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2016 Healthcare Changes In Ohio – What To Expect

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2016 Ohio health insurance plans will look different in 2016. The rates will change. Some plans will be added, while others will be eliminated. New carriers may enter the Marketplace, while others, such as Assurant, will exit the Exchanges. Federal tax subsidies will be different, depending on your projected household income.

Who knows what Ohio healthcare will look like in 2016. Well, We think we do! Our tongue and cheek predictions below may not come true, but we had a lot of fun writing them!


January – In an unprecedented move, all major Ohio health insurance companies offer to slash their 2016 rates by 60%. However, there is a big caveat. The stipulation is that the Cleveland Browns must win the Super Bowl on February 7th if prices are to decrease.

The problem is that the Browns finished the season with a  7-9 record, missed the playoffs, and aren’t even playing in the Super Bowl! When asked to comment, a Humana spokesman stated that  they will extend the offer to 2017 since the risk would still be “incredibly low.” Thankfully, the Bengals were not included in this offer.

February – Open Enrollment ends on January 31st, and millions of Americans, including many households in the Buckeye State, are still without coverage. However, on February 1, the Department of Health and Human Services announces that OE will be extended until December 31st.

To ease the burden on Department employees, consumers must apply for coverage only during designated times. These times are between 3:00 am and 4:00 am Tuesdays and Fridays, and only on odd-numbered days. General maintenance is expected to be performed between 3:10 and 3:50 am on these designated days.

March – Of course, that means March Madness, so during the NCAA Basketball Tournament, no new applications will be taken, no claims will be paid, no payments will be processed, and phone calls and emails will not be returned from any health insurance company in Ohio.

Funny Health Insurance Websites

Ohio March Madness!

However, there’s some good news! If any Ohio University (Ohio State, Miami, Xavier, Toledo, Kent State etc…) makes it to the “Final Four,” a $250 rebate will be given to all customers. If they win the National Championship, a $1,000 rebate will be given.

April – Is it an April Fool’s joke? Nobody seems to know. Apparently, Ohio grocers are offering to pay 50% of your health insurance bill on the first day of April. Your only requirement is to bring in your statement, and 16 forms of identification and the bill is instantly paid.

Ah. OK. It’s quite clear now. 16 forms of identification. Well…if you have plenty of aliases, multiple personalities or you tend to keep old college ID cards and driver’s licenses, you may catch a break. Otherwise, it appears to be an April Fool’s joke gone bad.

May – April showers bring….You know…May flowers.  So, to commemorate the upcoming warmer weather, each insurer has assigned itself to a specific flower, and all corporate and local offices must reflect that motif.

Some of the selections made by the carriers are listed below:

Aetna – Carnation

Humana – Snapdragon

Medical Mutual – Rose

Premier – Marigold

Anthem Blue Cross – Daffodil

Ambetter – Geranium

UnitedHealthcare – Hydrangea

SummaCare – Daffodil

NOTE: Anthem and SummaCare both selected the same flower and subsequently sued each other to determine who has the exclusive flower rights.

June – Ohio’s newest health insurance company is under investigation for allegedly not paying a single claim during the first five months of the year. “No Pain No Claim” is the name of the carrier that started to offer policies in 2016. Approved by regulators, they offer coverage in 12 Counties located near the Indiana border.

When asked to provide claim records and payout information, an official of the company said, “We don’t have any documentation regarding claims. Our operational expenses were too high this year although by 2020 we hope to start reimbursing a few policyholders.”

July – An enormous data breach hits the Midwestern states as a rogue hacker believed to be living in Cincinnati infiltrates many large financial institutions. Oddly, no personal or sensitive information is taken. But every policyholder receives new ID cards with their first-grade teacher’s name on it. Very strange.

Funny LeBron Stories

LeBron’s Marketplace!

August – In an effort to increase market share, surprisingly, Medical Mutual and Humana decide to change their corporate names and logos. The move is effective on October 1, and all stationery and business cards will also be changed.

Medical Mutual will become “LeBron’s Marketplace” and Humana will become “Buckeye Nuts And Guts.” Both companies are obviously attempting to capitalize on  the Ohio theme. Of course, it may not be so popular in other states.

September – A special Open Enrollment period has been approved for the entire month by the Department of Health and Human Services (HHS). To qualify, you must file your 2016 and 2017 federal tax returns before the end of 2015 and agree to pay applicable back-taxes of all immediate family members. Although it is not anticipated that any person will take advantage of this newly-created SEP, many Department employees are praising this idea as an “act of kindness.”

October – Halloween tricks and treats from the healthcare industry. In an effort to promote responsible eating, employees are encouraged to give out raspberries, beet juice, or broccoli spears to children, and forgo the traditional candy items. However, the city of Cleveland quickly responds to the idea, by extending Beggars Night to the entire month of October and requiring all treats consist of a minimum of one pound of chocolate, and two dozen Rice Krispies treats..

November – Open Enrollment officially begins with a massive advertising campaign designed to increase the number of Americans that sign up by 40%. As a special inducement, if you enroll in a plan during the first 15 days of November, a frozen turkey will be sent in time to enjoy before next July 4th.

However, for individuals or families that enroll AND refer a friend, a small mobile home that is completely furnished, will be sent. The value of this inducement is $11,500 and is unfortunately, taxable.

December – Keeping with the “Holiday Spirit,” during this month, insurers are offering potato latkes and pumpkin pie to all policyholders that schedule a preventative colonoscopy. Of course, the food is served after the procedure has completed. The evening before the colonoscopy, a tasty concoction of bowel-cleansing Miralax is provided.

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 February each year. During that time, no medical questions are asked, and single and family plan rates are  reduced by the federal government by using a subsidy in the form of an instant tax-credit. On and off Marketplace coverage is available, so if your income is high, you can still enroll in an affordable plan.

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. But 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 this 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. November 1st is the first day, and it runs through January 31st. If you miss the cutoff, you will probably need an “SEP” (discussed later) to receive favorable treatment.

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. Medical Mutual also offers competitive pricing.

Although temporary policies are ineligible for Obamacare subsidies, for most individuals and families, prices are still less than most Marketplace contracts. And, up to $1 million of coverage can be purchased  “per claim” or per “policy period.” You can terminate your benefits with a phone call and utilize a nationwide provider network.

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. It doesn’t matter if it occurs in January, July, September, or any other month.

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. However, in pregnancy situations, the newborn may enroll in a policy, but not either parent. Therefore, prenatal and delivery expenses will not be covered.

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 was 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.

And as previously mentioned, the OE period for 2016 is once again, only three months. Although extensions are possible because of occasional glitches and delays, January 31st is the expected last day to enroll. If you already have a policy, you can either keep your plan, or consider switching to a different option.

5. Don’t go without coverage. Just because you didn’t sign up in time doesn’t mean you have to remain uninsured. 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.

Short-term contracts won’t eliminate the special non-compliance tax. However, if you develop a serious illness, or have an accident that results in thousands (or hundreds of thousands) of medical bills, you’ll be able to easily cover the vast majority of expenses. And the cost of temporary plans is extremely cheap.

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. Since network provider lists change, it’s important to verify your doctor is not dropping the carrier you are using.

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 major disease or accident could have a dramatic impact on your financial health. Postponing your medical coverage to January 1st may be too late to treat a serious ailment.

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 claim form, insurance company, or approval process that the healthcare provider has to pay for. So everyone is a winner.

Unless, of course, you incur a huge hospital bill you can’t pay. In those situations, you may be able to negotiate a favorable billing alternative that works within your budget. A $10,000 obligation could result in only monthly payments of $100 or less.

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  is included. Often, it can be as much as $150-$200. Preventative benefits are not covered at 100%, and a large claim could easily result in tens of thousands of dollars of out-of-pocket expenses.

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. Obtaining a refund will be practically impossible, and speaking to a live person becomes much more difficult after they have processed your initial payment.

10. Watch for changes to the ACA legislation from the latest Supreme Court challenge such to Obamacare, such as King Vs. Burwell.The government sided with the original legislation in this decision, although future challenges may also reach the Supreme Court.

The King Vs. Burwell verdict ruled in favor of the legality of federal subsidies offered to residents of states that have not set up their own Exchange.  Ohio (and most other states) were at risk of losing these subsidies, which would have effectively doomed the future of Obamacare, unless drastic changes were made.

Premier Health Insurance Plans For Individuals For 2016

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Dayton’s biggest hospital network offers private health insurance plans in Ohio. Premier Health’s private and employer-sponsored policies are available through and outside the Marketplace. Open Enrollment for 2016 effective dates begins November 1st and continues through January 31st. 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. “Short-term” contracts can be approved in 24 hours but receive no government assistance.

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 operates as a separate business entity and offers policies that conform and meet the requirements of the Affordable Care Act legislation. Short-term and limited-benefit options will not be available. Comprehensive copay policies are the most popular option.

With more than 3,000 network providers available, access to quality treatment is 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 Under Age 65 Plans

For  2016 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). Common SEP  situations are divorce, birth of a child, moving to or from a different state, and losing existing benefits from an employer.

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.

NOTE: A Medicare Advantage plan and  a Dual Eligible Special Needs (DSNP) contract are also available (see several paragraphs below). 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 2016 policies offered to persons under age 65:

Bronze Tier

One Bronze 6850 – Cheapest available plan. Very simple concept. Once deductible has been met, 100% of covered medical expenses are paid.

One Bronze 6500 – Same as previous plan with lower deductible and slightly higher premium.

One Bronze 6000/40 – Lower $6,000 deductible with a copay ($50) on pcp office visits. Generic drugs also benefit with a copay ($21) instead of a deductible.

One Bronze 6000/35 – Similar to prior plan with lower copay ($40) and lower coinsurance after deductible is met (35% vs. 40%).

Silver Tier

One Silver 4500/20 – Least-expensive Silver-tier plan (by only a few dollars) features attractive $20 and $40 office visit copays. Deductible is $4,500 with  separate $1,000 deductible on prescriptions.

One Silver 4500/30 – Similar to previous plan with slightly higher specialist copay ($50) and 30% coinsurance instead of 20%. Also, no separate deductible on prescriptions.

One Silver 4000 – $4,000 deductible with low $20 and $50 copays on office visits. The generic drug copay is $15, while the preferred drug copay is $45. Approved diagnostic tests do not have a copay and  the Urgent Care copay is $75. Children’s vision coverage is included, but not dental.

One Silver 3000 – $3,000 deductible with 10% coinsurance before benefits are paid.

One Silver 2500 – $2,500 deductible with $40 copay for pcp office visits. $16 generic drug copay. 10% coinsurance.

Gold Tier

Health One Gold 1500 – $1,500 deductible with low $10 and $40 copays. $12 generic drug copay. 10% coinsurance with $5,500 deductible.

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.


Premier Ohio Medicare Advantage Plans

For Seniors, a single plan provides benefits for Medicare Parts A,B, and D. The insurer contracts with Medicare to provide benefits. Alternatively, a Medicare Supplement policy may be purchased which complements, but does not replace Medicare. Shown below are Premier’s Advantage plans.

Health Advantage HMO – Monthly premium is $0. The maximum out-of-pocket expense is $3,900 for all Medicare-covered benefits. Copays are $10 and $45 for primary-care-physician (pcp) and specialist visits respectively. Urgent Care and ER visit copays are $45 and $75. Inpatient hospital expenses are $250 per day for six days $295 for acute mental health).

Skilled nursing facilities are covered with no copay for the first 20 days. However, for the next 80 days, the copay is $160. Outpatient rehab costs just $40 while outpatient an procedure costs you only $250. An ambulatory surgery center visit is an included benefit with a $200 copay. Durable medical equipment is covered at 80% while Diabetic supplies have a $0 copay.

Lab services ($10) and x-rays ($15) are only subject to small copays, while a $200 service fee applies to MRIs, MRAs, PET scans, and radiology CT scans.

Preventative visits are always covered at 100%, and like many other Advantage contracts,  one free annual  eye exam is included. Additional exams are subject to a $45 copay and $100 is allocated each year for frames and glasses. Dental benefits include one routine oral exam, fluoride treatment and an x-ray with no out-of-pocket cost. An additional $800 benefit is also included for complex dental procedures, including  root canals and bridges.

Group Medical Coverage

Employer-provided medical plans are also available. Customized coverage specializes in developing a close relationship among physicians, specialists, and their patients. The most current techniques, technology, and information is used to allow business owners to provide comprehensive benefits at a price both business and employee can afford.

Both HMO and PPO plans are offered along with or without with high-deductible Health Savings Account options. Generic and Brand medications are covered with access to most local pharmacies, such as Walmart, CVS, Sam’s Club, Target, Rite Aid, and Kmart.


October  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.

November 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.

December 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. Typically, Premier offers plans that are less expensive than Anthem, Medical Mutual, Aetna, and UnitedHealthcare.

February 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.

October 2015 – Welcome TriHealth! Starting the first of the year, their physicians and facilities will be considered “in-network.” This will increase the number of total Commercial providers to more than 3,000.  Business Value and HealthOne customers will now have access to many more choices. TriHealth began operating in 1995 and is now the 4th-largest employer in the Cincinnati area. Good Samaritan and Bethesda Hospitals are the cornerstones of their network.

Ohio Obamacare Rates For 2016 – Instantly Compare Plans

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Health insurance rates in Ohio have increased for 2016, although the price hikes are relatively modest for most of the major companies with the largest market share. 2016 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. Only three companies have requested price increases of more than 10%.

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. And the King Vs. Burwell Supreme Court decision ensures that federal subsidies will continue to be available.

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 2015 Open Enrollment since it ended less than one year ago. And very few claims have been processed and studied. However, a plethora of data has been gathered from the first year of the ACA legislation (2014), and carriers have been able to utilize the information to help determine future rates.

Eighteen carriers  filed to do business in the Buckeye state for 2016. This represents one of the largest number of companies in any state. Premier (SW Ohio only) now has a year of experience, and will continue to offer some of the most competitive prices in Montgomery, Warren, and Greene Counties.

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 was an educated guess when determining what rates to charge in 2015. But with more claims experience on Obamacare coverage readily available, 2016 rates were easier to determine.

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 4% increase, many of the most popular plans will probably see lower price hikes. For example, although some Bronze plans might see double-digit increases, others will rise by less than 3%. 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). NOTE: Anthem’s Pathway network  includes fewer doctors and specialists than prior to the passage of Obamacare.

Medical Mutual – Non-profit MM is asking for an increase just under 17% which brings its average monthly premium to about $425 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 many parts of Montgomery County (and South), MM is “in the ballpark,” but not one of the cheapest options.

Medical and prescriptions costs have risen about 6%, and are expected to continue the upward trend. Of course, these expenses are largely passed onto the consumer. The combination of more persons using these services, along with the fact that they are more expensive, contributes to the premium increases on many plans. Last year, MM paid about $50 million more in claims and expenses than revenue that was received.

Some enhancements for 2016 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  previously marketet Ohio plans under the “Golden Rule” trademark, although they are back to using the UHC brand name  for 2016 “on-Exchange” policies. In 2014, they did not participate in the Marketplace festivities.  In 2015, they offered policies both “on” and “off” the Exchange.”Compass” is the brand name for their policies.

For 2016, the requested price increase is 22% for plans issued “off” the Marketplace. Depending on the policy, the rate could go up as much as 39%, or actually reduce by 3.3%. More than 2,000 policies are impacted. UHC’s earned incurred loss ratio (claims paid vs. premiums) dropped from 142% in 2014 to 117.7% in 2015. However, expenses still exceeded revenue, resulting in a net loss.

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. Policies are approved in less than one day and provide a cheap stop-gap solution.

Although UHC rates were a bit high in the Buckeye a few years ago, by sitting out a year and observing, they may have learned a few things. Their Bronze and Silver 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 2016 policies are Bronze Compass HSA 4900, Bronze Compass 5500, Silver Compass HSA 2600, Silver Compass 2000 and Silver Compass 3500. Plans are now available in many more counties compared to the first year of the Exchanges in 2014. The Columbus and Cincinnati areas (including Franklin and Hamilton Counties) are well-represented.

HealthSpan – If you don’t recognize their name, you’re not alone. HealthSpan purchased Kaiser Permanante’s block of business in 2014 year and began selling products under their own name. They are projecting a 17%  price increase for 2016, which will impact about 10,000 persons. Group pricing is increasing about 11%.

HealthSpan’s HSA product is once again, one of their best available products, and typically, despite the price hike, they offer very competitive rates in most areas of the state. In many areas, their combination of coverage and price is more attractive than major companies such as Anthem, UnitedHealthcare, and Aetna.

The vast majority of policies are issued as individual and family plans, not group contracts or SHOP-eligible options. The number of network providers is increasing and we anticipate HealthSpan to remain competitive for the next several years (or longer).

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 extremely 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 continue to maintain many “grandfathered” policies that were written in 2010 (or earlier) and are still in-force. For 2015, they concentrated on Cuyahoga County and the Cleveland area, and also reduced prices by approximately 6%-8%. This made them an attractive option, especially considering its large provider network.

2016 coverage has expanded to a larger portion of the state although rates are generally increasing. For example,  average premium hikes for the three most popular Metal tiers are 16.5% (Gold), 12.2% (Silver), and 13.4% (Bronze). About 20,000 existing customers will be impacted when their policy renews.

Higher treatment costs for physician services, emergency treatment, and pharmacy prescriptions are the principal reasons for higher premiums. Transitional reinsurance and enhanced network access standards also are a factor. NOTE: Coventry, a company they recently purchased, will concentrate on other states. But it is still undetermined if the Cleveland Clinic will eventually be part of the network.

Aetna’s most affordable 2016/2015 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 2010-2014, 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.

Not surprisingly, Assurant is shutting down their individual operations by the end of 2016. Existing policyholders will be able to change to other carriers. They also offer policies in 16 other states, so Ohio customers are not the only persons looking for alternative policies.

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 2016 pricing.

They don’t utilized brokers and seem rather uninterested in expanding. Customer-service, from our initial observation, is cordial, but not very effective. Just our hunch but 2016 prices will be substantially increasing.

SummaCare – Although only a regional carrier, (Northern portion of the state), SummaCare offered competitive prices in 2015 through four plans (Individual 6450-LD, 5000-LH, 2750-LK, and 750-LT). They were all fully-compliant (Gold, two Silver, and a Bronze plan) and often priced slightly less than Medical Mutual.

For 2016, an average increase of 3.7% is expected, with a maximum increase of up to 14% on selected plans. Less than 5,000 current customers will be impacted by the changes.

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. However, in selected counties, they are one of the two or three best options.

InHealth – Based in Westerville, this small company made its Marketplace debut in 2015. Although they offered selected plans to consumers last year privately, like Molina, they are not a widely-known company.As a non-profit CO-OP, any excess income (if there is any!) must be used to lower prices or improve benefits.

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. Their Silver-2000-3070 plan is very popular because of the relatively-low $2,000 deductible and $30/$50 copays on physician/specialist visits.

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. Their anticipated 2016 price increase will average about 5.5%. However,  depending on the policy and tier, increases could be as much as  13% and decreases of up to 6% are also possible.

In addition to individual products, Aultcare also offers Workman’s Compensation, Accidental Death & Dismemberment, and Short-term Disability policies. Also available are Medicare-related options.

Premier – Available in the Dayton area, last year, it was difficult to predict pricing when it was their first year of offering coverage, either on or off the Marketplace. But  their rates were extremely competitive for consumers that wanted an office visit copay instead of paying the entire amount out-of-pocket. In many situations, they were the best choice, taking into consideration price and provider availability.

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. NOTE: For 2016, Premier’s requested price increase is less than 10%. Therefore, they do not have to publicly announce the specifics.

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.

The big variable regarding whether to consider Ambetter is whether your current physicians and medical facilities are part of their network. If they are, you will be rewarded with very affordable premiums. Otherwise, another company should be considered.


We will keep you informed on any changes or projections for Ohio Health Insurance Exchange plans for 2016.  Additional Marketplace information regarding prices or policy availability will be regularly updated.


October 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 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 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 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.

September 2015 – Open Enrollment begins in about a month.  Our direct linking reduces the time to apply for coverage to about 10-20 minutes. Yes, it’s fast!

December 2015 – More than 40,000 Ohioans have enrolled since the OE period began on November 1st. More than half of the applicants have selected policies that cost less than $75 per month.  For persons not eligible for subsidies, many “off-Exchange” options are offered.

Ohio Health Insurance Coverage After Open Enrollment Ends

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Ohio Open Enrollment for single and family Obamacare health insurance Exchange plans ends on January 31st, 2016. 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 apply and there are 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. Remember 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. Benefits are excellent and you can apply at any time.

In many states, including Ohio, Medicaid expansion has made affordable (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. When you you leave your employer, you will receive written notification that will qualify as and SEP exemption.

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. These errors can be wrong information give over the phone, or an email or letter you received.

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. Presumably, by age 26 you are filing your own tax return. Therefore, your federal subsidy will be based on your income and not your parent’s income.

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, Medical Mutual, IHC  Group and HCC Life. Estimated monthly premiums for a 35 year-old male living in the Dayton 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 will have to pay for your own annual physicals, OBGYN visits and mammograms. NOTE: Several plans cover  annual physicals after a deductible has been met. Also, a rider may be available to cover limited preventative expenses.

Also, since it is not Affordable Care Act compliant, you may be subject to a 2.5% (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 2.5% penalty.

Short-term 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.

Medigap Plans In Ohio

Ohio Medicare Open Enrollment Begins October 15th every Year

Ohio Medicare Open Enrollment

For Seniors in the Buckeye State, the annual OE period is between October 15th and December 7th. This “Annual Election Period (AEP) is the time of the year when you can change your drug prescription benefits along with your Medigap or Supplement plan. No medical questions or underwriting is needed.

You are not required to make any changes to existing coverage, regardless if your premium increased or decreased. However, since contract benefits may be different on your renewal, or other new plans or carriers may now be available, it’s also a good time to compare policies. Your prescription and medical condition needs should always be considered (along with the rate) to ensure your Supplement, Advantage, or Part D drug plan properly covers your conditions.

If you currently are enrolled in Parts A and B, you can choose to switch to a Medicare Advantage (MA) contract, which is administered by a private insurer. You can also switch from one MA plan to another. If you already are covered under an MA contract, you can switch back to original Medicare, although your rates will likely increase.



February  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.

October 2015 – 2016 pricing for all Marketplace policies will be available on November 1st, although sporadic releases of rates are starting to appear. Although you can retain your current policy, we encourage the review of all new plans, since large rate changes will occur in many areas.