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Essential Health Benefits For Exchange Plans

Essential health benefits will be required on Ohio health insurance plans in 2014. The Affordable Care Act specifically mandates coverage that must be included on single and family policies. Some of the categories of these benefits include: preventive and wellness services, pediatric treatment, prescriptions, hospitalization, maternity, and mental health/substance abuse.

A “benchmark” plan is chosen to act as a starting point or “shell” of what all available Exchange policies should look like. Ohio’s benchmark choice was an Anthem BCBS PPO contract (Blue Six Blue Access). This plan contains many benefits that you probably already have on your individual or group contract. Some of these include primary care and specialist visits, emergency room services, prescriptions and many other familiar coverages.

However, some of the mandated (required) benefits will be quite new for many consumers. Some of these newer plan additions include non-emergency coverage outside of the US, annual eye exam, prenatal and postnatal care, all maternity delivery expenses, mental health inpatient and outpatient services, substance abuse disorder and non-preferred drugs. Complete details can be found here. Yes…all 26 pages.

Health Insurance Rates In Ohio

Ohio Health Exchange Enrollment Begins In October

Of course, since there are so many new benefits to be included on these policies, someone has to pay for it. And it’s YOU! Industry experts are predicting rate increases  as much as 70%. However, the government (through you again), will give a subsidy to reduce prices if you meet income requirements. If you’re confused, you’re not alone. We will be available to help sort out the mess.

Currently, health insurance rates in Ohio are quite low compared to other areas of the country. For example, our rates are about 15% lower than Indiana, 25% lower than Pennsylvania, and 60% lower than New Jersey. However,in 2014, when Exchanges become available, the situation will change. Although prices will increase, in fairness, Buckeye State premiums will still be very attractive compared to most other states.

Since “essential benefits” will have to be included on all plans, prices will go up. Lower income generates the higher the tax credit (subsidy)  you will receive to lower the premium. Four a family of four, if  household income is more than $96,000, to keep the rate affordable, you’ll have to get creative by selecting a “Bronze” (the cheapest) policy or perhaps buying coverage “outside” of the Exchange. The more members of the household, the larger your potential subsidy will become.

For lower-income households, Medicaid will still be available, and the cost of coverage will be low. For those households that prefer not to select Medicaid as their primary healthcare resource, Marketplace plans will still be offered (off-Marketplace), but federal subsidies will not be applied to reduce the premium.

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