The Ohio Health Insurance Marketplace 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-Exchange. 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. Newer plans created by the current Administration and the Department of Health and Human Services (HHS) may become available next year.
Affordable 2024 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 G is offered ($2,800 deductible) along with more comprehensive plans, such as F and G. A "High Deductible" Plan F option is also available for existing Medicare applicants. 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 changes in age.
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. Multiple plans can be easily compared, and the instant tax credit is immediately applied to the premium. An initial payment is not required.
And if your household income is limited, you may be eligible for Medicaid or CHIP benefits. Eleven companies offer Marketplace coverage, and only five counties offer less than three carriers (Ashland, Knox, Monroe, Washington, Meigs, and Gallia). 29 counties have two available companies and the remaining counties have three or more participating companies. Recently, Oscar and Anthem have been expanding coverage in additional counties. UnitedHealthcare has returned to the Ohio Exchange, and also in several other states including neighbor Pennsylvania.
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, Anthem, and Companion Life 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 2024 plans for persons under age 65, participating carriers include UnitedHealthcare, Anthem Blue Cross, Aultcare, Ambetter (From Buckeye Health), Medical Mutual, CareSource, Molina, Oscar Insurance, Oscar Buckeye State, 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 private plans because of previous large underwriting losses. Anthem BC currently offers coverage in 25 counties, up from only one county two years ago. Additional counties may be added in the near future. Molina Marketplace Ohio plans have become very popular because of their low rates and increased service area. Sidecar Health offers off-Exchange contracts.
Many companies offer affordable Medicare Supplement plans in Ohio, including Mutual Of Omaha, Humana, AARP-UnitedHealthcare, Medical Mutual, Manhattan Life, Union Security, United American, New Era Life, Medico, Elips Life, Continental Life, United States Fire, Bankers Fidelity, United States Fire, Capitol Life, Accendo, Central States, Paramount, Sentinel Security, National Health, Great Southern Life, and GPM Health.
Many of the companies that offer coverage to persons under age 65, also offer Senior plans. "Advantage" contracts are also available, and often include drug and prescription benefits. Several MA plans in Ohio with $0 monthly premiums include AARP Medicare Advantage Patriot (no Rx coverage), AARP Medicare Advantage Choice, AARP Medicare Advantage Flex Plan 6, Aetna Medicare Eagle (no Rx coverage), Aetna Medicare Premier, Aetna Medicare Value, Aetna Medicare Value Plan, Anthem MediBlue Service (no Rx coverage), Anthem MediBlue Access Core (no Rx coverage), Anthem MediBlue Preferred, Anthem MediBlue Access Core (No Rx coverage), and Anthem Veteran (No Rx coverage).
Also, Cigna Preferred Medicare, Cigna Preferred Savings Medicare, Cigna True Choice Medicare, Devoted Choice Ohio, Defeated CORE Ohio, Essence Advantage, Essence Advantage Choice, Humana Gold Plus, Humana USAA Honor (no Rx coverage), MedMutual Advantage Classic, MedMutual Advantage Access, MedMutual Advantage Signature, Molina Medicare Choice Care, Mount Carmel MediGold Cash Back No Premium MA Only (No Rx coverage), Paramount Elite Essential, Paramount Elite Courage (No Rx coverage), Paramount Elite Prevail (No Rx coverage), SummaCare Medicare Amber, The Health Plan SecureChoice Optimum, Wellcare Giveback, Wellcare No Premium, Wellcare No Premium Open, and Wellcare Dividend Giveback.
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 without answering medical questions.
Premier (located in the Dayton area) previously offered Senior Medicare and Marketplace coverage in Montgomery, Miami, Preble, Greene, and Warren Counties, and other surrounding areas. Miami Valley Hospital and its affiliates were key components in their servicing area and network. The Senior Medigap service area included the following counties: Mercer, Auglaize, Logan, Shelby, Darke, Miami, Champaign, Clark, Preble, Montgomery, Greene, Fayette, Clinton, Warren, Butler, and Highland. Although the Premier Network is still active, they no longer offer healthcare plans.
Premier Health Partners With Miami Valley Hospital In SW Ohio
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. However, you are not required to pay the outdated 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.
Often these types of policies only offer "fixed benefits" for serious illnesses, which can leave large out-of-pocket cost obligations. Also, instead of unlimited annual and lifetime limits, caps are typically imposed. The most common lifetime caps are between $500,000 and $2 million. Large copays and coinsurance are often policy features, and waiting periods may also be required for specific expenses.
HCC Life, UnitedHealthcare, Anthem, Allstate, 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.
Temporary plans should never be used to replace qualified benefits. Although inexpensive, contracts can be non-renewed if serious health conditions appear. Previously, several companies, offered both compliant Marketplace plans, and non-compliant short-term plans. UnitedHealthcare offers temporary plans through its subsidiary "Golden Rule." Initially, when the Exchanges were created, UHC also offered Marketplace plans.
Off-Marketplace 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. The offered policies are typically identical to their Marketplace counterpart plans.
For example, if you reside in Cincinnati, and are single (Age 30 and no dependents) making less than $49,000, there's a very high probability that you 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 less than $174,000, you also probably qualify for financial assistance. Selecting a policy away from the Marketplace will allow you to choose plans that may have larger provider networks. However, deductibles, copays, and maximum out-of-pocket costs may be higher than Exchange plan options.
Current Ohio Health Insurance Rates
Shown below are sample households illustrating the monthly premium for popular and affordable plan options. Federal subsidies, if applicable, have been applied.
30 year-old living in Cincinnati (Hamilton County) with income of $31,000
$15 -- Ambetter Clear Bronze
$20 -- Medical Mutual Market HMO 9100
$24 -- Medical Mutual Market HMO Standard Bronze
$25 -- Medical Mutual Market HMO 8000
$27 -- Anthem Bronze Pathway X HMO 9100
$28 -- Anthem Bronze Pathway X HMO 9100/0% Standard
$28 -- Ambetter Virtual Access Bronze
$66 -- Ambetter Essential Care 10
$29 -- Ambetter CMS Standard Expanded Bronze
$33 -- Anthem Bronze Pathway X HMO 6000
35 year-old married couple with one child (Total of three persons) living in Toledo (Lucas County) with income of $55,000
$1 -- CareSource Marketplace Bronze
$41 -- CareSource Marketplace Bronze First
$85 -- Paramount Bronze 2 HRA
$145 -- Caresource Marketplace HSA Eligible Bronze
$159 -- Molina Constant Care Silver 7 250
$168 -- Paramount Bronze 1 HSA
$174 -- Molina Constant Care Silver 4 250
$178 -- Ambetter Essential Care 1
$180 -- Molina Constant Care Silver 4 250
$182 -- Molina Constant Care Silver 1 250
45 year-old couple (two persons) living in Dayton (Montgomery County) with income of $50,000.
$30 -- Anthem Bronze Pathway X HMO 8700
$47 -- Anthem Bronze Pathway X HMO 6000
$60 -- Anthem Bronze Pathway X HMO 5000
$70 -- Anthem Bronze Pathway X HMO 6000 20 for HSA
$73 -- Anthem Bronze Pathway X HMO 6850 0 for HSA
$80 -- Anthem Bronze Pathway X HMO 5500
$151 -- Medical Mutual Market HMO 8700
$154 -- Medical Mutual Market HMO 8000
$179 -- Medical Mutual Market HMO 7000 HSA
$199 -- Anthem Bronze Pathway X HMO 6000 20 for HSA
50 year-old couple with two children (Total of four persons) living in Columbus (Franklin County) with income of $75,000.
$0 -- Oscar Bronze Simple
$0 -- Oscar Bronze Classic
$37 -- Oscar Bronze Classic -- $4700 Ded
$44 -- Oscar Bronze Classic -- $0 PCP
$51 -- Anthem Bronze Pathway X HMO 8700
$87 -- Oscar Bronze Simple HSA
$87 -- Anthem Bronze Pathway X HMO 6000
$114 -- Anthem Bronze Pathway X HMO 5000
$132 -- Oscar Bronze Classic -- $3000 Ded
$134 -- Anthem Bronze Pathway X HMO 6000 20 for HSA
60 year-old married couple living in Cleveland (Cuyahoga County) with income of $50,000.
$33 -- CareSource Marketplace Bronze
$95 -- CareSource Marketplace Bronze First
$201 -- Ambetter Essential Care 1
$204 -- Molina Constant Care Silver 7 250
$228 -- Molina Constant Care Silver 4 250
$236 -- Molina Constant Care Silver 4 250
$239 -- Molina Constant Care Silver 1 250
$257 -- Caresource Marketplace HSA Eligible Bronze
$264 -- Ambetter Essential Care 10
$302 -- Ambetter Essential Care 5
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 2023) 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 current Administration (or future Administrations) 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 $9,100 (maximum allowed) to less than $1,000. However, if your household income increases the following year, it may impact the amount of "cost-sharing."
Catastrophic Options
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 ($8,550), 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.
Bankruptcy Qualifies For A "Financial Hardship" Exemption
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. Several 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. Available catastrophic plan options are: Medical Mutual Market HMO Young Essentials, Anthem Catastrophic Pathway X HMO 8550, and Oscar Secure Free.
Although CareSource offers very attractive rates, their network is sometimes limited, and they do not offer catastrophic plans. However, their market share has been steadily increasing in the Buckeye State and Indiana.
Future Rates
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 100 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. HealthSpan (affiliated with Kaiser) offered plans only a few years. Each of the three 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 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, catastrophic-tier contracts have specific 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.
Catastrophic Tier
Medical Mutual Market HMO Young Adult Essentials -- $40 pcp office visit copay for the first three visits. Deductible is $9,100 with 0% coinsurance.
Anthem Catastrophic Pathway X HMO 9100 -- $40 pcp office visit copay for the first three visits. Deductible is $9,100 with 0% coinsurance.
Oscar Secure -- $50 pcp office visit copay for the first pcp office visit. Deductible is $9,100 with 0% coinsurance.
SummaCare Value -- Deductible is $8,700 with 0% coinsurance.
Bronze Tier
Medical Mutual Market HMO 9100 -- $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Medical Mutual Market HMO 8000 -- $40 and $80 office visit copays. Deductible is $8,000 with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. The generic drug copay is $30 ($90 for mail-order). Urgent Care copay is $80.
Medical Mutual Market HMO 7000 HSA -- HSA-eligible option with $7,000 deductible and maximum out-of-pocket expenses of $7,000 and 0% coinsurance.
Anthem BCBS Bronze Pathway X HMO 9100 -- Deductible is $9,100 with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Anthem BCBS Bronze Pathway X HMO 9100/0% Standard -- Deductible is $9,100 with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Anthem BCBS Bronze Pathway X HMO 6000 -- $50 pcp office visit copay for the first three visits. Deductible is $6,000 with maximum out-of-pocket expenses of $9,100 and 35% coinsurance.
Anthem BCBS Bronze Pathway X HMO 5000 -- $50 pcp office visit copay for the first three visits. Deductible is $5,000 with maximum out-of-pocket expenses of $9,100 and 40% coinsurance.
Anthem BCBS Bronze Pathway X HMO 5500 -- $50 pcp office visit copay. Deductible is $5,500 with maximum out-of-pocket expenses of $9,100 and 30% coinsurance. $20 generic drug copay ($60 mail order) and $50 Urgent Care copay.
CareSource Marketplace Bronze -- Deductible is $9,100 with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
CareSource Marketplace Bronze First -- $40 and $80 office visit copays. Deductible is $8,000 with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. The low-cost drug copay is $20 ($50 for mail-order). $50 copay for lab tests. $80 Urgent Care copay.
Ambetter Clear Bronze -- Deductible is $8,600 with maximum out-of-pocket expenses of $8,600 and 0% coinsurance. The preferred generic and generic drug copays are $5 and $25.
Ambetter Virtual Access Bronze -- Deductible is $7,000 with maximum out-of-pocket expenses of $8,550 and 50% coinsurance. $85 pcp office visit copay. $85 Urgent Care copay. The preferred generic and generic drug copays are $5 and $30 ($12.50 and $45 for mail-order). $75 copay for lab tests.
Ambetter CMS Standard Expanded Bronze -- $50 and $100 office visit copays. Deductible is $7,500 with maximum out-of-pocket expenses of $9,000 and 50% coinsurance. The generic drug copay is $25 ($62.50 for mail-order). $75 Urgent Care copay.
Ambetter Choice Bronze HSA -- HSA-eligible plan. Deductible is $6,900 with maximum out-of-pocket expenses of $6,900 and 0% coinsurance.
Ambetter Everyday Bronze -- $40 and $90 office visit copays. Deductible is $8,300 with maximum out-of-pocket expenses of $8,700 and 50% coinsurance. The preferred generic and generic drug copays are $5 and $30 ($12.50 and $75 for mail-order). $50 copay for lab tests. $50 Urgent Care copay.
Oscar Bronze Simple-Standard -- Deductible is $9,100 with maximum out-of-pocket expenses of $9,100 and 0% coinsurance. $3 and $30 Tier 1A and Tier 1B drug copays ($7.50 and $75 mail order).
Oscar Bronze Simple Select -- Deductible is $8,500 with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $75 Urgent Care copay. $3 and $30 Tier 1A and Tier 1B drug copays ($7.50 and $75 mail order).
Oscar Bronze Simple HSA -- HSA-eligible plan. Deductible is $5,200 with maximum out-of-pocket expenses of $7,450 and 50% coinsurance. $50 and $90 office visit copays subject to the deductible.
Oscar Bronze Classic Select -- Deductible is $7,750 with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $3 and $30 Tier 1A and Tier 1B drug copays ($7.50 and $75 mail order).
SummaCare Bronze 8000 -- $8,000 deductible with maximum out-of-pocket expenses of $8,700 and 50% coinsurance.
SummaCare Bronze 87000 -- $0 copay for first three pcp office visits and $30 copay thereafter. $8,700 deductible with maximum out-of-pocket expenses of $8,700 and 0% coinsurance.
Aultcare Bronze 8550 Select -- Deductible is $8,550 with maximum out-of-pocket expenses of $8,550 and 0% coinsurance.
Aultcare Bronze 8250 Select -- Deductible is $8,250 with maximum out-of-pocket expenses of $8,250 and 0% coinsurance.
Silver Tier
Ambetter Balanced Care 31 -- $60 Urgent Care copay. $5,450 deductible with maximum out-of-pocket expenses of $6,450 and 10% coinsurance.
Ambetter Balanced Care 30 -- $6,100 deductible with maximum out-of-pocket expenses of $6,100 and 0% coinsurance.
Ambetter Balanced Care 32 -- $45 and $100 office visit copays with lab tests subject to $50 copay. $60 Urgent Care copay. $8,100 deductible with maximum out-of-pocket expenses of $8,700 and 50% coinsurance. Preferred generic and generic drugs subject to $5 and $25 copays ($12.50 and $62.50 for mail order). Preferred brand drug copays are $75 and $187.50.
Ambetter Balanced Care 12 -- $35 and $70 office visit copays with lab outpatient and professional services subject to $35 copay. $55 Urgent Care copay. $6,500 deductible with maximum out-of-pocket expenses of $8,400 and 40% coinsurance. Preferred generic and generic drugs subject to $5 and $25 copays ($12.50 and $62.50 for mail order). Preferred brand drug copays are $60 and $150.
Ambetter Balanced Care 11 -- $30 and $60 office visit copays with lab outpatient and professional services subject to $30 copay. $60 Urgent Care copay. $6,000 deductible with maximum out-of-pocket expenses of $8,500 and 40% coinsurance. Preferred generic and generic drugs subject to $5 and $20 copays ($12.50 and $45 for mail order). Preferred brand drug copays are $55 and $137.50.
Anthem Silver Pathway X HMO 6900/25% -- $25 pcp office visit copay, along with $75 Urgent Care copay. $6,900 deductible with maximum out-of-pocket expenses of $8,700 and 25% coinsurance. Tier 1 and Tier 2 drug copays are $10 and $40 ($30 and $120 mail order).
Anthem Silver Pathway X HMO 6100 0 for HSA -- $6,100 deductible with maximum out-of-pocket expenses of $6,100 and 0% coinsurance. HSA-eligible.
Anthem Silver Pathway X HMO 5000 -- $35 pcp office visit copay, along with $50 Urgent Care copay. $5,000 deductible with maximum out-of-pocket expenses of $8,700 and 35% coinsurance. Tier 1 and Tier 2 drug copays are $10 and $40 ($30 and $120 mail order).
Molina Constant Care Silver 7 250 -- $30 and $90 office visit copays with $30 copay for Urgent Care visits. Blood work and x-rays are subject to $50 and $135 copays. $0 deductible with maximum out-of-pocket expenses of $8,550. Tier 1 and Tier 2 drugs subject to $30 and $100 copays.
Molina Constant Care Silver 4 250 -- $30 and $65 office visit copays with $30 copay for Urgent Care visits. $7,450 deductible with maximum out-of-pocket expenses of $7,450 and 0% coinsurance. Generic and preferred brand drugs subject to $25 and $75 copays.
Molina Constant Care Silver 2 250 -- $30 and $65 office visit copays with $30 copay for Urgent Care visits. $5,200 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. Tier 1 and Tier 2 drugs subject to $25 and $65 copays.
Medical Mutual Market HMO 4000 HSA -- HSA-eligible option with $4,000 deductible and maximum out-of-pocket expenses of $7,000 and 30% coinsurance.
Medical Mutual Market HMO 3000 -- $30 and $90 office visit copays with $90 Urgent Care copay for first three visits. $3,000 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. Generic and preferred brand drug copays are $30 and $60 ($90 and $180 mail order).
SummaCare Silver 5000 40 With SCConnect -- $25 pcp office visit copay. Deductible is $5,000 with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. Preferred generic and non-preferred generic drugs subject to copays of $15 and $25 ($30 and $50 for mail order).
SummaCare Silver 6000 SCConnect -- $20 pcp office visit copay. $6,000 deductible with $8,700 maximum out-of-pocket expenses and 40% coinsurance. $10 and $15 copays for preferred generic and non-preferred generic drugs. Mail order copays are $20 and $30.
CareSource Marketplace Low Premium Silver -- $35 and $70 office visit copays, along with $75 Urgent Care copay. $6,500 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. Generic and preferred brand drug copays are $20 and $50 ($50 and $125 for mail-order).
CareSource Marketplace Standard Silver -- $25 and $60 office visit copays, along with $75 Urgent Care copay. $5,800 deductible with maximum out-of-pocket expenses of $7,900 and 25% coinsurance. Generic and preferred brand drug copays are $20 and $50 ($50 and $125 for mail-order).
CareSource Marketplace Low Deductible Silver -- $25 and $60 office visit copays, along with $75 Urgent Care copay. $5,100 deductible with maximum out-of-pocket expenses of $7,500 and 20% coinsurance. Generic and preferred brand drug copays are $20 and $50 ($50 and $125 for mail-order).
AultCare Silver 7900 Premier Select -- $75 Urgent Care copay. $7,900 deductible with maximum out-of-pocket expenses of $8,700 and 25% coinsurance. $10 generic drug copay.
AultCare Silver 6850 Select -- $75 Urgent Care copay. $6,850 deductible with maximum out-of-pocket expenses of $6,850 and 0% coinsurance. $10 generic drug copay.
Oscar Silver Simple -- PCP Saver -- $20 pcp office visit copay, along with $75 Urgent Care copay. Deductible is $5,000, with maximum out-of-pocket expenses of $8,375 and 40% coinsurance. Generic drug copays are $3 and $20 (1A and 1B). $10 lab work copay.
Oscar Silver Simple -- Specialist Saver -- $40 office visit copays, along with $75 Urgent Care copay. Deductible is $6,450, with maximum out-of-pocket expenses of $8,700 and 50% coinsurance. Generic drug copays are $3 and $25 (1A and 1B). Preferred brand drug copays are $75 and $187.50. $10 lab work copay.
Paramount Silver 4 -- $35 and $85 office visit copays, along with $100 Urgent Care copay. $7,700 deductible with maximum out-of-pocket expenses of $8,550 and 40% coinsurance. Preferred generic and non-preferred generic drug copays are $15 and $25 ($37.50 and $62.50 for mail-order). Preferred brand and non-preferred brand drug copays are $60 and $250 ($150 and $750 for mail-order).
Gold Tier
Anthem Gold Pathway X HMO 2500 -- $25 and $45 office visit copays. $2,500 deductible with maximum out-of-pocket expenses of $8,550 and 20% coinsurance. Tier 1 and Tier 2 drug copays are $10 and $35 ($30 and $105 for mail-order). Urgent Care copay is $90.
Molina Confident Care Gold 1 -- $10 and $50 office visit copays with $10 copay for Urgent Care visits. Diagnostic tests, blood work, and x-rays are subject to a $15 copay $2,925 deductible with maximum out-of-pocket expenses of $6,500 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 Marketplace Gold -- $10 and $45 office visit copays, along with $75 Urgent Care copay. $2,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Generic and preferred brand drug copays are $15 and $50 ($37.50 and $125 mail order).
Ambetter Secure Care 5 -- $15 and $35 office visit copays. $1,450 deductible with maximum out-of-pocket expenses of $6,300 and 20% coinsurance. Generic and preferred brand drugs subject to $15 and $30 copays ($37.50 and $75 for mail-order). Non-preferred brand drug copays are subject to coinsurance and deductible. Urgent Care copay is $35. $15 copay for outpatient lab and professional services.
Medical Mutual Market HMO 2000/25 -- $25 and $75 office visit copays with $75 copay for Urgent Care. Deductible is $2,000 with $8,500 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 1800 -- Full coverage for first three pcp office visits, and $15 copay for additional visits. $50 copay for specialist and $75 copay for Urgent Care visits. $1,800 deductible with $8,550 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 1000 Select -- $25 and $45 office visit copays, along with $75 Urgent Care copay. $1,000 deductible with maximum out-of-pocket expenses of $6,600 and 20% coinsurance. Preferred generic and preferred brand drug copays are $10 and $20 ($30 and $55 for mail-order). Tier 4 drug copays are $45 and $125.
Oscar Gold Classic Gold -- $30 and $55 office visit copays, along with $75 Urgent Care copay. Deductible is $2,500, with maximum out-of-pocket expenses of $6,000 and 25% coinsurance. Generic and preferred brand drug copays are $3 and $50 ($7.50 and $125 mail order). $55 copay for blood work.
Paramount Gold 3 -- $15 and $55 office visit copays, along with $55 Urgent Care copay. $2,500 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Preferred generic and non-preferred generic drug copays are $10 and $20 ($25 and $50 for mail-order). Preferred brand and non-preferred brand drug copays are $50 and $250 ($150 and $750 for 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.
Affordable Ohio Health Marketplace Plans Are Available
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 and ends December 7th.
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 and Delaware Counties) also offer attractive rates, including options from Medical Mutual.
Low Cost Cleveland Healthcare Will Be Offered
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.
Easily Compare Ohio Medicare Health Plans From Multiple Companies
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 2023 monthly prices for various plans in several of Ohio's largest metropolitan areas. Prices are for a 65 year-old female. Male rates are typically higher.
Hamilton County Rates -- Plan A
$70 -- AARP-UnitedHealthcare
$87 -- Mutual Of Omaha
$93 -- Accendo
$94 -- Continental Life
$95 -- Medical Mutual
$101 -- New Era Life
$101 -- Elips Life
$101 -- Humana
$102 -- Medico
$102 -- National Health
$103 -- SBLI USA Life
$103 -- United States Fire
$103 -- AFLAC
$104 -- Manhattan Life
$106 -- Paramount
$106 -- Cigna
$112 -- Bankers Fidelity
$114 -- Capitol Life
$116 -- Heartland National Life
$116 -- United American
$119 -- Union Security
$124 -- Anthem
$127 -- Sentinel Security
$127 -- Central States
$133 -- Great Southern Life
$144 -- GPM Health
Hamilton County Rates -- Plan C
$143 -- AARP-UnitedHealthcare
$153 -- Western United Life
$199 -- Oxford Life
$273 -- Assured Life
Hamilton County Rates -- Plan F (High Deductible)
$36 -- New Era Life
$39 -- Great Southern Life
$45 -- Medico
$45 -- Cigna
Hamilton County Rates -- Plan F
$119 -- Humana
$125 -- Continental Life
$129 -- Mutual Of Omaha
$133 -- Lumico Life
$134 -- Accendo
$136 -- Great Southern Life
$138 -- New Era Life
$144 -- AARP-UnitedHealthcare
$150 -- Union Security
$155 -- Western United Life
$161 -- Cigna
$170 -- Anthem
$172 -- Transamerica
$189 -- Medico
$274 -- Assured Life
Hamilton County Rates -- Plan N
$76 -- Accendo
$76 -- Continental Life
$79 -- Mutual Of Omaha
$79 -- Humana
$80 -- Union Security
$84 -- Lumico Life
$84 -- Assured Life
$89 -- Western United Life
$90 -- New Era Life
$90 -- Great Southern Life
$92 -- AARP-UnitedHealthcare
$95 -- Transamerica
$97 -- Guarantee Trust Life
$97 -- Cigna
$100 -- Medico
$103 -- Anthem BCBS
$171 -- Oxford Life
Franklin County Rates -- Plan A
$69 -- AARP-UnitedHealthcare
$81 -- Continental Life
$83 -- Mutual Of Omaha
$86 -- Accendo
$93 -- United States Fire
$95 -- New Era Life
$95 -- Capitol Life
$98 -- Union Security
$99 -- Lumico Life
$100 -- Humana
$102 -- Transamerica
$106 -- Anthem BCBS
$106 -- Western United Life
$108 -- Great Southern Life
$118 -- Medico
$121 -- Cigna
$160 -- Oxford Life
Franklin County Rates -- Plan C
$131 -- AARP-UnitedHealthcare
$136 -- Western United Life
$185 -- Oxford Life
$273 -- Assured Life
Franklin County Rates -- Plan F (High Deductible)
$34 -- New Era Life
$37 -- Great Southern Life
$40 -- Cigna
$43 -- Medico
Franklin County Rates -- Plan F
$111 -- Accendo
$112 -- Continental Life
$114 -- Mutual Of Omaha
$117 -- Lumico
$119 -- Humana
$128 -- Great Southern Life
$129 -- Union Security
$130 -- New Era Life
$132 -- AARP-UnitedHealthcare
$137 -- Western United Life
$144 -- Cigna
$153 -- Anthem BCBS
$172 -- Transamerica
$178 -- Medico
$274 -- Assured Life
Franklin County Rates -- Plan N
$73 -- Accendo
$73 -- Continental Life
$74 -- Capitol Life
$74 -- Union Security
$76 -- Mutual Of Omaha
$77 -- United States Fire
$79 -- Lumico
$79 -- Humana
$84 -- Western United Life
$85 -- Great Southern Life
$90 -- New Era Life
$92 -- AARP-UnitedHealthcare
$95 -- Transamerica
$168 -- Oxford Life
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. All available plans should be reviewed before enrollment. Rates and benefits can vary, depending upon the county of legal residence.
Advantage Plans Without Drug Coverage
AARP Medicare Advantage Patriot
Aetna Medicare Eagle
Anthem MediBlue Access Core
Anthem MediBlue Service
Cigna True Choice Courage Medicare
Humana Honor
Lasso Healthcare Growth
Lasso Healthcare Growth Plus
MediGold Mount Carmel Cash Back No Premium MA Only
Paramount Elite Prevail
Prime Time Health Plan Basic -- MA Only
SummaCare Medicare Amber
The Health Plan SecureCare -- Option I
Wellcare Patriot Giveback Open
Advantage Plans With Drug Coverage
AARP Medicare Advantage Walgreens
AARP Medicare Advantage Plan 7
Aetna Medicare Premier Plus 1
Aetna Medicare Premier
Aetna Medicare Advantra Silver
Aetna Medicare Premier Plus 2
Aetna Medicare Value Plan
Allwell Medicare
Anthem MediBlue Essential
Anthem MediBlue Preferred
Anthem MediBlue Extra
Anthem MediBlue Prime Select
Bright Advantage
Bright Advantage Flex
Bright Advantage Flex Plus
Bright Advantage Flex Choice
Bright Advantage Access
Bright Advantage Assist
Bright Advantage Plus
CareSource Advantage Zero Premium
CareSource Advantage
Humana Value Plus
Humana Cleveland Clinic Preferred
HumanaChoice
MediGold Southeast Oh Essential Care
MediGold Southwest OH Essential Care
MedMutual Advantage Classic
MedMutual Advantage Choice
MedMutual Advantage Select
MedMutual Advantage Preferred
MedMutual Advantage Plus
PrimeTime Health Plan Aultimate
SummaCare Medicare Topaz
SummaCare Medicare Ruby
The Health Plan SecureCare Option IV
The Health Plan SecureCare Option II
UnitedHealthcare Dual Complete
Ohio Medicare Part D Prescription Drug Plans
There are 24 available plans including 15 enhanced plans and 9 basic plans. Rates on most plans increased, although the average was only $7.98 per month. Seven plans lowered their 2023 premiums. Four plans offer a $0 deductible option, and the least pensive plan ($0 deductible) is the Anthem MediBlue Rx Plus with a monthly rate of $66.60.
SilverScript Choice -- $505 deductible with 3,461 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $2, $7, and 17%. 90-day cost-sharing copays are $6, $21, and 17%. Monthly rate is $32.90 and the Plan Summary Star rating is 3.5.
SilverScript Plus -- $0 deductible with 3,553 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $0, and $47. 90-day cost-sharing copays are $0, $0, and $141. Monthly rate is $73.60 and the Plan Summary Star rating is 3.5.
SilverScript SmartSaver -- $505 deductible with 3,578 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $2, $15, and 25%. 90-day cost-sharing copays are $6, $45, and 45%8. Monthly rate is $5.10 and the Plan Summary Star rating is 3.5.
AARP MedicareRx Preferred -- $0 deductible with 3,624 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $7, $12, and $47. 90-day cost-sharing copays are $21, $36, and $141. Monthly rate is $109.20 and the Plan Summary Star rating is 3.5.
AARP MedicareRx Walgreens -- $350 deductible with 3,251 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $10, and $40. 90-day cost-sharing copays are $3, $30, and $120. Monthly rate is $28.20 and the Plan Summary Star rating is 3.0.
AARP MedicareRx Saver -- $480 deductible with 3,153 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $19, and $60. 90-day cost-sharing copays are $3, $57, and $138. Monthly rate is $42.20
Humana Walmart Rx Plan -- $480 deductible with 3,221 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $4, and 18%. 90-day cost-sharing copays are $3, $12, and 18%. Monthly rate is $22.70
Humana Premier Rx Plan -- $480 deductible with 3,281 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $4, and $45. 90-day cost-sharing copays are $3, $12, and $135. Monthly rate is $81.20
Humana Basic Rx Plan -- $480 deductible with 3,104 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $1, and 21%. 90-day cost-sharing copays are $0, $3, and 21%. Monthly rate is $42.30
WellCare Value Script -- $480 deductible with 3,450 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $4, and $42. 90-day cost-sharing copays are $0, $12, and $126. Monthly rate is $12.90
WellCare Value Classic -- $480 deductible with 3,110 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $7, and $40. 90-day cost-sharing copays are $0, $21, and $120. Monthly rate is $28.80
WellCare Medicare Rx Value Plus -- $0 deductible with 3,464 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $4, and $47. 90-day cost-sharing copays are $0, $12, and $141. Monthly rate is $68.90
Anthem Blue MedicareRx Standard -- $390 deductible with 2,958 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $2, and $35. 90-day cost-sharing copays are $3, $6, and $105.
Anthem Blue MedicareRx Enhanced -- $340 deductible with 3,183 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $2, and 20%. 90-day cost-sharing copays are $0, $6, and 20%.
Anthem Blue MedicareRx Plus -- $0 deductible with 3,191 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $3, and $43. 90-day cost-sharing copays are $3, $9, and $129.
Cigna-HealthSpring Rx Secure-Essential -- $435 deductible with 3,203 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $2, and 18%. 90-day cost-sharing copays are $0, $6, and 18%.
Cigna-HealthSpring Rx Secure -- $435 deductible with 3,244 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $1, $2, and $30. 90-day cost-sharing copays are $3, $6, and $90.
Cigna-HealthSpring Rx Secure Extra -- $100 deductible with 3,379 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $4, $10, and $42. 90-day cost-sharing copays are $12, $30, and $126.
Mutual Of Omaha Rx Value -- $435 deductible with 2,980 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $2, and $27. 90-day cost-sharing copays are $0, $6, and $81.
Mutual Of Omaha Rx Plus -- $435 deductible with 3,307 available drugs. 30-day cost-sharing copays for Tier 1, Tier 2, and Tier 3 drugs are $0, $10, and $42. 90-day cost-sharing copays are $0, $30, and $126.
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 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 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, according to figures from the US Census Bureau. The 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). 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.
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 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.