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2015 Premier Health Medical Plans For Individuals

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Dayton’s biggest hospital network now offers private health insurance plans in Ohio beginning in 2015. Premier Health’s private and employer-sponsored policies are available through and outside the Marketplace. Open Enrollment begins November 15th and continues through February 15th. Special enrollment exceptions (if qualified) will be available throughout the year.

For seniors, Medicare Advantage contracts will be offered when their Open Enrollment begins in October15th and continues through December 7th. However, if you turn age 65 or become eligible for Medicare, you have a special  “initial” enrollment period at any time throughout the year. It lasts for a total of seven months, beginning three months before your eligibility.

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The Gap Between Retirement And Medicare Can Be Easily Covered

Note: Often, there is a gap between retirement and Ohio Medicare eligibility. In these situations, a private plan can act as a bridge for this period of time, which may be only a few months, or  as long as 5-10 years. Subsidized policies are available.

Some of the popular and most-utilized services offered  include emergency and trauma, cancer care, maternity, sports medicine, neurosciences, orthopedics, cardiology,  gynecology, primary and after-hours treatment. Additional resources that are available to patients and their families are an online health encyclopedia, online patient registration, comprehensive risk assessment availability and wellness classes throughout the Dayton area.

Who Is Premier?

Located in Dayton, with more than 12,000 employees, they are a large network of hospitals, specialists, doctors and other facilities that specialize in treating the Southwestern Ohio community. The insurance company will operate as a separate business entity and will offer policies that conform and meet the requirements of the Affordable Care Act legislation. Short-term and limited-benefit options will not be available.

With more than 3,000 network providers available, access to quality treatment will not be a concern for patients. 2,000 of the providers are doctors specializing in cardiology, orthopedics, preventive treatment and neurosurgery. There are also several rehab locations including  the Rehabilitation Institute Of Ohio (RIO) which is on the grounds of Miami Valley Hospital. RIO treats more rehabilitative patients in the Miami Valley than any other similar company.

Available Network Providers

Five large hospitals surrounding the Miami Valley serve area patients. They are:

Atrium Medical Center (Middletown) – For more than a decade, Atrium has been a Level III trauma Care Center. Previously known as Middletown Regional Hospital, they have been treating the community for more than 90 years! They earned many “Healthgrade” awards including treatment for cardiac, pulmonary, critical care and neurosciences.

Good Samaritan Hospital (Dayton) – “Good Sam” has been around since 1932. The Sisters of Charity vision is still recognized by the hospital. Now a member of Catholic Health Initiatives (CHI) with more than 100 similar organizations, this hospital is very active in the Dayton community and well-recognized for its generosity. Gastrointestinal treatment is one of the many available specialties.

Upper Valley Medical Center (Troy) – Upper Valley is a fairly new facility. Serving the Miami County area since 1996, they are one of Dayton’s leading healthcare facilities North of I-70.  In addition to the diverse types of treatment that is available, local charity programs are available for local residents that are not currently insured.

The partnership with Edison Community College also provides comprehensive nursing programs including  college scholarships for area students. The outdoor fitness center at Edison is also available to the public at no cost.

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Miami Valley Hospital Is Part Of Premier’s Provider Network

Miami Valley Hospital (Dayton) – MVH is the flagship hospital of the area. More than 100 years old, it is now a regional trauma center facility with more than 800 available beds and 1,000 doctors and specialists. Also recognized as having one of the top nursing  practices, Miami Valley is recognized as a “Magnet” facility.

Recently, “US News And World Reports” recognized MVH as one of the top hospitals in the US. The combination of the Adult Burn Center, Level 1 Trauma Center, Care Flight ambulance availability and marrow transplant program makes this hospital one of the most recognized landmarks in Southwestern Ohio.

Miami Valley Hospital South (Centerville) – is located in the Dayton Mall area and was built in 2007. It serves southern Montgomery County, Northern Warren County and surrounding areas.  Currently, more than 50 beds are available, and obstetrics and orthopedics are a few of the specialties. A comprehensive cancer care center along with many physician offices are located on the property.

Available Plans

For 2015 effective dates, many individual/family policies are available as Marketplace subsidized plans. If your household income meets Federal Poverty Level guidelines, part (or all) of the premium will be paid by a subsidy. Financial aid is only offered during Open Enrollment and SEP (Special Enrollment Periods).

Platinum, Gold, Silver, Bronze and Catastrophic tier contracts are available for private purchase. Typically, carriers such as Anthem Blue Cross, Medical Mutual, Aetna, Cigna, UnitedHealthcare, and Humana do not offer options for all tiers. However, the Silver tier, because of its special cost-sharing features, is the most popular.

A Medicare Advantage plan and  a Dual Eligible Special Needs (DSNP) contract are also available. The Open Enrollment period is different than under-65 market. For Medicare-eligible plans, as previously mentioned, the sign-up period begins October 15th. Medigap (Supplement) coverage is also government-regulated and the available contracts are standardized to help in the consumer-comparison process. Advantage contracts (usually a PPO or HMO) are Medicare alternatives issued by insurers.

Listed below are 2015 policies offered to persons under age 65:

Bronze Tier

One Bronze 5500 – $5,500 deductible with 30% coinsurance. But only a $30 copay applies to primary care physician office visits. Typically, this plan is the least expensive of all available Premier contracts.

One Bronze 6000 – $6,000 deductible with no coinsurance.

Silver Tier

Silver One 3500 – $3,500 deductible with $20 and $40 copay on pcp and specialist visits (deductible does not apply). $17 generic drug copay.

Silver One 2000 – $2,000 deductible with 20% coinsurance. Deductible also applies to non-preventive office visits.

Gold Tier

Gold 1500 – $1,500 deductible with low $10 and $40 copays. $13 generic drug copay.

 

How To View Rates

Our website is considered by most consumer watch groups to be one of the most reputable and reliable resources for providing health insurance prices in Ohio…both on and off-Exchange. We feature a “free quote” box at the top of every page that is available at any time. You can also call or email us if you would prefer a more personal response.

Plans are available both “on” and “off” the Marketplace. If you qualify for a subsidy, “on” policies will be your best choice. However, if your total household income exceeds the benchmark needed for subsidy qualification, an “off” policy should be considered. We’ll show you the best of Premier’s portfolio along with any other company that can offer an equally or more competitive product.

UPDATES:

October 16 2014 – MediGold Medicare Advantage policies will no longer be accepted by Premier. Notification was sent two weeks ago to all impacted policyholders. Since Open Enrollment has just begun, affected customers can shop and apply for a plan with another carrier without answering any medical questions. Acceptance is virtually guaranteed.

One of the reasons for the change is that their own Medicare Advantage contract will be offered beginning in 2015. A per-capita payment is made by the federal government to help administer and manage claims,billing, and benefits.

October 31 2014 – Premier and CVS Health will be working together with the integration of  pharmacies in the provider network for 2015. CVS  MinuteClinic walk-in clinics will also be part of the network. Collaboration will also take place with improved and updated electronic medical record information.

Customers will notice medication counseling and management of chronic disease as two areas that are impacted immediately.  It’s also possible that the new merger will also reduce the cost of prescriptions to current and future policyholders.

November 17 2014 – 2015 prices have been released and plans are very competitively priced in Montgomery, Warren, and Greene counties. The “Silver One 3500″ plan is one of the most  attractive options, and along with Molina and Ambetter, gives consumers in the area many affordable choices. The higher-deductible “One Bronze 5500″ plan is one of the cheapest available policies, especially for persons over the age of 50.

Ohio Obamacare Rates For 2015 – Adults And Children

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Health insurance rates in Ohio are increasing in 2015, although the price hikes are relatively modest for most of the major companies with the largest market share. 2015 prices have been filed with the Oh Department of Insurance, and will be subsequently approved, or sent back for revision. The Department of Health And Human Services (HHS) must also approve any changes to Obamacare policies.

Free or low-cost medical coverage is still available in our state. With the availability of subsidized plans, dozens of policies from reputable carriers such as Medical Mutual, Anthem, Aetna, Premier, and UnitedHealthcare can be compared and purchased in minutes. It’s not unusual to find a family plan that costs between $40 and $150 per month.

There is great uncertainty when attempting to project the most appropriate price to charge consumers for their medical coverage here in the Buckeye state. There also is not a  a substantial amount of data that is available from the 2014 Open Enrollment. And very few claims have been processed and studied. 16 carriers have filed to do business in the Buckeye state for 2015. This represents one of the largest number of companies in any state.

Information on enrollee demographics, popularity of plans and market share can be easily studied. But the impact of offering every applicant guaranteed coverage may not be known for a few years. So although it’s not a crapshoot, it’s safe to say it’s an educated guess when determining what rates to charge in 2015.

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Are Higher Health Insurance Rates Making You Ill? There May Be Good News!

We researched all state filings and carrier information in predicting what to expect next year:

Anthem Blue Cross – Although their initial request is a 9% increase, many of the most popular plans will probably see lower price hikes. For example, although some Bronze plans will see double-digit increases, others will rise by less than 5%. The popular Silver plans offer the unique “cost-sharing” feature that substantially lowers your deductible if you qualify for federal subsidies.

The catastrophic option, one of Anthem’s cheapest plans in Ohio, and which is available to applicants under age 30, or anyone else that can show they can not afford other available options, will remain inexpensive, although benefits are limited and the deductible is above $6,000.

The least expensive plans in each tier are: Pathway X PPO 6600/0% (Catastrophic), Pathway X PPO 6000/0% HSA (Bronze), Pathway X PPO 3500/25% (Silver), and Pathway X PPO 1250/10% (Gold).

Medical Mutual – Non-profit MM is asking for an average increase just under 8% which brings its average monthly premium to about $400 for all plans. Of course Catastrophic and Bronze policies are the least expensive. The Northeastern portion of the state is where Medical Mutual is the most competitive.

Some enhancements for 2015 include better mental health and cardiac rehabilitation benefits. However, like many carriers MM will discontinue covering ER visits that are not a true emergency or if the treatment occurs outside the US. Also, skilled nursing facility benefits will reduce.

Their cheapest options include: Market Young Adult Essentials (Catastrophic), Market HSA 4000 and 6000 (Bronze), Market Classic 2000 (Silver), and Market Classic 1000 (Gold).

UnitedHealthcare -  UHC  markets Ohio plans under the “Golden Rule” trademark, although they may be using a different company for 2015 “on-Exchange” policies. In 2014, they did not participate in the Marketplace festivities. However, their “short-term” plan has been very popular for consumers that either forgot to enroll or simply wanted the cheapest option, regardless of non-compliance issues.

Although UHC rates were a bit high in the Buckeye state for 2014, by sitting out a year and observing, they may have learned a few things. We expect their Bronze and possibly catastrophic offerings to be the most popular. The new products will be sold under the “All Savers” brand name. Recently, “Golden Rule” has been the brand used locally and in many other states. Golden Rule will still offer “short-term” plans that are available as non-Marketplace plans.

The least expensive 2015 policies are Bronze Compass HSA 4900, Bronze Compass 5500, Silver Compass HSA 2600, Silver Compass 2000 and Silver Compass 3500. Plans are not available in all counties.

HealthSpan – If you don’t recognize their name, you’re not alone. HealthSpan purchased Kaiser Permanante’s block of business last year and began selling products under their own name. They are projecting a 6%-8%  price increase for the Northeastern portion of the state. Their HSA product is expected, once again, to be one of their best available products.

Their most affordable options are: Bronze 4000-70 HSA, Bronze 5000-80, Silver 1500-70 HSA, Silver 3000 HSA, Silver 2500-80, and Silver 2000-70.

Aetna - Welcome back Aetna! For many years, especially from 2009-2011, Aetna was very active in the individual Ohio health insurance market, and featured very competitive rates. Smokers and females age 50 and over were their best niches. But they did not participate in the 2014 Exchange in most states including ours. However, they still maintain many “grandfathered” policies that were written in 2010 (or earlier) and are still in-force.

For 2015, they will concentrate on Cuyahoga County and the Cleveland area. Aetna is also reducing prices by approximately 6%-8% which should make it an attractive option, especially considering its large provider network. Coventry, a company they recently purchased, will concentrate on other states. But it is still undetermined if the Cleveland Clinic will be part of their network.

Aetna’s most affordable 2015 plans include Bronze Deductible Only HSA, Bronze $20 Copay, Silver $10 Copay, Silver $5 Copay 2750, and Gold $5 Copay. In several counties, Aetna’s Oh rates are the lowest available option.

Assurant -  Recently, Assurant’s rates have not been competitive. In fact, from 2010-2013, often their prices for standard plans were about 40%-80% higher than most other companies. In 2013, they did not offer on-Exchange plans, although several off-Marketplace policies were available.  However, for many years, Assurant (also known as Time) was one of the few carriers to offer “child only” plans on a short-term basis.

Their 2015 rate request would place them about 30% (on average) higher than Medical Mutual. While Assurant may gather some market share, we don’t expect the final numbers to be significant.

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CareSource Headquarters In Dayton

CareSource – Based in Dayton, CareSource  used to be known as “Dayton Area Health Plan.”  They specialized in managed-care coverage for Medicaid recipients prior to the 2013 Exchange, which saw them offer numerous plans to consumers. No information is available regarding their projected 2015 pricing.

SummaCare – Although only a regional carrier, (Northern portion of the state), SummaCare offered competitive prices in 2014 through four plans (Individual 750, 5000, 6350 and Value). They were all fully-compliant and often priced slightly less than Medical Mutual. There is no advanced information available on their 2015 projected rates.

Molina Healthcare – Most persons haven’t heard of Molina since they don’t participate in all portions of the state. Although they only started offering coverage in 1980, they have grown to become a Fortune 500 company. They offer a Bronze, a Gold, and four Silver plans at reasonable rates. For 2015, they have increased prices in some states, and projected decreases in others (Washington State).

Molina’s rates next year should remain about the same, with increases in certain counties. They do not offer coverage in all areas  and typically are not competitive in most counties.

InHealth – Based in Westerville, this small company makes its Marketplace debut in 2015. Although they offered selected plans to consumers last year privately, like Molina, they are not a widely-known company. InHealth is expected to raise prices by about 10% compared to last year’s rates. However, they will still be extremely competitive with most other carriers, and probably  one of the least expensive companies in some parts of the state.

Aultcare – Offering plans mostly in the Northern portion of the state, this regional carrier writes a lot of business in Summit, Medina, Stark, Tuscarawas, Mahoning, Carroll and Holmes counties. There has been no formal announcement regarding any price changes for 2015.

We will keep you informed on any changes or projections for Ohio Health Insurance Exchange plans for 2015.  Additional Marketplace information regarding prices or policy availability will be regularly updated.

UPDATES:

October 14 2014 –  Although Open Enrollment begins in a month, it is not expected that rates for all carriers (for the upcoming year) will be released until the first or second week of November. Although many consumers feel this delay is political-motivated, in fairness, many states have not completed their examination and approval process of carrier rate-change requests.

November 26 2014 – Prices have been officially released, and as expected, some carriers substantially increased rates, while others were able to match 2014 plan costs. Enrollment times have been drastically cut with the help of redirect software. The quickest way to compare 2015 Ohio Marketplace plans is to use our Direct Enrollment Link that will save time, money and perhaps a lot of frustration!

December 11 2014 – Even if you don’t change coverage for 2015, it’s still important to verify that your primary care physician (PCP) is still considered “in-network” from your current carrier. Each years, may physicians add and delete companies from their “do accept” and “do not accept” lists.  Since the online directories may not be updated until after Open Enrollment ends, a quick verification call may save you money.

Get Ohio Health Insurance Coverage After Open Enrollment Deadline Expires

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Ohio Open Enrollment for single and family Obamacare health insurance plans ended on March 31 2014. In 2015, it will end on February 15th. After those dates, you need to purchase a plan through a “Special Enrollment,” that allows you to qualify for available federal subsidies and have any pre-existing condition covered without proving insurability.

What Is A “Special Enrollment” In Ohio?

This refers to specific situations that allow Buckeye consumers to buy policies outside of the normal period. For about 60 days, all Exchange plans that are offered on the Marketplace will be available, regardless of what time of the year this occurs. ACA tax subsidies will apply and there will be no extra fees or charges. To take advantage of these “special” situations, you must have a “qualifying life event.”

Your enrollment eligibility is not impacted by your income (unless you are Medicaid-eligible). Thus, if you have a high income that excludes you from receiving a tax subsidy, it will not affect your right to purchase a policy during this special period. Of course, if you apply during the OE period, you can view specific tips and information here.  And you won’t need a special exemption.

What Are The Qualifying Events?”

No Longer Eligible For Medicaid – If suddenly (for income reasons), you lose Medicaid eligibility, you can enroll. Keep in mind that Medicaid is different than Medicare. Medicare is for persons that have reached age 65 and are no longer working or are not covered under another plan. Medicaid is a national program that helps lower-income Americans obtain healthcare from conventional companies.

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Birth Of A Child Is Considered A “Qualifying Event”

Birth of a child  – This would refer to the newborn, and not the parents of the child. Premiums should be low because of the young age. If the child is born with any type of medical problem, the cost of treatment will be covered. Adoption is also an approved exception, although the appropriate documentation will be needed. Make sure your pediatrician is a participating network provider.

Divorce – This refers to the ex-spouse that is losing their coverage and does not impact the other ex-spouse’s existing plan. You can choose to duplicate (or closely duplicate) benefits, or choose an entirely different plan option. It’s always advisable to research plans in advance in case the cost information is needed for reimbursement purposes.

Cancellation Of Current Plan – Many in-force policies are being terminated with an option to convert to a different policy. Often, the conversion option is extremely expensive and has out-of-pocket costs that don’t match your budget. You may instead, compare Exchange plans that are eligible for the full federal subsidy. In most situations, this option will be less expensive than converting to the offered plan.

Notification of termination usually gives you at least 30-60 days to change policies. Your new policy is likely to contain many benefits you did not previously have. The subsidy (assuming you qualify), will help manage any rate increases.

COBRA expires – If you have exhausted your COBRA benefits (usually for 18 months), you no longer have to select a HIPAA plan. Previously, you faced an exorbitant premium that was often higher than COBRA. But starting in 2014, that ended. Now, it is a covered exception and there are many available plans. Most should be less expensive than COBRA.

Marriage –  Regardless of age (must be under age 65), this qualifies. Usually, one spouse loses their coverage, especially if the policy is an employer-sponsored group plan. You may have to change carriers and possibly find  a new doctor, depending on which company you choose. If you move to another state, you will re-enroll in another plan.

Termination of employment – One of the most common situations is when a job is lost. At least you won’t have to worry about medical issues since coverage is guaranteed. If the number of hours you are working is reduced, and the result is a loss of benefits, this will also qualify.

Retirement – If you are retiring from your employer and have to select your healthcare options, you are eligible. You may have an option to convert your group plan and that should also be considered. If you are offered a policy by a new employer, you forfeit the right to purchase a policy through SEP.

Many employers pay a significant amount of your group retirement policy (as much as 90% or more) based on your years of service. If you retire with more than 30 years of service, you may get an offer too good to refuse.

Move – If you permanently move to a different location which utilizes a different insurer  and creates different policy choices, you may select another plan. Keep in mind that your rate could dramatically fluctuate. For instance, a move from Ohio to New Jersey would not put a smile on your face. Conversely, if you move from New Jersey (or New York) to Ohio, you’ll have more spending money! Most Northeastern states tend to be more expensive than other parts of the US.

Error – If during your last enrollment, an error occurred, it’s possible you may be able to earn an exception. You will be asked to provide documentation and possibly details of the date you spoke to the representative. Although the number of errors is decreasing, they still occur.

“Minimum Essential Health” Benefits Were Lost – These are the 10 basic requirements of all Metal Exchange plans. Other than non-payment, lapse or forgetting to enroll, when any of these benefits are lost from your current plan, this exception may qualify. Maternity is expensive, and if it is removed from your policy, you will probably be able to select another plan. The assumption is that your existing policy was compliant before the removal of benefits.

Reach Age 26 – If you have been covered under a parent’s policy, when you reach 26,  you’re entitled to your own policy. Of course, you do not have to wait until January to apply for the new plan.

Not Eligible For Special Enrollment – Go Short-Term

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Don’t Take A Chance! Get A Cheap Short-Term Plan

If you don’t qualify for any of the exceptions listed above, there is a very low-cost policy available to both individuals and families at any time of the year. Referred to as “short-term” coverage, these temporary contracts will provide the cheapest Ohio health insurance coverage you can purchase. Not all companies underwrite the policies, but there are several trusted carriers that can be used.

The Positives –  The price. As earlier mentioned, it’s cheap and we’ll show some specific examples below. The simplicity. The 12-page applications have been removed, and replaced by a short form with about 3-5 medical questions. If you haven’t been treated by any of the conditions, and you have not been previously denied for coverage, you will automatically (Well…almost) get approved.

If you need coverage quickly, your wait time will be less than 24 hours and an application can be completed in about 10-25 minutes. You can complete the easy form online, or we can email or fax the application. No physical is required and only limited medical information is needed.

Short Term Plan Pricing

And the cost! It’s very inexpensive. The major companies in this niche are Anthem Blue Cross, UnitedHealthcare, Assurant, IHC  Group and HCC Life. Estimated monthly premiums for a 35 year-old male living in the Daytona are area are listed below:

$36 – $5,000 Deductible

$34 – $2,500 Deductible

$40 – $1,000 Deductible

(Lower coinsurance will increase premium)

The Negatives – If you have any existing conditions, it’s likely they will not be covered. And although preventive benefits are  mandated (required by law) to be covered on healthcare plans, the short-term plan is exempt, so you would have to pay for your own annual physicals, OBGYN visits and mammograms.

Also, since it is not Affordable Care Act compliant, you may be subject to a 1% (household income) tax for not purchasing a Marketplace policy. Although we would prefer this tax is waived, in many situations, the money that is saved, far exceeds the 1% penalty (which is scheduled to increase to 2.5% in 2016).

These types of policies are not designed to pay for long-term treatment of chronic illnesses and diseases. In addition to expensive therapy that may be limited, expensive non-generic drug use could create  some challenging financial situations. Other benefits, such as maternity and chiropractor visits are often not covered either.

Regardless of the reasons you missed Ohio Open Enrollment for Obamacare, there are  low-cost options that will allow you to quickly purchase coverage and get covered. We’re here to help.

Broker, Insurance Company Or Government Exchange?

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Purchasing healthcare coverage is  like filing your tax return. You know you have to do it, but it’s time-consuming, frustrating and you hope you don’t have to pay too much. And thankfully, you only have to take care of it once per year. You hope your premiums didn’t go up from the previous year (or not much), and you won’t spend too much time on the shopping, comparison and enrollment process

Here in Ohio, we get a big break. Not only are rates lower than most states, but we have a much broader selection of companies that offer policies. Whether its Anthem BC, Medical Mutual, Kaiser, Aetna, Coventry, HealthSpan, or UnitedHealthcare, low-cost policies are typically available. And of course, the federal subsidy often saves thousands of dollars per year in premiums.

So…Back to the original question. When you’re shopping for a policy, where do you find the best prices? Since rates are closely scrutinized by the Department Of Insurance,  you can’t get a better “deal” by using a specific, broker, company website or Exchange. However, finding the best low-cost plans that match a customer’s unique needs are best addressed by an experienced broker.

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A Broker Can Help You Select The Best Insurer

Instead of comparing policies from one specific carrier, you can view the best available policies from all major top-rated companies. It’s just like shopping for  a vehicle or appliance. Typically, you would like to see more than one brand before buying. The same applies to buying Ohio health insurance plans. While Anthem may be the perfect fit for your neighbor, perhaps Humana or Kaiser offer better policies for you. Thus, it’s critical to use an independent broker.

What about fees? Although many Agencies and some brokers charge a fee for their expertise and advice, we don’t. We never have and never will. It’s simply not ethical (in our opinion( since we are paid directly by the insurers. And most carriers prefer working with experienced websites/brokers since we handle much of their customer service needs at no cost to the carrier or consumer.

Not Just “Any” Broker

Brokers come in all shapes and sizes. Some are young and inexperienced, and others  are terrific resources for information and assistance. Their websites may be constantly updated or simply contain pictures of their favorite pets! You just never know.

With our website, you get the best of everything. We have the luxury of 34 years of experience along with utilization of the most modern and updated healthcare software, that helps us research, compare and recommend your best choices. When it’s time to apply or enroll for coverage, we’re at your side (if you want) throughout the entire process. Or just a phone call or email away. The choice is yours. We also provide an updated Q&A page that may easily answer many of your questions and concerns.

Our promise is that you will be presented with the best available options at the lowest possible costs. A federal subsidy, if applicable, will reduce your premium, and only the most reputable companies will be used.

 

Who should I contact

to compare plans, enroll, and seek advice?

 

 

A Licensed Agent

(Broker)

 

 

An Insurance
Company

 

 

The Government Exchange

 

ALL Sources?

Will they show plans ON the government Exchange Marketplace and plans OFF the Exchange (in the Private Market)?

Yes!

Yes, if they are participating in both markets

No, shows only plans on the Government Exchange (Marketplace)

ALL Plans?

Can they show plans from ALL major health Insurance Companies in the state?

Yes!  Independent Agents (Brokers) are licensed and contracted with many insurance companies 

No, only shows their own plans 

No, only the insurers on the Government Exchange (Marketplace) and only those specific plans

 

Personal Advice?

 

 

 

 

   Personal Advisor?

Yes!  Access to the same personal advisor, a licensed and insured Agent (Broker), who has years of experience and specialized training in the new laws

Many advisors in a call center, but no access to the same advisor.  Many of them have years of experience and specialized training in the new laws. 

Many advisors in a call center, or unlicensed and uninsured Navigators and Application Counselors, newly hired and newly trained

   Personal Phone Call?

Yes!

Call Center only

Call Center only

   Personal Consultation?

 

Yes!

No

Unlicensed newly hired Navigators or a meeting at the Exchange Call Center

   Website?

Yes!

Yes

Yes

 

Customer Service after the Sale?

 

 

Customer Assistance and help with understanding the insurance plan, claims, billing, enrollment rights, subsidies, problem resolution?

 

Yes!   

 

Yes, service from an employee of the insurance company

 

Yes, for some but not all issues.  The service is from a government employee.

 

 

Cost

The insurance price is the same no matter which choice you make. 

You do not pay a higher rate by using a broker and/or their website.

2015 Ohio Open Enrollment Help For Obamacare Health Insurance

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If you are enrolling for 2015 Ohio healthcare coverage through the Insurance Exchange, You’ll need free professional guidance to help compare the best medical plans, calculate your federal subsidy,  determine eligibility, and enroll online for the best effective date.

Fortunately, we specialize in assisting customers find the most affordable Ohio Marketplace policies, and making it easy to apply and purchase the most comprehensive benefits at the lowest cost. Although we probably say this on every page…it’s important to state it again – there are no costs or fees when we help you enroll.

How We Help You

Selecting the right plan is perhaps the most important part of the process. There are five types of coverage: Platinum, Gold, Silver, Bronze and Catastrophic. Although finding the least expensive offer should always be considered, it’s equally important to select the policy that pays most (or all) of your current medical bills with as little out-of-pocket expenses as possible.

For example, if you are required to have routine blood work every two or three months along with other diagnostic tests, it could be very expensive if you have to meet a deductible to cover these items. Easily, you could pay $2,000 or more. If you take medications, we’ll review the RX benefits of all available plans and show you the policies that will pay the highest percentage of your prescription costs.

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Take Prescriptions? We’ll Help You Find The Best Coverage

However, if an alternative plan places a copay on these types of charges, you might pay $40 instead of $400 when you receive treatment. The premium for this type of Ohio Exchange plan may only be  $5-$15 dollars more per month. We find and discuss these options with you, so you’re getting maximum coverage for your premium.

Note Regarding Prescriptions – Most carriers differentiate their drug coverage into four separate tiers (1, 2, 3, and 4). Usually, there is a small copay of approximately $3-$10 on the least expensive drugs (tiers 1 and 2). However, depending on the policy, there can be significant differences on the out-of-pocket costs on more expensive non-generic or non-preferred drugs. If you take prescriptions, it is important for us to review the plan drug coverage so you minimize your copays and coinsurance.

Also, you will always have “Essential Health Benefits”  included in Marketplace plans, since it is now required. These are 10 coverages that must be included in all  policies. Maternity and mental health are two of the biggest benefits, along with the standard expected coverages for hospitals, Emergency room, inpatient/outpatient, prescriptions etc…

Avoiding The Enrollment Nightmare

Although most of the “nightmares” have been eliminated, enrolling for new coverage can still be a challenge for consumers that attempt to secure coverage by themselves. Some of the most common issues are long delays on the phone or online, receiving incorrect subsidy or plan information, not being informed of lower-cost options, and providing financial information to persons that have had no background checks and are newly-hired.

Obviously, we eliminate all of those concerns with a combination of our 34 years of experience, and commitment to simplifying the enrollment process by working and guiding you every step until completion. The bugs and malfunctions of the government healthcare website are challenges we have learned how to avoid. However, if you are Medicaid-eligible, you will have to contact the State Medicaid office (phone or online) to formally apply.

New In 2015

For 2015, a new concept (re-direct software) allows you to enroll in a very short period of time. It’s a fairly simple concept and it works like this: Once you know which plan (and company) is being applied for, we create a unique specialized online link that is customized for you (and only you).

Also, as a licensed broker, with many carriers, we offer a direct-enrollment link, so you never have to visit any website other than the broker and insurer links. This typically is available if you do not qualify for any subsidy assistance or you are purchasing an “off-Exchange” policy. These plans are not available through the .gov website or any type of navigator. The application process is also significantly reduced from about 30-40 minutes to 10-20 minutes.

Cadillac Plan Options

Although there are dozens of low-cost high-deductible Marketplace plans available in Ohio, what about the policies that costs a little more, but feature smaller deductibles and coinsurance? Also included are copays that don’t cost almost as much as the actual visit to your primary care physician or specialist. We have listed several example below. NOTE: Not all plans are offered in all areas of the state.

Humana Gold 2500 – $2,500 deductible with $25/$35 copays on primary care physician (pcp)/specialist visits.

Premier Health Gold 1500 – $1,500 deductible with $10/$40 copays on pcp/specialist visits.

HealthSpanOne Gold 1000-80 – $1,000 deductible with $10/$30 copays on pcp/specialist visits. $30 copay on brand prescriptions.

UnitedHealthcare Gold Compass 500 – $500 deductible with $20/$40 copays on office visits.

Ambetter Secure Care 2 – $500 deductible with $50 and $75 copays on office visits.

HealthSpanOne Gold 250-70 – Similar to previous policy with very low $250 deductible but higher out-of-pocket maximum.

Anthem Gold Pathway X PPO 1250 10 – $1,250 deductible with $30 pcp copay and $3,100 maximum out-of-pocket expenses.

Aetna Gold $5 Copay – $1,400 deductible with $5 copay on pcp visits ($40 for a specialist).

Molina Marketplace Gold Plan – $500 deductible with $15 and $35 copays on office visits.

Medical Mutual Market HSA  2000 Gold – HSA-eligible plan with $2,000 deductible.

SummaCare Individual 750-LT – $750 deductible with $20/$40 copays.

 

How Long Must I Keep The Policy?

There is no time-period requirement for keeping the plan in-force. So whether you keep it a month, a few months, or a few years, it does not matter. You can cancel at anytime. Billing is usually monthly, so you have time to terminate coverage. For example, if you knew you would qualify for employer-sponsored benefits in four months, of course, you would not want to keep your policy, assuming you liked the group coverages.

Also, although there is a new Marketplace enrollment every year, you don’t have to apply for new coverage if you like what you have. Conversely, if you previously purchased a plan that no longer fits your needs, we can apply (without answering medical questions) for a new policy. NOTE: If you terminate a plan, unless you qualify for a special enrollment exemption, you may not be able to purchase a “subsidized” policy until the following November.

What If You Miss Open Enrollment In Ohio?

You definitely won’t be the first person! Officially, Open Enrollment ends on March 31st, 2014. However, the next Open Enrollment begins in about nine months, since it is an annual event. Of course, you may not want to go nine months without medical coverage.

If  the deadline is missed, you can apply for a “short-term” plan from several companies through our website. UnitedHealthcare will likely have the lowest rates, and you will be able to keep coverage up to 12 months. Pre-existing conditions would not be covered, since it is not considered an Exchange plan. Premiums are very inexpensive for both an individual and family policy.

Another alternative is purchasing a “limited-benefits” policy. Although it will not contain all of the required 10 essential benefits of an Exchange policy, this type of policy will offer an alternative that provides some financial relief if you incur large doctor and/or hospital bills. Usually, acceptance is just about guaranteed and premiums fluctuate in the $50-$150 per month per person range.

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Don’t Take A Chance By Missing Open Enrollment

What Are The “Special Enrollment Periods?”

You can purchase coverage outside of the designated enrollment periods if you have a “qualifying life event.” You won’t have to answer any medical questions and subsidy eligibility will be offered. Approved by the Department Of Health And Human Services (HHS), some of these “events” include:

Getting married

Adopt or have a child

A change in income that impacts eligibility for cost-sharing or tax credits

Relocation to a different city/state that offers different plan options

Loss of benefits due to divorce, job change, Medicaid, CHIP, COBRA etc…

Loss of coverage because of job termination.

Become a US citizen

If the Government (HHS)  makes an error causing you to lose or change benefits

COBRA Is Expensive. Can I Drop COBRA And Apply For An Exchange Plan?

Yes, COBRA is expensive, since it is designed to mirror your prior employer’s benefits. It often includes low deductibles, which raise the cost of coverage. Often, with the help of your subsidy, the Marketplace prices will be significantly lower, and become a very tempting target for enrollment.

This is the best time to apply for new coverage, since you won’t have to worry about any health-related issues, and you can (with our help), compare and select the policy that gives you the benefits you want at a reasonable cost. COBRA can be easily terminated to coincide with the effective date of your new policy.

However,  if you miss the deadline, and don’t qualify for any special circumstance exceptions (divorce, job termination etc…), you will have to wait for the next Open Enrollment or purchase an ACA non-compliant plan that may have limited coverages.

UPDATES:

November 14 2014 – Less than 48 hours until the second-ever Ohio Open Enrollment begins.  A major upgrade is the direct enrollment link we provide if you live in-state. It reduces the application time down to about 15 minutes and what an improvement that is from last year. Also, Aetna, UnitedHealthcare and Premier are new carriers in the state. At first glance, UnitedHealthcare, as always, appears to  offer many attractively-priced options.

December 3 2014 – Two new companies are doing well in their respective areas. Premier, based in Dayton, offers excellent prices in Montgomery County and the nearby area. In many situations, they’re the lowest-cost option available. Also, Ambetter offers very low rates in Hamilton County and the greater Cincinnati area. Although the cheapest plans have higher deductibles, also available are Silver-tier plans for frugal shoppers that want a low price and a moderately-low deductible.