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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

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.

What to know about insurance in Ohio

  • 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 from November 1 to December 15 each year. Missing this window means you’ll have to sign up during a special enrollment period or wait until the next year. There is a current special enrollment period that has been extended until August 15, 2021, due to the COVID-19 crisis.
  • 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, over 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 remaining7% of the state is uninsured.

How do I enroll in Ohio’s health insurance marketplace?

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 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.

How do I enroll in Ohio individual and family insurance?

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

How much does health insurance cost in Ohio?

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.

Average premiums in Ohio 2018 2019 2020 2021
Most affordable bronze plan $278 $296 $278 $280
Most affordable silver plan $362 $370 $368 $360
Most affordable gold plan $428 $456 $445 $428

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 and health and just want protection in case of an emergency. The most affordable bronze plan in Ohio costs $280 per month in 2021.
  • 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 $360 per month in 2021.
  • 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.

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.

What kind of low-income health insurance is available in Ohio?

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 over the age of 65, 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 over the age of 18. 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 under the age of 19 and pregnant women. Children and mothers enrolled in the program are covered for preventive care, prenatal care, vision, dental, diagnostic testing, and emergency care.

What are Ohio’s Medicare options for seniors and people with disabilities?

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 and Enrollment
Eligibility Ohioans qualify for Medicare at 65 or if you have a qualifying disability, including ALS or end-stage renal disease.
Enrollment Your initial enrollment period for Medicare begins three months before your 65th birthday, the month of your birthday, and another three months after that. Each year, the open enrollment period is between October 15 and December 7, which allows you to change your plan or enroll if you’re not already covered. If you qualify, there are also special enrollment periods and a yearly general enrollment period that begins on the first day of the year and lasts until March 31.

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.

Are there short-term health insurance plan options in Ohio?

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 Affordable Care Act. 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
  • COPD
  • Autoimmune disorders such as 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.

Ohio Insurance FAQs

Does Ohio require health insurance?

No law in Ohio requires residents to obtain health insurance. The Affordable Care Act mandated health coverage for all United States citizens, but the law is not enforced with a penalty. In 2019, the tax penalty for not having coverage was dropped.

Do I have to use the Health Insurance Marketplace in Ohio?

You don’t need to use the Health Insurance Marketplace to obtain insurance in the state of Ohio, but there are some benefits to doing so. The most important benefit is the Advanced Premium Tax Credit, which is only available if you purchase insurance through the exchange.

What type of marketplace does Ohio have?

Ohioans are required to use Healthcare.gov to sign up for marketplace insurance. Ohio doesn’t have its own marketplace.

How many health insurance carriers offer insurance through the marketplace in Ohio?

There are 10 insurance companies offering health coverage through Healthcare.gov to Ohio residents. Each insurer offers coverage to specific areas throughout the state, so you may not access all 10 insurers. Every county has access to at least two insurance companies.

Do I need health insurance if I have HSA/FSA?

Health savings accounts and flexible savings accounts are not health insurance. These accounts are designed to help you put away money that can allow you to cover out-of-pocket expenses when the need arises to undergo medical treatment for an injury or disease. Unless you’ve got a considerable nest egg, your savings won’t cover the cost of your care in most cases. It’s a good idea to combine an insurance policy with one of these accounts.

Do I need short-term disability coverage in Ohio if I have health insurance?

Health insurance and short-term disability coverage compensate for household expenses if a disability keeps you from returning to your job. Your medical bills will be covered by health insurance, while short-term disability insurance helps you pay your utility bills, mortgage, and grocery bills. It’s a good supplement to have but won’t replace health coverage.

Do I need long-term disability coverage in Ohio if I have health insurance?

Long-term disability insurance functions in the same manner as short-term disability coverage. If you’re permanently disabled due to an injury or medical condition, it helps you cover your out-of-pocket expenses so that you can meet your financial obligations. Health insurance is still needed to pay for routine doctor’s visits and advanced treatments.

What does CHIP cover?

The Children’s Health Insurance Program covers preventive care, emergency room visits, immunizations, vision, dental, mental health, and prescription medications. The program also helps connect families with doctors and resources.

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