The Ohio Health Insurance Exchange offers individuals, business owners and families the opportunity to purchase affordable coverage with the help of a federal tax subsidy and guaranteed-approval of submitted applications. Easily, you can shop for quality Ohio medical benefits at the cheapest available rates, either on or off the Marketplace. There are no exclusions, waiting periods or surcharges for pre-existing conditions. We do the shopping so you save. You can also select non-Obamacare Marketplace options. New plans created by the current Administration and the Department of Health and Human Services (HHS) may become available in 2019.
Affordable Senior Supplement, Advantage, and Part D prescription drug plan options are also offered through a separate Open Enrollment. For applicants that have reached age 65 and are eligible for Medicare, standardized Medigap options can reduce potential out-of-pocket expenses. A "High Deductible" Plan F is offered along with more comprehensive plans, such as F and G. The three types of underwriting are issue-age rated, attained-age rated, and community-rated (no age). Issue-age rating locks in the rate at the age you apply for coverage. Any premium increases will be based on inflation, instead of getting older.
In less than a minute, you can easily compare the companies that offer the lowest prices for Open Enrollment Exchange plans. You can not be denied for medical reasons, and we help you with the enrollment process. You don't have to worry about the constant glitches and delays that many persons previously experienced on the .gov website. The application process is now much more streamlined, and typically takes less than 15 minutes. And if your household income is limited, you may be eligible for Medicaid or CHIP benefits.
Did you miss Open Enrollment? We show you stopgap plans that cover you throughout the year. Many "short-term" options are available from major carriers (UnitedHealthcare, National General, Standard Life, HCC Life, and Medical Mutual generally have the most competitive prices). Coverage can be approved within 24 hours, and benefits will be effective immediately. However, temporary contracts generally do not pay for pre-existing conditions and are not eligible for instant federal tax credits. Depending on the company, preventative benefits (routine annual physicals, mammograms, OBGYN visits) may not be 100% covered.
Special Enrollment Periods (SEP) are available at any time if you have lost existing "credible" coverage, move to a different service area, get divorced, have a child, or have a major household income change. There are also several additional "qualifying life event" situations that will allow you to obtain coverage at any time of the year. When you qualify for an exemption, all Marketplace plans in your area are available, and a federal subsidy will apply if you meet household income guidelines. However, for example, moving from Beachwood to Shaker Heights, Kettering to Centerville, Gahanna to Dublin, or Madeira to Norwood, would not qualify as an exception.
Which Ohio Health Insurance Companies Offer Marketplace Plans?
For plans for persons under age 65, participating carriers include Anthem Blue Cross, Aultcare, Ambetter (From Buckeye Health), Medical Mutual, CareSource, Molina, Oscar, Paramount, and SummaCare. Humana, Premier, Assurant, HealthSpan, InHealth, and Celtic previously offered private plans but no longer are active writers in the state. UnitedHealthcare and Aetna also are not offering 2018 private plans because of large underwriting losses. Anthem BC currently only offers plans in one county.
Many additional companies offer affordable Medicare Supplement (Medigap) plans, including AARP, Aetna, Colonial Penn, Equitable, Gerber, Humana, Liberty National, Medical Mutual, Omaha, Physician's Mutual, Pekin Life, State Farm, Summa, Thrivent, United American, and USAA. Of course, many of the companies that offer coverage to persons under age 65, also offer Senior plans. "Advantage" contracts are also available, and can include drug and prescription benefits. Medicare Supplements are a popular option for consumers that need to reduce out-of-pocket expenses, including copays, coinsurance, and Part A and B deductibles. Medigap Open Enrollment begins on October 15th and ends on December 15th. NOTE: A seven-month enrollment period surrounding your 65th birthday allows you to sign up for Parts A and B.
Premier (located in the Dayton area) offers Senior Medicare coverage in Montgomery, Miami, Preble, Greene, and Warren Counties, and other surrounding areas. Miami Valley Hospital and its affiliates are key components in their servicing area and network. The Senior Medigap service area includes the following counties: Mercer, Auglaize, Logan, Shelby, Darke, Miami, Champaign, Clark, Preble, Montgomery, Greene, Fayette, Clinton, Warren, Butler, and Highland.
Many companies also offer short-term (see above) "off-Exchange" plans. These types of policies may NOT include "essential health benefits" and are therefore not be considered qualified options. Thus, you may be required to pay an Obamacare tax (2.5% of household income) because you did not purchase the type of medical coverage that is required. Several carriers offer specialized options, including critical-illness and accidental expense contracts, that are designed to reduce the expenses of high deductibles and out-of-pocket costs. However, often these types of policies only offer "fixed benefits" for serious illnesses, which can leave large out-of-pocket cost obligations.
HCC Life, UnitedHealthcare, National General, and IHC Group also feature temporary plans that are not compliant with ACA regulations, but should be considered if you are not eligible for a special enrollment period. You can choose from a wide range of deductibles ($250 to $10,000) with several coinsurance options. These plans are not long-term solutions, but will prevent a catastrophic claim from taking most of your assets. You may contact us for additional specific details. Benefits from $250,000 to $2 million are available. NOTE: Temporary plans should never be used to replace qualified benefits. Although inexpensive, contracts can be non-renewed if serious health conditions appear. Also, several companies, offer both compliant Marketplace plans, and non-compliant short-term plans.
In some situations, there are affordable policies that can be purchased outside of the Marketplace that meet the "essential health benefits" requirement. Since subsidies will not be payed on these contracts, they are viable choices for families with household incomes that do not receive government financial aid. If you lack physicians or specialists in your area, these policies should also be considered since the number of participating doctors, hospitals, and facilities, may be higher than "on-Marketplace" policies. Occasionally, the rate is also slightly less.
For example, if you are single (Age 30 and no dependents) making more than $31,000, there's a very high probability that you don't qualify for a federal subsidy. Also, if your family consists of four persons (Ages 40, 40, 12, and 10), and your total household income is more than $100,000, you probably do not qualify for financial assistance. Therefore, selecting a policy away from the Marketplace will allow you to choose plans that may have larger provider networks. However, specific deductibles, copays, and maximum out-of-pocket costs will not vary from standard policies. Also, any person who is subsidy-eligible, can choose to enroll in a non-subsidized plan.
Shown below are sample households illustrating the monthly premium for 12 of the most popular and affordable plan options. Federal subsidies, if applicable, have been applied.
30 year-old living in Cincinnati (Hamilton County) with income of $24,000.
$58 -- MedMutual Market HMO 7350
$60 -- Molina Marketplace Bronze
$72 -- MedMutual Market HMO 6400 HSA
$72 -- Molina Marketplace Options Bronze
$75 -- CareSource Bronze
$88 -- MedMutual Market HMO 5250 HSA
$92 -- CareSource Bronze Dental And Vision
$98 -- CareSource HSA Bronze
$106 -- Ambetter Balanced Care 5
$111 -- CareSource Federal Simple Choice Bronze
$126 -- Ambetter Balanced Care 2
$127 -- CareSource Federal Simple Choice Bronze Dental And Vision
45 year-old couple (two persons) living in Dayton (Montgomery County) with income of $40,000.
$35 -- CareSource Bronze
$60 -- Molina Marketplace Bronze
$75 -- CareSource Bronze Dental And Vision
$90 -- CareSource HSA Bronze
$93 -- Molina Marketplace Options Bronze
$119 -- CareSource Federal Simple Choice Bronze
$159 -- CareSource Federal Simple Choice Bronze Dental And Vision
$226 -- CareSource Low Premium Silver
$266 -- CareSource Silver
$279 -- Ambetter Balanced Care 5
$299 -- CareSource Federal Simple Choice Silver
$299 -- Molina Marketplace Silver
50 year-old couple with two children (Total of four persons) living in Columbus (Franklin County) with income of $60,000.
$0 -- MedMutual Market HMO 7350
$2 -- MedMutual Market HMO 6400 HSA
$8 -- CareSource Bronze
$61 -- CareSource HSA Bronze
$75 -- MedMutual Market HMO 5250 HSA
$118 -- CareSource Federal Simple Choice Bronze
$196 -- CareSource Federal Simple Choice Bronze Dental And Vision
$326 -- CareSource Low Premium Silver
$402 -- CareSource Silver
$403 -- CareSource Low Premium Silver Dental And Vision
$482 -- MedMutual Market HMO 3500
$484 -- MedMutual Market HMO 2000/30
60 year-old married couple living in Cleveland (Cuyahoga County) with income of $50,000.
$86 -- CareSource Bronze
$123 -- Molina Marketplace Bronze
$153 -- CareSource Bronze Dental And Vision
$177 -- Molina Marketplace Options Bronze
$178 -- CareSource HSA Bronze
$227 -- CareSource Federal Simple Choice Bronze
$249 -- MedMutual Market HMO 7350
$333 -- MedMutual Market HMO 6400 HSA
Which Type Of Coverage Is The Cheapest?
Policies are available in four actuarial "Metal" categories. They are Platinum, Gold, Silver and Bronze. The cheapest policy is the Bronze option since it pays the least out-of-pocket expenses (expected). Unlike the Platinum option that covers 90% of expected expenses, the Bronze plan only covers 60%. The State Department Of Insurance regulates the policies although the Federal Government operates the Exchange (for now). It's possible in the future (perhaps in 2019) we'll operate our own program here in the Buckeye state, although tens of millions of extra dollars will be needed. Another variable is determining what changes the Trump Administration and Congress will implement.
Bronze deductibles are higher, and if you utilize the prescription benefits, you'll pay more. However, you also pay a lower premium, and that extra savings can be used to offset some of your higher expenses. This option is closely comparable to HDHP plans that have been "grandfathered" for many consumers. Silver plans are the second-least expensive policy and are ideal for Ohioans willing to pay a slightly higher premium to reduce deductibles and copays. Since maximum out-of-pocket expenses (MOP) are less than Bronze-tier contracts, they are better choices when the risk of meeting a deductible is higher.
NOTE: Silver tier contracts are the only policies that offer "cost-sharing," a special feature that lowers your out-of-pocket expenditures (deductibles,coinsurance, and copays) if your income is within specific ranges. Some popular "Silver" plans are listed later. Often, depending on your total household income, Silver-tier options are actually more cost-effective than either Gold or Platinum plans. Deductibles can reduce by thousands of dollars and maximum out-of-pocket costs can reduce from more $7,350 (maximum allowed) to less than $1,000. However, if your household income increases the following year, it may impact the amount of "cost-sharing."
A catastrophic plan is offered to consumers that may not be able to afford more expensive policies with the required mandated benefits. If you are under age 30, you can automatically qualify. If you are older than age 30, and there are no "affordable" plans available in your area, you will be able to buy this type of bare minimum coverage. Although the deductible is high ($7,350), the rates are typically cheap. Another method of qualifying is if you can prove "financial hardship." NOTE: These types of contracts are ineligible for subsidies, so if your income is below 400% of the Federal Poverty Level, another tier may be a better option. Also, specialist visits are often subject to a deductible, and not a copay, and non-generic prescriptions are also likely to be subject to a deductible.
The financial hardship exemptions that you are most likely to utilize, include recent death of a family member, bankruptcy filing within the last 180 days, large unpaid medical expenses in the last two years, individual plan was terminated and no other affordable options, and Medicaid ineligibility because of lack of state expansion. A few of the least-likely exemptions you might utilize are if you are if you are homeless, received a shut-off notice from your electric/gas company, or a recent victim of domestic violence.
Typically, we recommend a Bronze or Silver-tier option instead, since the coverage is much richer and the premium difference many not be substantial. 2018/2019 available catastrophic plan options are: AultCare Catastrophic, AultCare Catastrophic Select, Medical Mutual Market HMO Young Adult Essentials (Pro Medica, OhioHealth, Mercy, and NE Ohio), Oscar Simple Secure, and SummaCare Value. Although CareSource offers very attractive rates, their network is limited, and they do not offer catastrophic plans.
The Society of Actuaries has predicted that prices will continue to increase. They based this prediction by comparing the current average monthly premium of $223 to the projected premium of $420. Although rates did go up last year (and sharply for many individuals and families), the average increase was actually much lower than anticipated. However, for married persons 55 and over with no children in the household, price increases were the highest. For persons under age 35, prices only increased slightly.
The instant federal tax credit (subsidy) helps many consumers pay some of these increases. There are more than 150 plans offered, so broker and website assistance (which we provide free) is highly recommended. Each year, plans change, and often, you actually may be forced to switch policies because your existing contract no longer meets "Metal" guidelines. That is, the actuarial value (AV) changes and a new tier must be classified. Also, many companies discontinue plans at the end of the calendar year. Thus, you must either choose a similar plan with the same carrier, or pick an option with another company. We help you compare the best options and apply before the Open Enrollment deadline expires.
Also, occasionally, new carriers are approved to begin offering qualified coverage, and of course, companies also exit the market. For example, previously, Premier began offering policies in several counties in the Dayton and Cincinnati areas, but exited the market after two years. InHealth offered policies in Columbus and selected other areas but quickly became insolvent and exited. Both companies did not offer private plans prior to the creation of the Exchanges. CareSource previously offered Medicaid coverage, but they have now expanded their portfolio to include Marketplace options. Paramount is also a fairly new carrier that offers plans in Northwest Ohio. However, HealthSpan and Premier stopped writing policies and terminated all existing business.
What Are The Least Expensive Ohio Health Insurance Plans?
Listed below are many of the most affordable individual (and family) plans available for single persons or families. It is important to understand that not all plans are offered in all counties, and federal financial subsidies do not apply to "catastrophic" tier contracts. Also, as previously mentioned, catastrophic-tier contracts have unique eligibility requirements.
The "cheapest" option may not be the most cost-effective, depending upon many factors, including medications you take and yearly medical expenses. Please contact us before applying for coverage. We will review and compare the specific benefits and cost of your best options. The enrollment process typically takes only 15-25 minutes.
Medical Mutual Market Young Adult Essentials -- $40 pcp office visit copay for the first three visits. Deductible is $7,350 with 0% coinsurance.
Oscar Simple Secure -- $0 pcp office visit copay for the first three visits. Deductible is $7,350 with 0% coinsurance.
SummaCare Value -- $0 pcp office visit copay for the first three visits. Deductible is $7,350 with 0% coinsurance.
Molina Marketplace Bronze -- $35 and $80 pcp and specialist office visit copays. Deductible is $6,400 with $7,350 maximum out-of-pocket expenses with 40% coinsurance. Diagnostic tests, blood work, and x-rays also are subject to only a copay. Generic and preferred brand drugs receive $20 and $60 copays respectively.
Molina Marketplace Options Bronze -- $35 and $75 pcp and specialist office visit copays. Deductible is $6,650 with $7,350 maximum out-of-pocket expenses with 40% coinsurance. Generic drugs receive a $35 copay.
Medical Mutual Market HMO 7350 -- $50 copay for first pcp office visits. Specialist office visits must meet deductible. $7,350 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. One free annual eye exam for children is also provided.
Medical Mutual Market HMO 6400 HSA -- HSA-eligible option with $6,400 deductible and maximum out-of-pocket expenses of $6,400 and 0% coinsurance.
CareSource Bronze -- $35 pcp office visit copay. Deductible is $7,250 with maximum out-of-pocket expenses of $7,350 and 40% coinsurance. The generic drug copay is $25 ($62.50 for mail-order).
CareSource HSA Bronze -- HSA-eligible plan. Deductible is $4,000 with maximum out-of-pocket expenses of $6,550 and 50% coinsurance.
Oscar Simple Bronze -- Free calls to doctors. Deductible is $7,350 with 0% coinsurance.
SummaCare Bronze 5000 HSA -- HSA-eligible option with $5,000 deductible and maximum out-of-pocket expenses of $6,550 and 20% coinsurance.
AultCare Bronze 7350 Select -- Deductible is $7,350 with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. The generic drug copay is $25 ($62.50 for mail-order).
AultCare Bronze 6550 Select -- Deductible is $6,550 with maximum out-of-pocket expenses of $6,550 and 0% coinsurance.
Paramount Bronze 1 HSA -- HSA-eligible option with $6,650 deductible and maximum out-of-pocket expenses of $6,650 and 0% coinsurance.
Ambetter Balanced Care 5 -- $40 and $80 office visit copays with diagnostic tests and x-rays subject to deductible. Urgent Care copay is $100. $7,350 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. Generic and preferred brand drugs subject to $20 and $60 copays ($60 and $180 for mail-order). Non-preferred brand and specialty drugs must meet deductible.
Ambetter Balanced Care 2 -- $30 and $60 office visit copays with diagnostic tests and x-rays subject to deductible. $6,500 deductible with maximum out-of-pocket expenses of $6,500 and 0% coinsurance. Generic and preferred brand drugs subject to $15 and $50 copays. Non-preferred brand and specialty drugs must meet deductible.
Ambetter Balanced Care 1 -- $30 and $60 office visit copays with diagnostic tests and x-rays subject to deductible. $5,500 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Generic and preferred brand drugs subject to $15 and $50 copays.
Ambetter Balanced Care 10 -- $20 and $40 office visit copays with diagnostic tests and x-rays subject to deductible. Urgent Care copay is $100. $5,000 deductible with maximum out-of-pocket expenses of $6,700 and 20% coinsurance. Generic and preferred brand drugs subject to $10 and $50 copays ($30 and $150 for mail-order). Non-preferred brand and specialty drugs must meet deductible.
Molina Marketplace Silver Plan -- $30 and $75 office visit copays with $75 copay for Urgent Care visits. Diagnostic tests and x-rays are subject to $75 copay, and blood work is subject to a $40 copay. $4,950 deductible with maximum out-of-pocket expenses of $7,350 and 40% coinsurance. Tier 1 and Tier 2 drugs subject to $20 and $60 copays.
Molina Marketplace Options Silver Plan -- $30 and $65 office visit copays with $75 copay for Urgent Care visits. Diagnostic tests, x-rays, and blood work are subject to 20% coinsurance. $3,500 deductible with maximum out-of-pocket expenses of $7,350 and 20% coinsurance. Tier 1, 2, and 3 drugs subject to $15, $50, and and $100 copays.
Medical Mutual Market HMO 4000 HSA -- HSA-eligible option with $4,000 deductible and maximum out-of-pocket expenses of $4,000 and 0% coinsurance.
Medical Mutual Market HMO 3500 -- $25 and $75 office visit copays (first three visits) with $50 Urgent Care copay (also first three visits). $3,500 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Generic and preferred brand drug copays are $20 and $40 ($60 and $120 mail order).
SummaCare Silver 3000 With SCConnect -- First three pcp office visits are free, and then a $10 copay applies thereafter. Specialist copay is $55, with diagnostic tests and x-rays subject to 30% coinsurance. Deductible is $3,000 with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. Preferred generic, non-preferred generic, preferred-brand, and non-preferred brand drugs subject to copays of $5, $15, $50, and $100 respectively. Non-preferred brand drugs also must meet the deductible.
CareSource Low Premium Silver -- $20 and $40 office visit copays, along with $100 Urgent Care copay. $6,150 deductible with maximum out-of-pocket expenses of $7,300 and 15% coinsurance. Generic and preferred brand drug copays are $20 and $50 ($50 and $125 for mail-order).
CareSource Silver -- $10 and $50 office visit copays, along with $75 Urgent Care copay. $3,900 deductible with maximum out-of-pocket expenses of $7,300 and 30% coinsurance. Generic and preferred brand drug copays are $10 and $60 ($25 and $150 for mail-order). The non-preferred brand drug copays are $200 and $500.
CareSource Federal Simple Choice Silver -- $30 and $65 office visit copays, along with $75 Urgent Care copay. $3,500 deductible with maximum out-of-pocket expenses of $7,350 and 20% coinsurance. Generic, preferred brand, and non-preferred brand drug copays are $15, $50 and $100 ($37.50, $125, and $250 for mail-order).
SummaCare Silver 3000 SCConnect -- Full coverage for first three pcp office visits, and $10 copay for additional visits. $55 copay for specialist and $50 copay for Urgent Care visits. $3,000 deductible with $7,150 maximum out-of-pocket expenses. $5 and $15 copays for preferred generic and non-preferred generic drugs. $50 copay for preferred brand drugs.
AultCare Silver 6849 Select -- $10 and $25 office visit copays (maximum four combined visits), along with $75 Urgent Care copay. $6,849 deductible with maximum out-of-pocket expenses of $6,849 and 0% coinsurance. Generic and preferred brand drug copays are $10 and $20 ($30 and $55 for mail-order). Tier 3 and Tier 4 drug copays are subject to the deductible.
AultCare Silver 4999 Select -- $35 and $50 office visit copays (maximum four combined visits), along with $75 Urgent Care copay. $4,999 deductible with maximum out-of-pocket expenses of $6,000 and 40% coinsurance. Generic and preferred brand drug copays are $10 and $20 ($30 and $55 for mail-order). Tier 3 and Tier 4 drug copays are $45 and $50 ($125 and $150 for mail-order).
Oscar Classic Silver -- Free calls to doctors. $50 and $75 office visit copays, along with $100 Urgent Care copay. Deductible is $4,500, with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. Generic and preferred brand drug copays are $15 and $100 ($37.50 and $250 mail order).
Oscar Saver Silver -- Free calls to doctors. HSA-compatible. Deductible is $5,000, with maximum out-of-pocket expenses of $5,000 and 0% coinsurance.
Molina Marketplace Gold Plan -- $10 and $35 office visit copays with $60 copay for Urgent Care visits. Diagnostic tests and x-rays are subject to $35 copay, and blood work is subject to a $15 copay. $3,800 deductible with maximum out-of-pocket expenses of $7,350 and 20% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $50 copays, while Tier 3 and Tier 4 drugs are subject to 30% coinsurance.
CareSource Gold -- $10 and $50 office visit copays, along with $75 Urgent Care copay. $1,500 deductible with maximum out-of-pocket expenses of $5,000 and 20% coinsurance. Generic and preferred brand drug copays are $10 and $50. Non-preferred brand drugs have a $200 copay.
Ambetter Secure Care 1 -- First three pcp office visits are free with diagnostic tests and x-rays subject to coinsurance and deductible. $1,000 deductible with maximum out-of-pocket expenses of $6,350 and 20% coinsurance. Generic and preferred brand drugs subject to $10 and $25 copays ($30 and $75 for mail-order). Non-preferred brand drug copays are $75 and $225.
Medical Mutual Market HMO 2000/25 -- $25 and $75 office visit copays with $50 copay for Urgent Care. Deductible is $2,000 with $7,350 maximum out-of-pocket expenses and 20% coinsurance. Generic and preferred brand drug copays are $20 and $40 ($60 and $120 for mail-order).
SummaCare Gold 750 SCConnect -- Full coverage for first three pcp office visits, and $10 copay for additional visits. $50 copay for specialist and Urgent Care visits. $750 deductible with $7,150 maximum out-of-pocket expenses. $5 and $15 copays for preferred generic and non-preferred generic drugs. $50 copay for preferred brand drugs.
AultCare Gold 350 -- $25 and $45 office visit copays, along with $75 Urgent Care copay. $350 deductible with maximum out-of-pocket expenses of $6,350 and 25% coinsurance. Generic and preferred brand drug copays are $10 and $20 ($30 and $55 for mail-order). Tier 3 and Tier 4 drug copays are $45 and $50 ($125 and $150 for mail-order).
Oscar Classic Gold -- Free calls to doctors. $25 and $50 office visit copays, along with $100 Urgent Care copay. Deductible is $1,500, with maximum out-of-pocket expenses of $7,350 and 20% coinsurance. Generic and preferred brand drug copays are $10 and $50 ($25 and $125 mail order).
Is The Government Paying Part Of My Premium?
Ohio health insurance rates, like other states, will be reduced, if you qualify for the immediate tax credit (subsidy). Here's how it works: Individuals and families that have incomes between 100% and 400% of the Federal Poverty Level (FDL), and who buy an "Exchange" policy are eligible for assistance. Medicare and Medicaid recipients are not eligible. If you miss Open Enrollment and are not eligible for a special exception, you probably will not be eligible for a subsidy. However, you can buy "short-term" coverage to help cover larger potential medical claims until the next OE period begins. Temporary plans, although very inexpensive, do not offer unlimited coverage, and are also medically underwritten.
The tax subsidies immediately reduce your premium. Unlike a normal credit, you don't have to wait for a refund to use the money. Based on current FDL levels, a 30-year-old (male or female) living in the Dayton area (Montgomery County) that makes $35,000 per year, will not receive a subsidy. However, if their income is only $30,000, they will receive approximately $60. $20,000 of income provides a subsidy of about $1,548. However, subsidies can vary, depending on your county of residence. For instance, if the same person lived in the Cincinnati area (Hamilton County), the subsidies would be $240 and $1,728. In the Toledo area, the subsidies would be $36 and $1,536.
For a family of four (husband and wife age 40 and two children) with a household income of $60,000, the subsidy will be $5,940, or about $495 per month. For this example, we assumed the family lived in Franklin County. Of course, a "Bronze" plan costs less, but would involve more out-of-pocket risk. Once this family income reaches about $98,000, they are no longer eligible for financial assistance. However, larger families can qualify for subsidies with bigger incomes. Your MAGI (Modified Adjusted Gross Income) is used to determine eligibility.
When And How Do You Apply For A Policy?
Our website has direct links that make it easy for you to apply for coverage. Tax subsidies are automatically calculated so you know how much (if any) of the premium will be paid by the federal government. Open Enrollment begins in November each year and continues for 45 days. However, as previously mentioned, if you forget to apply for coverage, other options are available, including SEP exceptions and temporary plans. If you reach age 65 before October 15th, and are Medicare-eligible, you may enroll in an Ohio Medigap plan without proving insurability or answering medical questions.
Although the standard application has various questions, none are related to any medical condition you had in the past, or are currently being treated for. The vast majority of questions refer to members of the household and other administrative topics. If you qualify for a federal subsidy, some basic financial questions will be asked about your projected income. We're always available to help you fill out and complete the application. Choosing the most cost-effective plan may also require some assistance.
Can You Buy A Policy That Is Not Through The Exchange?
Yes. The provider list for Exchange plans is limited, compared to plans offered before Obamacare. In some situations, "off-Exchange" plans offer a wider selection of doctors and hospitals, and they may be a better solution for your specific situation. For example, many carriers have limited specialists and medical facilities available for their Marketplace options, but may offer broader network coverage for off-Exchange policies. Tip: If the carrier network has an "X" in the name, often that signifies it is an "on-Exchange" policy. However, many carriers utilize the same network for Group and private plans.
Prices for all plans are typically released in the late summer for the following calendar year. However, once released, the rates are guaranteed and can not increase until the next Open Enrollment begins. And occasionally, prices remain very stable, or slightly reduce. The State DOI receives filings from companies requesting rate changes, and determines how much (if any) of the proposed changes will be accepted. Prices for Senior products (Advantage and Supplement) are generally posted earlier, since the annual Open Enrollment period begins October 15th.
Are Rates The Same In All Areas Of The State?
The cost of healthcare in Ohio is different, depending upon which county you reside in. For example, prices in and around Columbus are typically less expensive than prices in Cleveland and Youngstown. Cincinnati pricing is different than Athens, Toledo, or Canton. It may not necessarily be as substantial as it once was, but there is still a variance. Typically, cities in the Northern counties are the most expensive. The least expensive areas are the counties surrounding Dayton, Columbus, and Cincinnati (Montgomery, Miami, Greene, Preble, Warren, Hamilton, Butler, and Clermont). However, many of the counties in the Columbus area (Franklin County) also offer attractive rates, including options from Medical Mutual.
Naturally, older persons will pay higher premiums and smokers will pay more, unless they quit for at least 12 months. But, as previously discussed, your pre-existing conditions (if applicable) will not impact what you pay. And you can not be denied for a medical issue. Whether you had cancer 10 years ago, or you were just diagnosed with heart disease or diabetes, it will not affect the premium. However, if you miss Open Enrollment, you may be forced to apply for a non-qualified plan, which could require medical questions to be answered. A denial of coverage is also possible.
Are HSA Plans Available?
They are available under "Bronze" and "Silver" tiers, which are the least expensive policy that is offered. These types of plans must meet a "60%" requirement (Plans must pay 60% of the average anticipated medical expenses for an applicant) with a maximum available deductible of $6,550. "Catastrophic" plans may also feature HDHP plans. Periodically, the maximum allowed deductible increases. An embedded deductible is permissible on family coverage, if that deductible is not lower than the minimum family deductible. Non-grandfathered Group plans also must offer embedded deductibles.
HSA plans have historically helped consumers become more cost-conscious with their spending, so their out-of-pocket costs reduce, and a tax-break is included. Coupled with the negotiated pricing that saves money, this type of option is always very popular. Listed below are several popular low-cost HSA plans in the Buckeye State. Not all policies are offered in every county, and many areas do not have an HSA available. Rates also will not be identical in different counties. Historically, prices in the Southwestern and Western portions of the state have offered the lowest prices.
CareSource HSA Bronze
Medical Mutual Market HMO 6400 HSA OhioHealth
Medical Mutual Market HMO 5250 HSA OhioHealth
Medical Mutual Market HMO 4000 HSA OhioHealth
Medical Mutual Market HMO 6400 HSA ProMedica
Medical Mutual Market HMO 5250 HSA ProMedica
Medical Mutual Market HMO 4000 HSA ProMedica
Medical Mutual Market HMO 6400 HSA Mercy
Medical Mutual Market HMO 5250 HSA Mercy
Medical Mutual Market HMO 4000 HSA Mercy
Oscar Saver Silver
Paramount Bronze 1 HSA
SummaCare Bronze 5000 HSA
Are There Special Plans For Self-Employed Persons?
Although there are not "special" options available, there are many policies that are very suitable if you work for yourself. For example, an HSA (previously mentioned) is designed to keep rates low, reduce your taxes, and allow you to accumulate money in a side-account. Additional HSA information online can be found on another page. You can also use these funds to pay for medical, dental, vision or long-term care benefits. Funds not used are never lost. You can allow them to continue to accumulate to be used by yourself or any other family member listed on your policy.
Certainly, many other plans can be utilized for persons that own their own business. Health insurance rates in Ohio are cheaper than most other states, so Buckeye State business owners sometimes have a competitive advantage. We are recognized experts on finding the best policies for single, family or business (small and large) situations. Please email or call. Instantly, we will review your best options and provide a written copy (sent or emailed). Group plans covering employees can also be viewed through the SHOP Exchange.
Ohio Senior Medical Insurance
If you have reached age 65, you are probably eligible for Medicare (not Medicaid!). Although benefits are comprehensive, and most Seniors don't incur high out-of-pocket expenses, Medigap Supplement policies and Advantage plans that replace Medicare, are very popular. They provide affordable options to reduce the cost of deductible, coinsurance, and copays, at a premium that makes financial sense. Policies can be canceled (by you) at any time, and there are many resources that help you compare the benefits and differences between plans.
Medigap contracts are issued by private insurers. Several of the major carriers that offer Senior supplemental plans include Aetna, UnitedHealthcare (AARP), Cigna, Kaiser, Blue Cross, Humana, and Transamerica. Applicants must be presently covered for Parts A and B, and policies are issued separately. Thus, a married couple must apply for two policies. Also, not all companies are licensed in every state, although all issued policies are guaranteed renewable, regardless of any past, present, or potential health conditions.
We also review and compare Senior policy options and free customized quotes are available by providing your zip code. Unlike private coverage for persons under age 65, enrolling in a supplementary plan is not mandatory, and not necessary if you are satisfied with the basic Medicare benefits that are provided. A separate Open Enrollment period typically runs from October 15th to December 7th. During this "Annual Enrollment Period," (AEP), you can change plans and carriers. Below, we have listed current estimated monthly prices for various plans in several of Ohio's largest metropolitan areas. Prices are for a 65 year-old female. Male rates can vary.
Cincinnati Rates -- Plan C
$127 -- Cigna
$129 -- Greek Catholic Union
$129 -- United World
$136 -- AARP-UnitedHealthcare
$145 -- Manhattan Life
$152 -- Individual Assurance
$152 -- Shenandoah Life
$154 -- CSI Life
$167 -- Humana
$176 -- Oxford Life
$181 -- Philadelphia American
$191 -- United American
$218 -- Gerber
Cincinnati Rates -- Plan F (High Deductible)
$30 -- United American
$36 -- New Era Life
$40 -- Cigna
$43 -- Medico
$52 -- Humana
$68 -- Pekin Life
Cincinnati Rates -- Plan N
$87 -- Transamerica
$88 -- Greek Catholic Union
$89 -- Manhattan Life
$91 -- Medico
$93 -- Individual Assurance
$93 -- Cigna
$94 -- Shenandoah Life
$95 -- United World Life
$98 -- CSI Life
$98 -- Humana
$101 -- Central States
$101 -- American Retirement Life
$101 -- AARP-UnitedHealthcare
$108 -- Combined Insurance
$122 -- Philadelphia American
$127 -- Equitable
$140 -- Oxford Life
$144 -- United American
Ohio Medicare Advantage Plans
"Advantage" plans have become very popular because of their low premiums and smaller deductibles. Shown below are several options from licensed and registered companies. Of course, all available plans should be reviewed before enrollment.
Advantage Plans Without Drug Coverage
AARP MedicareComplete Essential
MediGold Medical Only
Anthem MediBlue Access Core
Prime Time Health Plan Basic
HealthSpan Medicare Only Basic
Advantage Plans With Drug Coverage
AARP MedicareComplete Plans 1,2,3,4,5,6,7, and 8
Aetna Medicare Value Plan
Medigold Classic Preferred
Prime Time Health Plan Aultimate
UnitedHealthcare Assisted Living Plan
UnitedHealthcare Dual Complete
Aetna Medicare Select
Anthem MediBlue Access Enhanced
HealthSpan Medicare Plus 1,2,3 and 4
Additional Information And Past Updates:
About 60,000 applicants from here in Ohio have enrolled in the Marketplace through the end of January. These numbers are a bit lower than originally predicted, and match the lower than expected enrollments of young persons under age 35.
About 18 days remain in this year's Open Enrollment period. However, once the date expires (April 1), Buckeye residents will not necessarily have to wait until November to purchase a policy. There are several plans that can be purchased at any time throughout the year.
Temporary policies cost about 35%-75% less than conventional plans (without the subsidy), and can be kept for as long as one year. There are limitations, including a maternity exclusion, but it will provide up to $1 million of major medical coverage until you can enroll through the Marketplace again.
Ohio Open Enrollment for 2015 is less than five months away! It begins on November 15th and there will be numerous changes. Additional carriers will be offering policies (possibly Aetna and/or UnitedHealthcare) and rates are expected to only slightly increase. In specific areas, prices may actually reduce from 2014 levels. Tax subsidies will continue to reduce premiums and the noncompliance penalty for not enrolling is still in effect.
Anthem, Medical Mutual, Humana and HealthSpan are early favorites to have the most competitive pricing. As soon as the 2015 prices are posted, we'll discuss them with you.
Ohio is one of 15 states that have lowered the number of uninsured consumers. Almost 50,000 fewer persons went uncovered in 2013, according to figures from the US Census Bureau. The 2014 statistics will be available next Fall, and are expected to show a continuing trend, and possibly as many as 100,000 fewer persons without benefits.
"OneExchange," will administer the Medicare-eligible coverage for the Ohio Public Employees Program (OPERS) in 2016. About $150,000 persons and their spouses will be impacted. The change should result in a higher number of available options at a lower cost. Typically, persons enrolled in OPERS receive more than $300 per month to apply towards their medical plan selection.
2016 Ohio Marketplace rates have not been released yet. But the initial filings that were submitted last month indicate some increases are coming. We posted below several of the requests submitted by major companies.
19.56% -- UnitedHealthcare Off-Exchange Individual
17.84% -- Aetna HMO Small Group
17.29% -- HealthSpan Individual
16.99% -- Medical Mutual Individual
13.92% -- Medical Mutual Small Group
Assurant is in the process of exiting the US individual market and will not be offering policies next year. Existing Ohio customers will be able to change carriers without having to medically qualify.
Several companies are beginning to show signs that large financial losses may be looming. UnitedHealthcare, Humana, and HealthSpan are discouraging 2016 enrollments by eliminating all broker compensation for individual and family plan enrollments. Although the dollar amount involved is not substantial, it appears that a substantial amount of unanticipated claims may cost these carriers hundreds of millions of dollars.