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Ohio Medicaid Health Insurance Information – Applications And Qualifications

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Ohio Medicaid Health Insurance is available to many Buckeye State residents. Medical plans are currently provided to more than three million individuals and families, with pre-existing conditions covered, and premiums either free or extremely inexpensive. Comprehensive benefits  are provided after a short application is submitted and approved. Food and cash assistance, help with housing and utilities, and mental health and addiction services are also offered through other Agencies.

The two public assistance cards are  “Direction” and “EPPIC.” If you currently utilize either of the cards, an additional application is not needed. Veterans or persons serving in the Military may have additional options. WIC (women, infants, and children)  offers supplementary nutrition assistance to breastfeeding and pregnant women, and children less than five years old. Nutrition and breastfeeding education, and specific foods (eggs, vegetables, fruits, whole grains) are provided to eligible persons. Infant mortality has been greatly reduced, while birth weight and length of pregnancy have increased, due to WIC and other similar  programs.

Qualifications

Applicants that can qualify for benefits include individuals with low income, persons with disabilities, older adults, infants, small children, and pregnant women.  Additional requirements are US citizenship, legally reside in Ohio, and be able to meet specific income guidelines. Applications can be submitted online or through the mail. A personal visit is not required. Non US citizens that are ineligible for coverage can apply for alien emergency medical assistance or refugee medical assistance. Refugees who have been in the US less than eight months, and are ineligible for Medicaid, may be able to receive benefits if their household income is less than 100% of the poverty level.

CHIP and Medicaid eligibility is largely determined by the MAGI (Modified Adjusted Gross Income). Of course, the more money the household earns, the less federal or state funds are provided. You can view specific information regarding the calculation here.  Expansion has taken place in many states (including Ohio), so more applicants are now eligible.  “Healthy Start” and “Healthy Families” are available to state residents that have a social security number and meet certain financial requirements.

Healthy Start

“Healthy Start” (also known as “SCHIP”) is available to uninsured children (19 and under) with household income up to 206% of the Federal Poverty Level (FPL). Applicants must  be a US citizen, permanent resident, or legal alien. Any person that has illegally entered the United States will not be eligible for benefits.

Pregnant women in families with income up to 200% of the FPL and covered children (19 and under) with household income up to 156% of the FPL also qualify.  There is no pre-existing condition clause, or waiting period for treatment, once enrolled in the program.  After becoming eligible for Medicaid, each child will have access to Healthchek, Ohio’s early and periodic screening, diagnosis and treatment program.

Comprehensive coverage is provided (including preventative benefits) along with other coverage, including  dental, ER, alcohol and drug addiction, family planning, hospitalization, Healthchek (see below), vision, transportation, mental health, pregnancy, transportation, prescriptions, and medical equipment.

Healthy Start Oho medical coverage

Affordable Quality Ohio Healthcare Is Available

Healthy Families

“Healthy Families” is offered to families, with a child under age 19,  that have income no higher than 90% of the Federal Poverty Level. Coverage is available to the adults, but not children. Applicants must be a US citizen and a legal resident of Ohio. There is no cost to enroll or secure coverage. Once approved for Medicaid, fee-for-service benefits begin, although you are required to re-apply every six months. Proof of US citizenship and income will be required.

Household income will be re-calculated every six months to ensure continued eligibility. Case workers should always be informed of changes that impact income or eligibility. Once approved, there is no waiting period before using services. A case worker will be assigned to provide assistance, and record changes that may impact eligibility.

Applying for coverage can be completed online by completing a CPA (Combined Programs Application). Phone assistance is also available. Covered benefits include Preventative healthcare, dental, vision,  ER, outpatient and inpatient hospital expenses, prescription drugs, pregnancy and prenatal care, drug and alcohol addiction, and HealthChek. Typically, a “managed care” plan must be chosen.  The four available options in Ohio are:

UnitedHealthcare Community Plan

Molina Healthcare

CareSource

Buckeye Health Plan

Paramount Advantage

Healthchek

Healthchek” provides newborns, children, and young adults (through age 20) preventative, diagnosis and treatment services. Ten  checkups in the first two years along with follow-up annual checkups provide comprehensive healthcare. If additional treatment is required, Medicaid will pay for the expenses. NOTE: The program is also known as EPSDT (Early Periodic Screening, Diagnosis, and Treatment).

Each physical examination includes a medical history review, complete unclothed exam, vision and dental screening and other screenings and services, if recommended by the attending physician. Physical therapy benefits are actually more comprehensive than similar coverage offered to adults. Dental coverage is also more comprehensive than many plans offered to adults.

Other  services include hearing and immunization assessments and additional diagnosis and treatment if a potential health problem is discovered. Any necessary lab tests  and nutritional advice will also be provided. Additional  information can be found here. Note: Newborns should utilize all 10 exams before their third birthday. By age three, only one exam is generally required each year. Physicians that accept Medicaid for insurance reimbursement, can also be used for Healthchek exams. If you move to a different county, a Healthchek Coordinator should be notified.

How to apply for Medicaid in Ohio

Preventive Benefits Are Covered By Ohio Medicaid

Medicaid Covered Benefits

The list is long and comprehensive, but we have highlighted the major coverage below:

Mental Health And Illness – Crisis intervention, partial hospitalization, psychological testing, group and individual counseling, psychiatric diagnostic interview,  and pharmacological management.

Preventative Health – Immunization, mammogram,  OBGYN visit, routine annual physical, annual flu and pneumonia shots, chest x-ray, and prostate and cancer screenings.

Drug And Alcohol Addiction – Case management, methadone administration, intensive outpatient, crisis intervention, drug/alcohol screening and lab urinalyses, and Naltrexone injection.

Pregnancy, Maternity, And Delivery – Covered females can receive benefits on all deliveries, including C-Sections. Generally, a $0 copay applies. Common benefit services include preconception and prenatal care, amniocentesis, physical examinations, blood tests and urinalyses, medical history assessment, counseling, high-risk monitoring, transportation of mother, ultrasound, pain medication, and of course, the delivery.

ER Visits – Benefits are included although a low $3 copay may apply if treatment is not considered an emergency.

Medical Equipment – Approved durable equipment includes (but is not limited to) walkers, wheelchairs, speech-generating devices, hospital beds, crutches, canes, prosthetic devices, breast pumps, diabetic supplies, and oxygen supplies.

Dental – Checkups and cleanings are provided every six months for persons under age 21 and annually for adults. A $3 copay applies to adult visits. Braces and orthodontia often require prior approval. Dentures and partial plates also must be approved. Fillings, extractions, root canals, and crowns are often covered. level of benefits are often determined based on medical necessity.

Vision – Medical and surgical benefits are provided along with annual vision checkup with one pair of glasses (every two years for adults). Screenings for Glaucoma are also covered.

Additional  resources and initiatives include:

Balancing Incentive Program – Increased federal funding is utilized  to improve long-term care services. Disabled persons and Seniors can live in non-conventional residences, and learn more about available services.

Electronic Visit Verification – Provides verification  of services and the length of time they were performed. Private duty and home health nursing are included.

Payment Innovation – Quality of services rendered should be rewarded, as opposed to the volume of services provided.

MyCare Ohio  – See below.

Disability Determination Changes – Several administrative procedures that determine eligibility were combined into one process. Persons impacted include the blind, aged, or disabled. “Spending down” is not required, and more lower-income individuals can qualify for benefits.

Budget Cost-Containment – Limiting per-member cost increases to less than 3% is the ultimate goal.

Transition Of Home And Community-Based Services – HCBS must meet specific guidelines and provide protections to persons receiving benefits.

Persons Receiving Both Medicaid And Medicare Benefits

Managed care benefits are available through MyCare Ohio, who provides long-term, medical, and behavioral coverage. Enrollment is required if you live in a “demonstration” county, are 18 or older, and currently are receiving Medicare and Medicaid benefits. A plan will be chosen for you, if you do not select a choice. Written confirmation will be sent, with the your deadline for enrollment. Behavioral support and long-term care is also provided. Note: You can compare Medicare Supplement plans in Ohio, and customize benefits and cost. Many levels of prescription drug coverage can also be chosen.

MyCare began in 2014 and provides benefits in 29 counties for more than 100,000 persons. Medicare-eligible applicants can retain their existing coverage. A “care team” helps coordinate your treatment. Members of the team include your primary-care physician, specialists, family members, case managers, and other medical personnel. Generally, reviews of your overall health are conducted regularly, and all treatment (if needed) is discussed. This system simplifies and organizes your benefits, since you have one main point of contact, instead of several persons in different cities.

Long-Term Care

Disabled and older adults often need assistance with routine daily activities, such as eating, getting mail, taking baths or showers,  and preparing meals. LTC services help individuals and families enjoy a more routine and comfortable life, with Medicaid’s help. Specific services offered include private duty nursing (PDN), if the need is between 4 and 12 hours of continuous assistance. The personal-care physician (pcp) can help coordinate nurse’s care. Hospice services are also available for the terminally ill, and they can discontinue the benefits at any time.

Trumpcare Health Insurance Coverage In Ohio – American Health Care Act

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President Donald Trump is sending Obamacare (Affordable Care Act) to its grave. Open Enrollment will change. The mandate requiring the purchase of compliant medical coverage will change.  The American Health Care Act will be passed. And Ohio individual and family health insurance rates will go down. Or will they increase? So many unanswered questions and unquestioned answers.

With the help of Washington insiders, the Cleveland Indians, and our Seinfeld sense of humor, we present to you – “10 Things You Wanted To Know About Trumpcare, But Were Afraid To Ask.” Tongue and cheek, of course.  Please enjoy!

 

Donal Trump's New Medical Plan

How About That TrumpCare Health Insurance!

 

Individuals that complete an annual physical each year, and take no major medications, will be rewarded with a free three-night stay at any Trump resort in the world. Popular US destinations include New York, Chicago, Miami, and Las Vegas. Gold-plated faucets and curtains cost extra, although gold-colored blankets and sheets are standard. The mini-refrigerator comes with a full stock of food and beverages, including selections from Trump Winery.

 

“Trump Points” will be awarded to all persons that pay their out-of-pocket costs (copays, deductibles, and coinsurance) by the due date of the bill. If you pay 14 days early, an extra 1,000 “Trump Points” will be earned. At the end of the calendar year, you can redeem your points for great gifts, including electronic items, clothing, outdoor patio furniture, and shares of stock of Sears. If Sears files for bankruptcy, Walmart gift certificates will be available. Target and Kohls gift certificates are also available, for a slight cost.

 

Have you been thinking about getting an alarm system for your home to keep burglars away and strangers off your property? Congratulations! As part of an introductory  promotion, the first 1 million persons to sign up for the new healthcare coverage will get their choice of a 10-feet wall built around their house or a 15-foot moat that surrounds the property. And by the way…Kentucky will pay for it. An optional swinging door pet gate will allow cats and dogs to enter the country, as long as they are spayed or neutered.

 

Trump Tower

Cleveland’s Key Tower

 

The Key Tower,  in downtown Cleveland, is the tallest building in Ohio, and the 24th tallest building in the US. It can be seen 20 miles away, and is home to KeyCorp. But the new Buckeye-Trump Tower will begin construction in late 2017 and will eventually be the home to Department of Health And Human Services (HHS) employees. It will replace the Key Tower at the tallest building in Ohio. And actually, it will become the tallest building in the world, reaching more than 27 miles in the sky. From the top floor, with a strong telescope, you’ll be able to see Uranus.

 

Health Savings Accounts (HSAs) will continue to be offered by most major insurers, with a new wrinkle. In addition to depositing tax-deferred dollars into your account, you will now be able to deposit “Trump Dollars” into your HSA. Available at most fine restaurants, grocery stores, and Ohio State football games, this new currency will have one advantage over regular US dollars. You can redeem any unused funds at the end of the year for several gifts, including gold-plated teeth, Long John Silver’s gift certificates, and free tickets to the Cincinnati Zoo.

 

A new 24-hour television network, “The Apprentice,” will be aired on Channel 146. It will also be aired on channels 151-289 and channels 14-75.  New episodes will be filmed from the White House.  A local “Ohio Apprentice” will be filmed at Kings Island, and aired on weekends only. Network programming will offer free healthcare tips and a free database of all Donald Trump press conferences within the last three years. Young entrepreneurs with great ideas can apply online to pitch their product.

 

TrumpCare “Preferred Status” will be awarded to all household members who don’t drink, smoke, or have a BMI (Body Mass Index) more than 15% of their recommended level. Special perks will include two free ER visits, a selfie with President Trump, or any other family member, and  a lifetime free pass to the Pro Football Hall Of Fame in Canton. You’ll also receive free dried fruit snacks every month until you reach age 70.

 

The Cleveland Indians will be re-named the Cleveland Trumpeters, and all home games will be played in New York City. To accommodate season ticket holders, loyal baseball fans will be able to fly one-way from Cleveland at half-price. The return trip will be handled by Southwest Airlines, with all direct routes stopping in Chicago and Las Vegas, before heading back to Cleveland. Any passenger caught wearing any New York Yankees-related clothing, will be immediately deported.

 

Health Savngs Accounts Ohio

Save Money With A Trump HSA

 

WSAs (Wall Savings Accounts) will also be created under the Trump Administration. The WSA (Wall Savings Account), will allow Ohio residents to contribute tax-free dollars to help pay for the wall separating the US and Mexico. For every dollar invested, two additional dollars will immediately become available to pay for policy copays, coinsurance, and deductibles. And as a special perk, free vacations to Cancun and Mexico City will be offered to every college student that graduates with at least a 3.5 GPA.

 

 

“Make Ohio Great Again” will become the new state motto, with souvenir t-shirts given out to every resident. As a special inducement to wear the t-shirt, when renewing driver’s licenses or vehicle registrations, a 25% discount will be applied to the cost, if the t-shirt is clearly visible. Any person who has the slogan on their pants, will receive  a free vanity license plate with “Make Ohio Great Again” prominently displayed on the top and bottom.

Ohio State Student Health Insurance Plan Options – Compare OSU Rates

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As a condition for enrollment at Ohio State University (OSU), students are required to be covered under a qualified health insurance plan. This requirement applies to undergraduate students enrolled for six or more eligible credit hours (four or more eligible credit hours for graduate and professional students and three hours for post-candidacy students). You may choose to purchase private on and off-Marketplace coverage or the OSU option.

All international students must also meet these requirements, and are automatically enrolled in the “comprehensive” plan. Also, auto-enrolled are students that study overseas, interns, and persons working on dissertations or a thesis. However, if alternative qualified coverage is in-force, a waiver will be granted. If no selection is made, the comprehensive plan will automatically be selected. Generally, you must select a choice about seven days before August Semester classes begin.

When registering for classes for the first calendar year term, the Buckeye Link will indicate the cost of coverage for the comprehensive plan option. That coverage can be kept, or waived, with proof of another qualified policy. If waived, a supplementary WilceCare policy (discussed in detail later) also becomes available. NOTE: The annual period of coverage is August to August as opposed to using the calendar year.

Qualifying Events

If you miss the Enrollment/Select/Waive period for changes to the comprehensive plan, a 31-day period is granted if you qualify for a “qualifying event,” and submit the appropriate form to SHI. However, any form received after that period will not be considered. Coverage can be requested to be added or terminated. Examples are listed below:

Death of spouse, child, or dependent

Dependent no longer eligible for other coverage because of age restriction

Adding a spouse because of marriage

Deleting a dependent because of divorce

Dependent becomes US citizen

Adding a newborn from legal adoption or delivery

Dependent leaves country to return home

Employment change leads to new healthcare eligibility

Domestic partnership is terminated

 

2016-2017 Rates

OSU student health insurance rates for 2016-2017 are listed below. These rates are “per semester” with the plan offered and underwritten by UnitedHealthcare, one of the nation’s largest healthcare providers. Details of the OSU student health insurance plan can be viewed through the provided link. NOTE: Although UHC has greatly reduced their presence on state and federal Exchanges, it does not impact the specific plans offered at OSU. All of the options below satisfy ACA (Affordable Care Act) requirements and regulations, and include “minimum essential requirements.”

(Paid TWICE per year)

Student –   $1377

Student And Spouse –   $2754

Student And Spouse And  Child –   $4131

Student And Two Or More Children –   $4131

Student And Spouse And Two Or More Children –   $5508

OSU Medical Center Serves Ohio State Students

Ohio State University Hospital Is One Of The Finest In The Midwest

Plan Overview

The policy provides comprehensive healthcare benefits, including coverage for office visits, prescriptions, Urgent Care and ER visits, major medical, mental illness, dental, and vision. If network facilities are utilized, maximum out-of-pocket expenses will be minimized. However, the UnitedHealthcare network is also available for off-campus treatment. Within the Franklin County PPO Network area, there are many available facilities. NOTE: Picture above is property of OSU.

Additional specific network highlights include a low $100 deductible and $2,000 maximum out-of-pocket costs (in-network treatment). Both primary-care physician (PCP) and specialist office visits  are subject to only a $15 copay with no limit on the number of covered visits. Also, no referrals are required. Vision and dental exams also feature the $15 copay. NOTE: The benefit package was recommended by the Student Health Insurance Advisory Committee and approved by the Board of Trustees.  Additional benefits include:

100% qualified preventative benefits with no out-of-pocket costs.

10% coinsurance for diagnostic tests (blood work and x-rays), MRIs, and PET/CT scans.

10% coinsurance for generic drugs, 20% for preferred brand drugs, and 50% for non-preferred brand drugs.

10% coinsurance for physician/surgeon and facility fees.

10% coinsurance and $100 copay for Emergency-Room visits.

10% coinsurance for hospice and rehabilitation services, skilled nursing care, and durable medical equipment.

 

Exclusions

Not all medical expenses are covered, regardless if treatment is performed in the Columbus area, or outside of Ohio. A partial listing of exclusions is listed below:

Experimental or unapproved surgery

Bariatric surgery

Cosmetic surgery

Hearing aids

Infertility treatment

Adult dental care

Weight loss programs

Long-term care

Foot care

If you receive treatment at the Wilce Student Health Center, usually there will be very little (or no) out of pocket cost. Otherwise, copays of $15 and $25 apply to many popular office visits. There is a $100 deductible to meet and the  maximum out of pocket amount is $5,000. A 10% coinsurance often applies to services, which is fairly typical.

Ohio State University Student Health Insurance Options

The WilceCare Supplement covers diagnostic lab tests and X-rays.

WilceCare Supplement Plan Option

If you opt out of the “comprehensive” option, and choose to utilize your own private plan, depending on your deductible and network benefits, higher out-of-pocket expenses could result, depending on the number of submitted claims. The WilceCare option is a pre-paid coverage that provides benefits for common ailments (and injuries).  It is not a qualified insurance plan, and covered treatment must be provided at the Wilce Student Health Center during normal operating hours.

The two main components of the contract are prescription drugs and outpatient treatment. In-hospital expenses, or any services provided away from the Wilce Center are not covered.  The Buck ID is the only identification needed for treatment. Major highlights of the rider are listed below:

Annual cost is $225. Spouses and dependents are not eligible for coverage.

$2,000 is the maximum amount of benefits paid for the contract year. Prescription drugs have a separate maximum of $225.

Outpatient services include office visits, physical therapy, allergy injections, diagnostic services, including x-rays, lab tests, and electrocardiograms, and needed supplies.

Prescription drugs for conditions that are covered under the program. Coinsurance is 10% for generic drugs, 20% for brand name drugs (no possible generic substitute offered), and 50% for brand name drugs with generic substitute available. A $10 copay also applies, unless the cost of the prescription is less.

Exclusions

The following conditions and expenses are excluded:

Dental and vision treatment, including glasses, contact lenses, and hearing aids.

Non-prescribed medications (over-the counter) and contraceptives.

Preventative treatment. NOTE: These types of expenses are 100% covered under private and group plans.

Psychotherapy and psychiatry.

OSU Ohio Healthcare Plans

It’s Important To Properly Compare All Ohio Student Health Insurance Plan Options

Comparison Of OSU Student Plan To Available Private Plans

For our comparison, we are assuming the insured is a healthy 20 year-old  who lives in the Columbus area. It should be noted that rates vary, depending on where you live, your smoking status, and age. For this comparison, we did NOT include a federal subsidy, which can substantially lower premiums if you meet eligibility requirements. Listed below are some of the best plans to consider for student health coverage in Ohio. Rates are monthly:

$112 – CareSource Just4Me Bronze – $6,650 deductible with $40 and $80 copays on pcp (Primary-Care Physician) and specialist office visits respectively.

$132 – UnitedHealthcare Compass HSA 5500 – HSA-eligible plan with $5,500 deductible and $6,500 maximum out-of-pocket expenses.

$136 – Molina Marketplace Silver – $2,000 deductible with $20 and $55 office visit copays. The generic drug copay is $10.

$148 – Anthem Bronze Pathway X PPO 5000 30 – $5,000 deductible with pcp office visit of $55.

$173 – Molina Marketplace Gold – $500 deductible with $15 and $35 office visit copays. Maximum out-of-pocket expenses are $6,850.

$179 – UnitedHealthcare Gold Compass 0 – $0 deductible with $30 and $60 office visit copays. $6,850 maximum out-of-pocket expenses.

$185 – Anthem Silver Pathway X PPO 2000 20 – $2,000 deductible with $45 copay on pcp office visits.

$197 – Anthem Gold Pathway X HMO 1450 20 – $1,450 deductible with $30 and $50 office visit copays. )nly $3,100 for maximum out-of-pocket expenses.

$201 – Medical Mutual Market 1750 – $1,750 deductible with $30 and $60 office visit copays (with 25% coinsurance).

$245 – Market 1000 – $1,000 deductible with $25 and $50 office visit copays. Maximum out-of-pocket expenses are $6,500.

There are many affordable student health insurance options and it’s very possible one of the plans listed above may be worth considering. Our contact information is listed at the top of the page and we are always available to discuss the best choices.

Summary

We continue to be recognized as the premier resource for all student medical coverage. You can view additional details here and view quotes live online. Often, purchasing your own private coverage is much less expensive and many benefits will be much more comprehensive. However, each situation is different so we’ll be happy to provide our unbiased advice and input.

It is also important to note that we are not affiliated with the OSU student health insurance program. However, optional  coverage from many top-rated companies is very comprehensive, and rates are quite attractive. Specific questions regarding OSU student plan rates, coverage, eligibility requirements and enrollment details should be directed to this website.  However, we also encourage comparing rates from all of the available carriers, not just one. Our quote section at the top of the page will help.

2017 Ohio Health Insurance Plan Rate Projections – Individual/Group

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Ohio health insurance companies are required by the Affordable Care Act legislation to provide rate increase requests of more than 10% to the federal or state government. These price increases will be studied and reviewed, to determine if the changes are fair and warranted. Consumers can voice their opinion regarding the evidence the insurers have provided to justify the premium hikes.

Below, we have provided ACA-compliant plans in Ohio and their requested (from the insurer) rate increases for January 1, 2017 effective dates. It is unlikely that the Department of Insurance will approve all premium increases in their entirety. Information is imported from “Rate Review,” which is managed by the Center for Medicare and Medicaid Services.

 

Aetna

13.19% – HMO Small Group

9.02% – HMO Sam’s Small Group

7.28% – Indemnity Plan Small Group

12.57% – PPO Small Group

12.97% – Managed Choice – PD – Individual

11.37% – Managed Choice Individual

 

AultCare

9.95% – Small Group HMO

10.43% – Small Group

24.09% – Individual

 

Anthem BCBs (Community Insurance)

12.04% – HMO Individual

9.48% – PPO Individual

4.96% – PPO Small Group

2.5% – PPO Off-Exchange

 

Buckeye Community Health Plan (Ambetter)

-0.79% – Ambetter Individual

-1.14% – Ambetter Individual Plus Vision

 

CareSource

13.29% – HMO Enhanced Individual

13.53% – HMO Basic Individual

 

Consumers Life (MedMutual)

1.86% – Off Exchange Individual

1.88% – HMO Individual

 

Federated Mutual

20.61% – Small Group

 

Freedom Life

9.98% – Individual

 

Humana

7.39% – Small Group

12.45% – Cincinnati/No.KY HMOx Small Group

 

Medical Health Insuring Corp. (Medical Mutual)

-17.13% – MedMutual HMO Individual

-17.17% – MedMutual HMO Off-Exchange

18.32% – MedMutual Connect Small Group

 

Medical Mutual

18.36% – MedMutual Small Group

 

Molina

2.36% – Molina Healthcare Individual

 

Paramount

9.88% – Individual Exchange

2.22% – ALLC OOA Small Group

 

Pekin Life

5.11% – Choice Plus Small Group

6.47% – Flex Plus Small Group

5.92% – Classic Choice Small Group

 

Premier Health

39.82% – Premier Individual

39.23% – Premier PD Individual

 

Summa

1.51% – QHP Group Small Group

4.78% – QHP Group Qualified Small Group

6.22% – QHP Individual Qualified

 

Health Plan Of The Upper Ohio Valley

7.92% – Silver HMO Small Group

9.04% – Gold HMO Small Group

7.90% – Platinum HMO Small Group

16.64% – Bronze Individual

13.46% – Bronze HMO Small Group

 

THP Insurance Company

5.40% – Gold PPO Small Group

8.19% – Bronze PPO Small Group

5.64% – Silver PPO Small Group

5.84% – Platinum PPO Small Group

5.92% – Gold HRA Small Group

6.57% – Silver HSA Small Group

18.30% – Bronze HSA Small Group

 

UnitedHealthcare

6.55% – Heritage Plus Small Group

5.91% – Choice Plus Small Group

6.68% – Navigate Small Group

 

US Health And Life

6.61% – PPO Small Group

6.65% – HSA Small Group

Paramount Health Insurance Plans And Rates In Ohio

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Low-cost health insurance in Northwest Ohio is offered by Paramount. Plans are available to individuals and groups, both on and off the Marketplace Exchange. Residents can choose affordable HMO, Elite, and Advantage options that provide quality coverage at a competitive price. The rates you view on our website from your free quote request, are the lowest offered prices since the Department of Insurance regulates pricing.

Paramount has offered policies for more than 25 years, and features popular consumer-driven products to applicants under the age of 65, along with Seniors that are eligible for Medicare. A National Committee for Quality Assurance (NCQA) accreditation was originally awarded in 1995. A “Quality Improvement Program” has been implemented, and is designed to improve patient treatment and service, and review the effectiveness and efficiency of their providers. Affiliated with ProMedica, plans are also offered to small and large companies that are providing group benefits to their employees.

Policies are offered in 4o counties in Northeastern Ohio and Southern Michigan. Partial benefits are provided in Delaware, Hardin, Knox, Allen, and Paulding counties. If additional areas are added to their network coverage area, we will update the map below.

Paramount Health Insurance Ohio Network

Paramount Ohio Service Area

Available Individual And Family Plans – Under Age 65

Exchange (and off-Exchange) coverage is offered during Open Enrollment, and after the OE period has ended (with a special exemption). A large Paramount Ohio Insurance Provider Network (doctors, specialists, hospitals, and medical facilities) gives state residents many local options for treatment. Shown below are single and family policies that are not medically underwritten.

 

Bronze 1 HSA – HSA-eligible plan with $6,500 deductible and 0% coinsurance. You may choose a financial institution to administer your tax-free deposits that can pay for qualified medical, dental and vision expenses. Generally, this option is most cost-effective if there are no major medical conditions, and you do not anticipate that any family member is likely to meet the deductible. One annual eye exam and a pair of glasses each year are provided at no cost.

Bronze Standard – $45 primary care physician (pcp) office visit copay with no limit on the number of allowed visits. Specialist and Urgent Care visits are subject to 50% coinsurance. Deductible is $6,650 with maximum out0of-pocket expenses of $7,150 and 50% coinsurance. Preferred and non-preferred generic drugs are subject to a $35 copay. Other drugs are subject to 35%-45% coinsurance.

Silver 1 – $30 and $75 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,250 deductible with maximum out-of-pocket expenses of $7,150 and 40% coinsurance. $10, $20, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance.

Silver Standard – $30 and $65 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,500 deductible with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. $15, $15, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance. Very similar to previous plan, but slightly more expensive.

Silver 3 – Same rate as Silver 2 plan but with a $500 higher deductible ($3,500), but also a higher specialist copay ($75 vs. $65).

Gold 1 – Low $1,000 deductible with $20 and $30 office visit copays. Generic drug copay is only $7, and Brand drugs do not have to meet a deductible.

Gold 2 – Slightly more expensive than previous plan. $1,500 deductible with $10 and $20 office visit copays. $6 generic drug copay with $5,000 maximum out-of-pocket expenses. Specialty prescriptions are subject to a 20% copay.

Sample Rates (Under Age 65)

Since the cost of coverage varies, depending on several factors, we have illustrated below monthly rates for specific household situations. If a federal subsidy is available, it has automatically been applied to reduce the premium. However, any applicant can choose to decline the Obamcare subsidy. This federal aid is only offered during Open Enrollment and SEP situations. If you missed Ohio Open Enrollment, many options are available, including inexpensive (but non-compliant) short-term plans.

 

25 Year-Old Male Living In Zip Code 43617 – $15,000 Income (Sylvania – Lucas County)

$78 – Bronze 2

$107 – Silver 1

$153 – Gold 1

 

40 Year-Old Couple Living In Zip Code 43608 – $27,000 Income (Toledo – Lucas County)

$176 – Bronze 2

$250 – Silver 1

$366 – Gold 1

 

50 Year-Old Couple Living In Zip Code 45840 – $45,000 Income (Findlay – Hancock County )

$219 – Bronze 2

$326 – Silver 1

$492 – Gold 1

 

45 Year-Old Couple With Two Children Living In Zip Code 44870 – $55,000 Income (Sandusky – Erie County )

$195 – Bronze 2

$318 – Silver 1

$508 – Gold 1

 Medigap Plans In Northern Ohio

Affordable Senior Ohio Health Plans Are Available

Senior Medicare Plans And Medigap Supplements

Medigap coverage can help policyholders pay deductibles, and reduce out-of-pocket expenses. Typically, you can choose and physician, specialist, or hospital that accepts Medicare patients. Four plans are available to eligible applicants residing in the service area. The monthly rates shown below are for selected ages that do not use tobacco products.

Age 65

$102 – Plan A

$119 – Plan N

$147 – Plan C

$155 – Plan F

Age 70

$122 – Plan A

$142 – Plan N

$175 – Plan C

$185 – Plan F

Age 75

$148 – Plan A

$172 – Plan N

$213 – Plan C

$224 – Plan F

 

Advantage Plans

Three Ohio  options are shown below. “Advantage” contracts are issued by private carriers who have contracted with Medicare to provide Parts A and B coverage. Depending on the company, HMO, PPO, Fee-For-Service, and Medicare Savings Accounts are available. If you have End-Stage Renal Disease (ESRD), unfortunately, you are not eligible. The official enrollment period begins on October 7th and ends on December 15th.

All three “Elite” plan options include an annual routine vision exam, 100% preventative benefits, health and wellness programs, and a Silver Sneakers membership. The negotiated network discounts should always be used for any expenses that are subject to a deductible and/or out-of-pocket expenses. The Elite contracts also received a 4-Star rating from Medicare for 2016. An overall and summary star rating is assigned.

Dental Benefits

An optional Delta Dental rider is available for $18.50 per month. Two exams and cleanings are covered each year. The annual maximum benefit is $500 and Full-Mouth x-rays are covered every three years. Emergency palliative benefits and a brush biopsy (for oral cancer detection)are also included. NOTE: Delta dental plans are not offered outside of the Open Enrollment period.

DentaQuest and EyeQuest Networks are used with Advantage contracts. Elite plans are available in the following counties: Allen, Cuyahoga, Defiance, Erie, Fulton, Henry, Lake, Lorain, Lucas, Medina, Ottawa, Sandusky, Williams, and Wood.

Elite Standard Medical And Drug – $36 per month.  Office visit copays are only $5 and $40 with maximum policy out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $5 and $20 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.

Elite Enhanced Medical Only – $0 per month. Yes, that premium is correct. Office visit copays are $20 and $45 with maximum out-of-pocket expenses of $6,100. There is no deductible to meet and most lab tests, diagnostic tests and x-rays must only meet a small copay of $0-$10. The hospital outpatient copay is $200 and the Urgent Care copay is $45.

Elite Enhanced Medical And Drug – $78 per month. Office visit copays are $5 and $40 with maximum out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $2 and $15 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.