Ohio Medicare benefits are activated.  The amounts Ohio residents pay for doctor visits may be higher if the chosen health care provider, medical supplier, or doctor does not accept assignment through Ohio Medicare.

Three LMRPs (Local Medical Review Policies) and a dozen NCDs (National Coverage Determinations) have been written to explain when certain Ohio Medicare supplies or services are covered.  The LMRPs and NCDs also explain when these services or supplies are considered to be “medically necessary.”  This information is available through the online Medicare Coverage Database at www.cms.hhs.gov.

The Golden Buckeye Program

The free Golden Buckeye Card is a discount card provided to Ohio citizens aged 60 years or older. Adults aged 18-59 years who suffer from disabilities as defined by Social Security are also eligible for this Ohio Medicare-approved card.

Ohio residents holding current, valid driver’s licenses or state ID cards automatically receive the card during the month of their 60th birthday.  Those Ohioans who do not receive it automatically can apply for it at libraries and similar locations.

The Golden Buckeye Card provides prescription drug savings at many Ohio pharmacies, and many Ohio merchants give discounts to cardholders.  Cardholders who do not have prescription drug coverage through Ohio Medicare (or some other carrier) can save an average of 24%, depending on the pharmacy and prescription.

The Ohio Medicare plan appears to be a helpful health insurance plan for Ohioans.  Those residents who are not covered by Ohio Medicare or similar plan can still save at the pharmacy via the Golden Buckeye card.