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If You Missed Ohio Open Enrollment – 10 Things You Need To Know

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Open Enrollment to purchase subsidized health insurance in Ohio typically occurs between November and December each year. During that time, no medical questions are asked, and single or individual plan rates are often reduced by the federal government. On and off Marketplace coverage is available.

However, if you didn’t watch the news or read a newspaper, procrastinated too long, or simply didn’t have money set aside to buy a policy, you probably missed the OE period. However, you can still obtain affordable healthcare benefits. Here are 10 items that will help you secure coverage now, and ensure you won’t miss Open Enrollment next year!

1. Don’t miss Open Enrollment next year! There’s always plenty of advertising in both the print and online media. Generally, if you want your policy to be effective January 1, the deadline is December 15th, so don’t wait after the Holidays to do your healthcare shopping.

2. Consider purchasing a temporary Ohio health insurance plan. No, it won’t match the office visit and prescription copays that an Exchange policy offers, but it will provide a very inexpensive stopgap option that is easy on your pocketbook and can be placed in-force within 24-36 hours. UnitedHealthcare is one of many companies that offers low rates.

Ohio Open Enrollment Missed

Having A Baby Qualifies For A Special Enrollment Period

3. Determine if you qualify for a “Special Enrollment Period.” Commonly referred to as an SEP, specific life events that cause a change in family status, allow you to take advantage of this special period of 60 days to secure either subsidized or unsubsidized Exchange coverage.

Several of the most common Life events include getting married or divorced, reaching age 26, losing existing employer-provided benefits, moving to a different residence, and becoming pregnant.

4. Be aware of changing OE dates. For example, for 2014 effective dates, the starting date was October 1 2013, and the ending date was March 31 2014. That’s six full months for consumers to take about 25 minutes and purchase their coverage. For 2015 effective dates, the starting point was November 15th and it ended on February 15th. The application time plummeted to about 90 days from about 180 days.

5. Don’t go without coverage. Just because you didn’t sign up in time doesn’t mean you have to go without coverage. Although you won’t be able to duplicate Marketplace plan benefits and prices, you can still obtain a medical plan. Major medical expenses are the most important item to cover, and many available contracts will reduce your potential risk against these types of claims.

6. Find out in advance which companies accept your physicians and specialists. The most time-consuming and frustrating part of the process is finding a plan that meets your coverage and budget objectives, but doesn’t include your providers. By contacting doctors and medical facilities in advance, you can ensure that the plan you purchase (even after the OE period) will provide in-network” benefits for routine and scheduled treatment.

Health exchange Enrollment

If You Miss Open Enrollment, Eat Your Vegetables!

7. Stay healthy, and eat your vegetables, especially if you don’t plan to purchase any major medical or catastrophic coverage throughout the year. Don’t go outdoors, don’t answer the door, don’t eat raw meat, and don’t travel in any vehicle with the possible exception of a golf cart.  Of course, we’re being a bit satirical, but any serious disease or accident could have a dramatic impact on your financial health.

8. Negotiate lower medical bills with your physician, specialist, hospital, and any other facilities you receive treatment. Often, by paying directly in cash, you can reduce your expenses by as much as 50%. And why not? There’s no claims form, insurance company, or approval process that the healthcare provide has to pay for. So everyone is a winner. Unless, of course, your incur a huge hospital bill you can’t pay.

9. Do NOT buy a “Limited Benefit” plan. Generally, these are the policies that are underwritten by a company you may not be familiar with, obtaining specific benefit details are almost impossible, and a mysterious “application” or “enrollment” fee in is included. Often, it can be as much as $150-$200.

These contracts are often peddled from boiler rooms that are located outside of Ohio. Your payment information (credit card or check) will be requested on the first contact.

10. Watch for changes to the ACA legislation from the latest Supreme Court Challenge to Obamacare, King Vs. Burwell. At issue is the legality of federal subsidies offered to residents of states that have not set up their own Exchange. Currently, Ohio (and most other states) are at risk of losing these subsidies, which would effectively doom the future of Obamacare, unless drastic changes were made.

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 on October 15th 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.

Pre-Medicare Healthcare In Ohio

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.

Additional Services

In addition to the standard coverage, such as inpatient and outpatient hospital treatment, ER, and others named above, many other services (and facilities) are available through local providers and the Miami Valley Hospital network. It is possible that some exclusions, deductibles and coinsurance may apply. Some of these options include:

Blood And Marrow Transplants

Burn Center

CareFlight Air

Diabetes Services

Electrophysiology Lab

Genetic Testing And Counseling

Homeless Clinic

Movement Disorders

Neuro Rehabilitation

Pain Center

Pelvic Services

Spiritual Care

Sports Medicine


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.

Premier Healthcare Plans Ohio

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. It has become a very convenient location for residents that live South of Dayton, including Centerville, Kettering, Springboro, and Franklin.

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. This particular policy compares very favorably with all other major companies.

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.

Partnership With CVS Pharmacy

Premier Ohio Health Insurance And CVS Pharmacy

Premier And CVS Working Together

Premier customers can utilize prescription counseling, monitoring of chronic disease, electronic records, and several wellness programs at CVS and MinuteCLinic locations. Providing a current identification card will allow access to many additional services at the more than 7,000 locations throughout the US.

There are nine CVS stores located in the Dayton area with possible future expansion within the next five years. The nine stores are located in Union, Trotwood, Oakwood, Moraine, Miamisburg, Kettering, Centerville, Huber Heights, and Germantown. The emphasis on outpatient treatment should become more noticeable in these locations.

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.


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.

February 21 2015 – About 2,000 customers purchased Premier plans for 2015.  Considering that policies are only available in a handful of counties in the Dayton area, the number is quite impressive. It’s expected that next year, quite a few more members will enroll in coverage. 2016 policy designs are not released yet, but may involve slight changes.

Ohio Obamacare Rates For 2015 – Instantly Compare Plans

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Health insurance rates in Ohio have increased for 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, Ambetter, 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.

Predicting Future Rates

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  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 crap-shoot, it’s safe to say it’s an educated guess when determining what rates to charge in 2015.

2015 Healthcare Rates in Ohio For Individuals

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. In many situations, choosing a “Bronze-tier” instead of a catastrophic plan will actually save money.

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 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. In may parts of Montgomery County (and South), MM is “in the ballpark,” but not one of the cheapest options.

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). Fortunately, many less-expensive “grandfathered” plans are being renewed. Often, their premiums are as much as 20%-40% less than newly-offered policies.

UnitedHealthcare –  UHC  markets Ohio plans under the “Golden Rule” trademark, although they are back to using the UHC brand name  for 2015 “on-Exchange” policies. In 2014, they did not participate in the Marketplace festivities. “Compass” is the brand name for their new policies.

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. They remain available for purchase throughout the year, regardless if you qualify for a special approved enrollment exemption.

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. Their Bronze and possibly catastrophic offerings are the most popular. The new products are 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 other plans (besides temporary) that are available as non-Marketplace plans.

Best Ohio Marketplace Plans

UnitedHealthcare’s Compass Plans Are Very Affordable

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 including much of the Dayton area. The Columbus area (including Franklin County) are well-represented.

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 once again, 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. In many areas South of I-70, their Silver-tier options are among the best choices. By adding the “cost-sharing,” you’ll enjoy low rates, low deductibles, and low copays. That’s a winning combination!

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 are concentrating 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. NOTE: Their prices in the Southwestern counties are VERY attractive (Montgomery, Warren and Butler).

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.

Get CareSource Healthcare Quotes For Individuals

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.

They don’t utilized brokers and seem rather uninterested in expanding. Customer-service, from our initial observation, is cordial, but not very effective.

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.

Premier – Available in the Dayton area, it’s difficult to predict pricing when it is their first year of offering coverage, either on or off the Marketplace. But it appears their rates will be extremely competitive for consumers that want an office visit copay instead of paying the entire amount out-of-pocket.

In many situations in Warren and Montgomery County, Premier will be the best option for purchasing a comprehensive plan. The provider network is Miami Valley Hospital-based and there is a wide selection of physicians and facilities in the area.

Ambetter – Part of the Buckeye Community Health Plan, Ambetter’s pricing will be among the lowest in many counties, including Hamilton and Montgomery. However, there coverage area is limited, although in Indiana, they also offer policies in many counties. Several inexpensive Bronze plans allow you to add three primary care physician (pcp) visits for a nominal charge.


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.

February 2 2015 – When you file your taxes, if you received a federal subsidy, you must complete IRS Form 1095-A. This new addition to the IRS code is the official Marketplace Statement verification and works with Form 8962, the Premium Tax Credit statement. Form 8962 must be used when premium assistance has been received.

Get Ohio Health Insurance Coverage After Open Enrollment Ends

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Ohio Open Enrollment for single and family Obamacare health insurance Exchange plans ended on February 15th 2015. After that date, you need to purchase a plan through a “Special Enrollment,” (SEP) that allows you to qualify for available federal subsidies and have any pre-existing condition covered without proving insurability. Marketplace plans are available when you enroll using an SEP.

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.

In many states, including Ohio, Medicaid expansion has made low-cost (sometimes free) coverage available to households with limited income. Although provider networks are smaller than a conventional plan, there are still many doctors, specialists, hospitals and other medical facilities to serve your needs.

Having A Baby Allows You To Go Through Obamacare Open Enrollment

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 pick 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. Regardless if this occurs before or after the OE period, you can qualify for a federal tax credit.

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. NOTE: Expiration of 12 months of COBRA is not enough. You must utilize 18 months of benefits.

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

Temporary Medical Plans With Cheap Rates

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.


February 9 2015 – 2015 Open Enrollment concludes in six days. Applications submitted before that date will receive a March 1 effective date. Without an approved SEP, after February 15th, although many policies will be available from several insurers, they may not necessarily contain all 10 “Essential Benefits” that are required under current legislation.

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.

Pick The Best Health Insurer

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




An Insurance



The Government Exchange


ALL Sources?

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


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?


Call Center only

Call Center only

   Personal Consultation?




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






Customer Service after the Sale?



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




Yes, service from an employee of the insurance company


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




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.