Ohio Health Insurance: Find Affordable Plans

Ohioans have access to many health insurance options, including plans through the federal exchange, Medicare or Medicaid, or directly from an insurance company. Read on to understand your Ohio health insurance options.

• Plan options: In Ohio, you have the freedom to choose your health coverage. If your employer coverage doesn’t meet your needs, you can seek coverage elsewhere.
• Marketplace plans: You can get a health insurance quote through the Health Insurance Marketplace. You’re able to choose from Bronze, Silver, Gold, and Platinum plans, which vary in cost and coverage.
• Open enrollment: To enroll in a health insurance plan through the Health Insurance Marketplace, you need to sign up during the open enrollment period. In 2022, Ohio open enrollment runs from November 1 to January 15. Missing this window means you’ll have to sign up during a Special Enrollment Period or wait until the next year.
• Special enrollment: Special circumstances, such as relocating, getting married, having a child, or losing your job, are qualifying events for a Special Enrollment Period so that you can obtain health coverage.
• Subsidized premiums: Ohio uses the federal Health Insurance You need to enroll through the marketplace if you’re interested in getting the Advanced Premium Tax Credit. While you’re entitled to buy insurance outside of the exchange, you won’t get this advantage unless you use the exchange. If you’re not interested in the tax credit or don’t qualify for it, you’re free to purchase a policy from any insurer you choose.
• Coverage types: In Ohio, more than 52% of residents receive health insurance through their work, while another 4% are insured through private policies. Around 15.9% of residents are enrolled in Medicare, and another 20% receive coverage through Medicaid services. The remaining 7% of the state’s residents are uninsured.

While Ohioans can sign up for insurance offered through the Affordable Care Act (ACA), the state doesn’t have its own marketplace. You can sign up through the federal Health Insurance Marketplace by visiting HealthCare.gov. You have to create an account to browse Ohio health plans and enroll. You’ll follow the instructions, enter your contact information, select a password, and create several security questions.

After entering your information, HealthCare.gov will automatically determine if you qualify for financial assistance programs such as Medicaid. You’ll also find out if you qualify for the Advanced Premium Tax Credit (APTC) on this step. You need the full name, Social Security number, and birth date for each member of your household.

After answering some questions about your income, marital status, and who you claim as dependents on your taxes, you can review available insurance policies. The website provides a tool that lets you pick up to three plans to compare side-by-side before deciding which plan you would like to enroll in. After you’ve decided on the plan you like most, you can follow the instructions to complete your enrollment.

If you’re overwhelmed, you can use the Find Local Help tab to get a list of certified agents or insurance navigators that can help you choose a plan.

There is no difference in the processes required to enroll in individual insurance plans and family coverage. Still, your priorities may differ depending on whether you’re enrolling for a family or only yourself. Before you begin shopping for an individual or family health policy, evaluate your medical condition and the needs of your family. Also, consider what type of plan you’d like to purchase, the deductible you’re willing to pay, and what your monthly budget for insurance premiums will be.

Insurance for individuals in Ohio

If you’re shopping only for yourself, you can save money by choosing a lower premium and high deductible so long as you’re in good health and don’t expect to need routine medical treatments. Keep in mind that if you have a high deductible, you’ll receive no coverage for expensive medical services until that deductible is met. There are benefits and drawbacks to the type of plan that you choose.

• Health Maintenance Organization (HMO) plans are usually the most affordable plans but come with restrictions that may make it more difficult for you to receive care. In addition to needing to only see in-network doctors, you’ll need to get a referral whenever you want to see a specialist.
• Preferred Provider Organization (PPO) plans allow you complete autonomy to choose where you receive treatment, but this comes at the cost of higher premiums.
• Point-of-Service (POS) plans are the middle ground because you’re still required to see doctors in the plan’s network to receive the full benefit of your plan, but you’re also allowed to see doctors outside of your network while paying a higher copayment. Like HMOs, POS plans also require you to get a referral for a specialist unless you wish to pay a higher copayment.

Insurance for families in Ohio

If you’re shopping for health coverage for your entire family, you’re no longer the only person whose needs will impact the coverage you select. While you might be in perfect health, you’ll need a policy that lowers your out-of-pocket expenses if your spouse or child suffers from a chronic medical condition.

Try to balance the monthly cost of your insurance premium with its benefits. It might lower the total annual cost of your health care to purchase a more expensive plan when you consider your annual deductible and coinsurance. Consider whether an HMO plan has a network that provides all of the services you need before determining whether a PPO or POS service would suit your needs better.

The following insurance companies offer both individual and family coverage in the state of Ohio. Access to each company depends on where you reside, but all Ohioans will have access to two or more insurers.

• AultCare Insurance Company
• Buckeye Community Health Plan
• CareSource
• Community Insurance Company
• Medical Health Insuring Corp. of Ohio
• Molina Healthcare of Ohio, Inc.
• Oscar Buckeye State Insurance Corporation
• Oscar Insurance Corporation of Ohio
• Paramount Insurance Company
• Summa Insurance Company

Insurance plans fall under four tiers of coverage on the Health Insurance Marketplace based on factors such as monthly premiums, annual deductibles, and coinsurance. Lower tiers provide less coverage for a lower monthly premium, while higher tiers cost more each month while offering more comprehensive coverage.

The four tiers are Bronze, Silver, Gold, and Platinum.

• Bronze tier plans are the most affordable plans but have high deductibles and copays. You are responsible for 40% of any expenses you incur for your medical treatment on one of these plans and must meet your deductible before you receive coverage. These plans can be a good choice if you’re young, healthy, and want protection in case of an emergency. The most affordable Bronze plan in Ohio costs $307 per month in 2022.
• Silver tier plans offer slightly better coverage with lower deductibles. Your copayment on a Silver plan would be 30%, and your monthly premium would be higher. If you qualify for a cost-sharing plan, you may enroll in Silver plans for less than the cost of a Bronze plan if your income falls below a certain threshold. The most affordable Silver plan in Ohio costs $371 per month in 2022.
• Gold and Platinum tier plans provide the highest levels of coverage but are the most expensive plans available for purchase. If you enroll in a Gold plan, you’ll be required to pay 20% of your medical expenses while a Platinum plan requires a copayment of only 10%. These plans are best if you or someone you plan to cover on your plan suffers from an illness that requires regular and ongoing treatments. While you may pay a higher monthly premium, you’ll save more money on the latest state-of-the-art medicine your family requires. The most affordable Gold plan in Ohio costs $441 per month in 2022.

Before you choose a plan, consider more than the monthly premium and determine whether you’ll save more money by selecting a higher-tier plan.

Ohioans can receive insurance assistance through MyCare Ohio (Medicaid) and the Children’s Health Insurance Program (CHIP). Both of these programs are managed cooperatively by the state of Ohio and the United States federal government.

Medicaid in Ohio

MyCare Ohio is the state Medicaid program, which serves the legally impaired, those with disabilities, residents aged 65 and older, and families whose incomes are considered low or extremely low. Those receiving Medicaid are covered for preventative care, emergency room visits, hospital stays, and procedures deemed medically necessary by a doctor.

To qualify for benefits, your income must remain under a threshold that changes depending on the number of people in your household. For individuals, this would amount to $17,131 in annual income, and a family of three wouldn’t be able to earn more than $29,207 in total. You must also be disabled, caring for someone with a disability, pregnant, or caring for one or more family members under the age of 18.

The MyCare Ohio program also assists residents who require nursing care aged 18 and older. To enroll in Medicaid in the state of Ohio, you’ll need to select a managed care plan during your enrollment, and all services will be provided through the plan you choose.

Ohio CHIP Program

Children in families that make too much money to qualify for Medicaid may still qualify for insurance benefits through the Ohio CHIP program. This program provides coverage to individuals aged 9 and younger and pregnant women. Children and mothers enrolled in the program are covered for preventive care, prenatal care, vision, dental, diagnostic testing, and emergency care.

If you qualify for Medicare, you can choose between traditional Medicare Parts A and B or a Medicare Advantage Plan. If you seek prescription coverage, you’re also able to enroll in Medicare Part D:

• Original Medicare includes Part A and Part B. Medicare Part A covers your inpatient care, and Part B covers outpatient care, defined as medical procedures conducted outside of a hospital, routine preventive care, diagnostic testing, medical devices and supplies, and medical transportation.
• Medicare Advantage Plans cover everything that traditional Medicare covers but may also include coverage for prescription medications, dental, and vision, among other categories.

You may enroll in Medicare Part D regardless of whether you’re enrolled in an Advantage plan or not, which may help with your prescription drug coverage needs. If you’re unsure of whether you’ll be able to meet your Medicare deductibles and coinsurance requirement, you can shop for a Medicare Supplement Insurance plan to help reduce your out-of-pocket expenses.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

For more information about Medicare and assistance applying for your benefits, you can call the Ohio Department of Insurance at (800) 686-1526. The Ohio Department of Insurance also offers assistance to those who may not afford their medical expenses.

A temporary health insurance policy provides coverage if you have a gap in coverage due to events, such as losing a job, relocating, or missing the enrollment period for Medicare or health insurance. These plans aren’t meant to cover you for long-term medical treatment but will cushion the blow from any large medical bills when you’re not covered by insurance.

Ohio allows insurance companies to provide short-term plans for no longer than a year. Policies can’t be renewed after expiration, and plans aren’t bound by the rules mandated by the ACA. A short-term insurer may deny you coverage, increase your rates due to your medical history, and refuse to cover preexisting conditions and prenatal care. You may be turned away if you’re suffering from any of the following:

• Illnesses that impact kidney function
• Heart conditions
• Genetic disorders or birth defects
• Cancer
• Epilepsy
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Autoimmune disorders like lupus

The best time to apply for short-term health insurance is immediately after you find out you’re going to need it. If you don’t begin shopping for coverage right away, you might not be able to enroll in a policy before your current coverage expires. If you’ve missed enrollment for Medicare or insurance through the Health Insurance Marketplace, it’s a good idea to enroll in a temporary policy until the next enrollment period.

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