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Confused About The Healthcare Reform Law?

Changes in the way you buy health insurance in Ohio have helped many consumers obtain low-cost (and sometimes free) medical coverage. No questions to answer or physicals to take. Others have lost their existing plans that they were perfectly happy and satisfied with. The new policies they were required to buy (or face a federal tax) now cost thousands of dollars more and provide benefits that they don’t want. Change is good…but not for everybody.


Comprehensive coverage. Catastrophic coverage.  If you”re a consumer shopping for individual or family health insurance, rates are perhaps the most important factor. But policy coverages are a key component, and ultimately, often determine which company is chosen.

How do you know which policy is right for your conditions? What if you don’t have any existing conditions? Is a catastrophic plan the best option? It might be, if you’re allowed to buy it! Under the new Obamacare legislation that was passed in 2010 (effective January 1 2014), unless you’re under age  30 or can prove “financial hardship,” you are forced to purchase benefits that you may not want, probably won’t use, and especially don’t want to pay for. What a revolting development!

But, in fairness, there is a method to the their madness and your confusion. There are many folks here in Ohio that do have serious pre-existing conditions and are able to utilize most parts of their policy. Anyone with a chronic condition with ongoing treatment understands the value of the new legislation. Other Ohioans that have lost their job, healthcare benefits, or both, are grateful for the Affordable Care Act.

So…Let’s simplify it so you better understand what you should know, and skip the portions of the law that are least likely to impact you or your family. The confusion disappears once you realize that there aren’t as many changes as you might have thought.

The Key Points To Understand

Pre-Existing conditions are covered and you can not be denied for medical reasons when you apply for a “Marketplace” plan. These are policies that are issued through the Ohio Health Insurance Exchange during Open Enrollment. Typically, this takes place between November and February. For example, the 2015 enrollment period is between November 15th and February 15th.

After those dates, a special qualified “life event” will have to occur for the consumer to purchase a policy. If you forgot to enroll in an Exchange plan, there are many “special lifestyle events” that allow you to purchase subsidized policies. If you don’t qualify for one of these exceptions,  alternative options are available including month-to month contracts.

The basic structure of policy benefits has not substantially changed. Comprehensive contracts still cover most claims including small well-check visits along with large hospital bills. Catastrophic (high-deductible) contracts remain popular and offer lower premiums in exchange for potential high out-of-pocket expenses since the consumer is accepting more risk. And of course, there are many blended plans that combine features from both concepts.

The main carriers have not changed although a few new companies have joined the Ohio Marketplace. Anthem Blue Cross, Aetna, UnitedHealthcare and Humana continue to dominate market share. But HealthSpan, Assurant and Premier (the newest entry) will be active, and will offer competitive plans in specific areas and niches. Other carriers such as Cigna, don’t currently offer individual plans in the state. But within the next few years, several “name” companies could shift their focus to the Buckeye state.

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