The 2016 Ohio Health 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.
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 will help you with the enrollment process. You don't have to worry about the constant glitches and delays that many persons experience on the .gov website. The application process is now much more streamlined, and typically takes less than 20 minutes. If you are 65 or over, you are eligible for Medicare benefits. And if your household income is limited, you may be eligible for Medicaid.
Missed Open Enrollment? We'll show you stopgap plans that cover you throughout the year. Many "short-term" options are available from major carriers (UnitedHealthcare and Medical Mutual generally have the most competitive prices) that can be kept as long as 12 months. Special Enrollment Periods (SEP) are available at any time if you have lost existing coverage, move to a different area, get divorced, have a child, or have a major household income change. There are also several additional situations that will allow you to obtain coverage at any time of the year.
Which Ohio Health Insurance Companies Offer Marketplace Plans?
Participating carriers include Anthem Blue Cross and Blue Shield, Aetna, Ambetter (From Buckeye Health), Medical Mutual, CareSource, HealthSpan, Humana, InHealth, Molina, UnitedHealthcare, Paramount, Premier, and SummaCare. Assurant and Celtic previously offered private plans but no longer are active writers in the state. Many additional companies offer affordable Medicare Supplement (Medigap) plans, including AARP, Equitable, Liberty National, Omaha, Physician's Mutual, State farm, and USAA. Of course, many of the companies that offer coverage to persons under age 65, also offer Senior plans.
Premier (located in the Dayton area) offers coverage in Montgomery County and other surrounding areas. Miami Valley Hospital and its affiliates are key components in their servicing area and network. Even nearby counties such as Miami, Warren, Clark, Preble, Butler, and Greene are the home of some Premier providers. Although they have only offered individual coverage since 2014, their prices are extremely attractive in Dayton, Middletown, Kettering, Centerville, Oakwood, Franklin, Huber Heights, Tipp City, Vandalia, and Troy.
Many companies also offer short-term "off-Exchange" plans. These types of policies may NOT include "essential health benefits" and are therefore not be considered qualified options. Thus, you may have 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.
HCC Life 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 can email or call us for additional specific details. Benefits from $250,000 to $2 million are available.
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.
For example, if you are single (Age 30 and no dependents) making more than $32,000, 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 $98,000, 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.
Shown below are sample households illustrating the monthly premium for 10 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 $22,000.
$71 -- Molina Marketplace Bronze
$80 -- Ambetter Essential Care 1
$87 -- Ambetter Essential Care 5
$104 -- Ambetter Balanced Care 2
$108 -- Molina Marketplace Silver
$133 -- Aetna Bronze $15 Copay
$153 -- Humana Silver 3800
$166 -- Molina Marketplace Gold
$200 -- Humana Gold 2250
$201 -- Anthem Silver Pathway X 3000 10
45 year-old couple living in Dayton (Montgomery County) with income of $37,000.
$126 -- Premier Health One Bronze 6850
$139 -- Premier Health One Bronze 6500
$166 -- Molina Marketplace Bronze
$168 -- Ambetter Essential Care 1
$187 -- Ambetter Essential Care 5
$233 -- Ambetter Balanced Care 2
$244 -- Premier Health One Silver 4500/20
$270 -- Molina Marketplace Silver
$331 -- Anthem Silver Pathway X 4250 30
$404 -- Premier Health One Gold 1500
50 year-old couple with two children (Total of four persons) living in Columbus (Franklin County) with income of $55,000.
$148 -- CareSource Just4Me Bronze
$235 -- Aetna Bronze Deductible Only HSA
$302 -- UnitedHealthcare Bronze Compass HSA 5500
$307 -- Anthem Bronze Pathway X 5000 40
$321 -- Aetna Bronze $15 Copay
$337 -- Molina Marketplace Silver
$448 -- UnitedHealthcare Silver Compass HSA 3000
$499 -- Anthem Silver Pathway X 4250 30
$505 -- UnitedHealthcare Silver Compass 2000
$614 -- Molina Marketplace Gold
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 after 2018) we'll run our own program here in the Buckeye state, although tens of millions of extra dollars will be needed.
Bronze Deductibles are higher, and if you utilize the prescription benefits, you'll pay more. However, you do 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 than $6,000 to less than $1,000.
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, if 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 ($6,850), the rates are typically cheap. Another method of qualifying is if you can prove "financial hardship."
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 homeless, received a shut-off notice from your electric/gas company, and 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.
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.
The instant federal tax credit (subsidy) helps many consumers pay some of these increases. There are more than 200 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.
What Specific Plans Are The Least Expensive?
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 10-20 minutes.
Catastrophic Tier (Three Office Visits Per Year Allowed With No Deductible)
Humana Basic 6850 -- $25 office visit copay and $6,850 deductible. Only available in Dayton, Cincinnati and Cleveland areas.
InHealth Catastrophic-- $6,850 deductible with 100% coverage for first three office visits.
Medical Mutual Market Young Adult Essentials -- $40 office visit copay with $6,850 deductible.
Anthem Catastrophic Pathway X 6850 0 -- Very similar to Medical Mutual plan although slightly more expensive.
SummaCare Value -- Same deductible as other plans and first free pcp visits are free. Most expensive of all Catastrophic-tier plans.
Premier Health One Bronze 6850 -- Available in Dayton area only. $6,850 deductible with 100% coverage after deductible is met. $6,500 deductible is also available.
Premier Health One Bronze 6000/40 and 6000/35 -- $6,000 deductible with copays on pcp office visits ($50 for 6000/35 plan and $40 for 6000/35 plan). Coinsurance of 40% and 35% respectively.
Ambetter Essential Care 1 -- $6,800 deductible with no coinsurance.
Ambetter Essential Care 5 -- $6,800 deductible with three free pcp office visits.
Humana Bronze 6450 Dayton HMOx, Cincinnati/Northern Kentucky HMOx and Cleveland HMOx -- Available in three areas. $6,450 deductible and then 100% coverage.
Aetna Bronze Deductible Only HSA -- One of best HSA options in the state. $6,450 deductible with 0% coinsurance.
Molina Marketplace Bronze -- $5,000 deductible.
Anthem Bronze Pathway X 5000 40 -- $6,850 deductible and 40% coinsurance.
Aetna Bronze $15 Copay -- $6,850 deductible but low $15 copay on pcp visits (unlimited). Nice plan for families with several healthy children.
HealthSpan Select Bronze 4500-70 HSA -- Another HSA option with a $4,500 deductible and 30% coinsurance.
Is The Government Paying Part Of My Premium?
Ohio health insurance rates, like other states, will be reduced, if you qualify for the new 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. Medicaid and Medicaid recipients are not eligible.
The tax subsidies will 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) that makes %$50,000 per year, will not receive a subsidy. However, if their income is only $25,000, they will receive approximately $1,700. You will also find that some plans will be free!
For a family of four (husband and wife age 40 and two children) with a household income of $75,000, the subsidy will be $4,422, or about $370 per month. For this example, we assumed the family was applying for a "Silver" plan. Of course, a "Bronze" plan would cost less, but would involve more risk. Once the family income reaches about $95,000, you are no longer eligible for financial assistance.
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 will automatically be 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 three months. However, as previously mentioned, if you forget to apply for coverage, other options are available.
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 prior to 2014. 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.
Prices for these options have yet to be determined, but will be released shortly (check our website for quotes). Mandated essential benefits will have to be included, so coverage will not be an issue. But it's possible rates will be lower than Exchange plans if you don't qualify for a subsidy. The difference is likely to be in the 5%-20% range.
Will Rates Be The Same In All Areas Of The State?
The cost of healthcare in Ohio will be different, depending upon which county you reside in. For example, prices in and around Columbus are going to be less expensive than prices in Cleveland. Cincinnati pricing will be different than Athens. It may not necessarily be a substantial difference (as it once was), but there will be a variance. Typically, cities in the Northern counties may be the most expensive.
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 cancer, it will not affect the premium.
Will HSA Plans Be Available?
They will be available under "Bronze" plans, the least expensive policy that will be offered. These types of plans must meet a "60%" requirement (this means they are expected to pay 60% of the average anticipated medical expenses for an applicant) with a possible deductible of $6,000. "Catastrophic" plans may also feature HDHP plans.
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 will once again, be very popular.
Are There Special Plans For Self-Employed Persons?
Although there are not "special" options available, there are many policies that would work well 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.
Certainly, many other plans can be purchased since health insurance rates in Ohio are cheaper than most other states. We're experts on finding the best Marketplace policies for single, family or business situations. Quote, email or call. We'll try to help.
February 2014 -- 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.
March 2014 -- 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.
June 2014 -- 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.
October 2014 -- 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.
November 2014 -- "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.
July 2015 -- 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.
January 2016 -- 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.