With Original Medicare
Original Medicare has no network. You can see any doctor, hospital or other provider in the United States that's enrolled in Medicare and accepting new Medicare patients. Participating providers accept assignment, meaning they take the Medicare-approved amount as full payment and you pay only your deductible and coinsurance. If you add a Medigap policy, it works with the same doctors, anywhere in the country, which helps Ohioans who winter in Florida or have family out of state.
Ohio's balance-billing law
Federal rules let a non-participating provider charge up to 15% above Medicare's approved amount for many services, called the limiting charge. Ohio doesn't allow that. Under Ohio Revised Code Chapter 4769, Ohio-licensed practitioners, from physicians and nurses to therapists, chiropractors, psychologists and pharmacists, can't charge a Medicare patient more than Medicare's rate for a covered service. When Medicare is your secondary insurance, the same limit applies to what you owe.
If you get a bill above Medicare's rate from an Ohio provider, ask the office to correct it. If it won't, the Ohio Department of Health takes complaints and can order the provider to repay you with interest. The law covers Ohio-licensed practitioners, so it may not help with a provider in another state.
With Medicare Advantage
Medicare Advantage plans use provider networks. In an HMO you usually must use network doctors, except in emergencies; in a PPO you can go out of network but generally pay more. CMS data show the number of Medicare Advantage plans open to everyone ranges from 22 in Scioto County to 68 in Summit County for 2027, and networks differ from plan to plan. If your plan is ending, see Ohio plans ending in 2027.
- List your doctors and hospitals. Include specialists you see only once or twice a year.
- Check each plan's provider directory. Then call each office to confirm it's in network for 2027.
- Find doctors who take Medicare. Use Medicare's Care Compare.
A licensed insurance agent who works with Benefits Life can check your doctors against plans from the companies they work with, at no cost to you. You can request a call from a licensed insurance agent, or see plans for your ZIP code. See also Medigap vs. Medicare Advantage in Ohio.
Related questions
Does Medicare cover mental health care?
Therapists, telehealth and costs.
Does Medicare cover eye exams and glasses?
What Part B covers for your eyes.
How do I choose a Medicare plan in Ohio?
Doctors, drugs and costs.
Sources
- Ohio Revised Code — Section 4769.01, Balance billing definitions
- Ohio Revised Code — Section 4769.02, Balance billing for supplies and services
- Ohio Revised Code — Section 4769.03, Disciplinary actions
- Medicare.gov — Does your provider accept Medicare as full payment?
- Medicare.gov — Care Compare
More questions in this guide
- Does Medicare cover assisted living in Ohio?
- Does Medicare cover dental in Ohio?
- Does Medicare cover diabetes supplies in Ohio?
- Does Medicare cover eye exams and glasses in Ohio?
- Does Medicare cover hearing aids in Ohio?
- Does Medicare cover home health care in Ohio?
- Does Medicare cover mental health care in Ohio?
- Does Medicare cover nursing home care in Ohio?
- How do I get rides to the doctor with Medicare in Ohio?
Part of the guide: Medicare basics for Ohioans · All questions
Frequently asked questions
Can an Ohio doctor charge me more than Medicare's rate?
Not for a Medicare-covered service. Ohio Revised Code 4769.02 bars Ohio-licensed health care practitioners from billing Medicare patients above the Medicare reimbursement rate, apart from your normal deductibles and coinsurance. You can complain to the Ohio Department of Health, which can order repayment with interest.
What if my doctor leaves my Medicare Advantage plan's network?
Providers can leave a network during the year. Your plan must tell you, and you can ask about continuing treatment. Your network doctors can change from year to year, so check the plan's provider directory every fall before Open Enrollment ends December 7.
What is an opt-out doctor?
Some doctors opt out of Medicare for at least two years and see Medicare patients only under a private contract. Medicare won't pay for their services except in emergencies, and Medigap won't pay either, so ask what you'll be charged before your visit.
Medicare in your Ohio county
Plans, local agents and help, county by county: Franklin · Cuyahoga · Hamilton · Summit · Montgomery · Lucas · Butler · Stark · Lorain · Warren · Delaware · Lake · Mahoning · Clermont · Trumbull · Licking · Medina · Greene · Fairfield · Portage · All 88 counties →
