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Ohio Health Insurance Exchange Frequently Asked Questions

The Ohio Health Insurance Exchange is the new way to buy healthcare in the Buckeye state. Although our website makes it easy for you to compare Marketplace plans and apply for coverage, we understand there are many questions that consumers have. Whether its regarding 2016 Open Enrollment, Obamacare subsidies or finding the cheapest options, we have the answers for you.

What Is The ” Exchange” And When Can I Buy Policies?

It’s the relatively new “Marketplace” that was created by the passage of “The Affordable Care Act.”  Different plans are offered from various companies (not all of them) and policies are quite different since there are mandatory coverages that must be included. Single, family and small business plans are offered.

Open Enrollment typically begins in November for policies that have next-year effective dates. However, the deadline for coverage on the 1st of a month is the 15th day of the preceding month. For example, if you want benefits to begin on January 1st 2016 or 2017, we must process your application no later than December 15th.

What Is The Easiest And Quickest Way To Enroll?

We make it very easy for you. Our “Direct Enrollment” link allows you to streamline the process by electronically transferring your information to the .gov website without you having to personally visit the site. Your federal subsidy is automatically calculated and applied, and in most instances, you’re finished in 10 minutes.

The secure link is below and once your application has been submitted, we monitor all progress and keep you informed.

Click Here To View Your Open Enrollment Ohio Health Insurance  Marketplace Plan Options

I Have Coverage At Work Already. Am I Eligible?

More than likely, you can buy a policy since you probably meet all of the eligibility requirements. However, you may not be able to qualify for the federal subsidy. If your work plan is considered “affordable,” then no government financial aid will be provided for the purchase of a private policy.

What defines “affordable?”  If your cost (not the entire family cost) of the group plan (minimum value standard) offered at work is less than 9.5% of your household income. The “minimum value standard” is supposed to pay (on average) 60% of expected medical costs. For example, if your annul income is $40,000, and the cost of your medical coverage at work is $400 per month, you can qualify for a subsidy. But if the cost of your employer-provided medical benefits only cost $250 per month, a subsidized plan is not available.

So unless your company coverage is VERY expensive and/or you are in a higher household income bracket, you may be better off with your employer-sponsored plan. Often, at work, part of your premium is payed by the company you work for. If you opt out of your group coverage, your employer is not likely to help you pay your premium.

What Is The Tax Penalty If I Don’t Buy Coverage?

Currently it is $695 per year (adults) and $347.50 (children under 18) or 2.5% of your income, whichever is higher. However, each year, these amounts increase.  If using the 2.5% formula, the first $10,000 of single income is not counted because of the tax filing threshold. Also, if you had qualified coverage for part of the year, the penalty will be pro-rated.

The penalty is based on the number of months you were not covered, so if you missed six months, then the penalty will be about 50% (or less) than the annualized amount. Grandfathered plans do count as qualified coverage and avoid the penalty. However, most grandfathered plans have been terminated by either the customer or insurer. You may also be able to avoid the penalty of you qualify for “financial hardship.” “Short-term” and Limited Benefit” policies do not meet the Department of Health and Human Services guidelines.

What Companies Can I Buy A Policy From?

Find Companies On Ohio Health Exchange

Ohio Health Marketplace Insurers By County

In addition to Anthem (mentioned above), other carriers offering policies during Open Enrollment include Medical Mutual, UnitedHealthcare, Humana,  Aetna, Aultcare, CareSource, Molina, Ambetter, InHealth, HealthSpan, Paramount, Premier,  and SummaCare. Kaiser was purchased by HealthSpan, so names of approved plans changed a few years ago. Catholic Health Partners, which is headquartered in Cincinnati, is the parent company of HealthSpan. Confusing isn’t it?

What If I Miss Open Enrollment?

“Qualifying Life Events” allow you to purchase a policy outside of the conventional period. Some of the special circumstances include divorce, ending of COBRA, loss of eligibility for Medicaid or CHIP, dependent reaching age 26, moving out-of-state and birth of a child.

You may be able to buy an Ohio health insurance policy that is considered “outside” of the Exchange. However, you will still owe any applicable tax penalties. An example of these types of policies is a “temporary” plan that is typically cheap, and quickly approved. However, deductibles usually apply to most claims and pre-existing conditions are not covered. NOTE: Not all “outside” plans are non-compliant. See below:

“Off-Exchange” options are also offered by the large companies (available through our website), and are popular if your household income disqualifies you from receiving a subsidy. In these situations, you can purchase coverage “away” from the Marketplace and avoid the mandatory tax previously mentioned. Although financial aid is not included in the rate, the 10 “essential health benefits” are part of the contract. Therefore, you are considered “compliant” when enrolling.

Can I Buy A Children’s Only Policy?

Now you can. From 2012-2014,  unless it was a limited short-term plan, other than Assurant, no other carrier wanted the business. But that has changed. During Open Enrollment,  you can choose to cover yourself, your spouse, your child (children), or all persons. Depending on your household income, CHIP or Medicaid may be offered. It is also possible to for your children to be eligible for public assistance while you do not.

When there are multiple family members to be covered, if desired, you may enroll in separate plans. Although in some situations, it may result in lower out-of-pocket expenses by eliminating a potential deductible, generally, it is best to place all applicants on the same policy.

Who Can Buy The Cheap Catastrophic Health Plans?

If you are under age 30, then you are eligible for this low-cost plan. For anyone else, if no available Marketplace options cost less than 8% of their household income, then they also are eligible to purchase this type of policy.

A catastrophic policy covers all 10 “Essential Health Benefits,” but also features a high $6,850 deductible for individuals and a whopping $13,700 deductible for families. There is no coinsurance so the out-of-pocket expense is $0 after the deductible is met. In many situations, a Bronze or Silver plan, since it is eligible for subsidies, will be a cheaper alternative with better benefits. Humana’s “Basic 6850,” InHealth’s “Catastrophic PPO,” and Medical Mutual’s “Young Adult Essentials” are popular plans in this category.

What Are The Best Ohio Anthem Blue Cross Plans?

Anthem offers several options in every county. Platinum and Gold-tier plans are the most costly, but feature lower out-of-pocket costs. If you qualify for a federal subsidy, a Silver-tier plan may offer “cost-sharing,” which reduces deductibles and copays. Bronze-tier options are typically, the least-expensive policy. We have listed below the Anthem plans with the most comprehensive benefits in each tier.

Catastrophic Pathway X PPO 6850

Bronze Pathway X PPO 5550 20

Silver Pathway X PPO 3750 0

Silver Pathway X PPO 2000 20

Gold Pathway X PPO 1250 10

Gold Pathway X HMO 1450 20


Are Dental Benefits Included?

If you are under age 18, it is a mandatory requirement (One of the 10 Essential Benefits) that you have access to  coverage as part of your healthcare policy or separately. Benefits include preventative, cleanings, X-rays, and some minor and major services. Oral surgery is typically considered a “health” expense, and therefore subject to applicable copays and deductibles.

Adults can purchase separately a wide range of dental options. Monthly rates usually range from about $-$12 (Bare bones ) to about $20-$32 (comprehensive). There may be a waiting period for major claims (root canal, for example), and both network and non-network plans are available.  Comprehensive plans are offered by Aetna, UnitedHealthcare, Humana, Cigna, Medical Mutual, and Delta.

What Are The Different Billing Options?

Previously, it was acceptable for a company to require you to pay electronically if you selected the monthly method. However, that practice has changed.  Now,  electronic fund transfers, hard-copy checks,  money orders and debit cards must be accepted. These new billing options will apply to both new premiums and ongoing bills.

However, other than the initial payment, credit card payments are generally not an approved ongoing billing mode. In some situations if your premium is past-due, you may be able to submit a payment via credit card (Visa, MasterCard, Discover, or American Express). Most carriers also allow you to pay over the phone or via an online link.

Is It True That Only Certain Insurers Have The Cleveland Clinic In Their Provider Network?

Healthcare From Cleveland Clinic

Cleveland Clinic Is In Medical Mutual’s Network

If you purchase an Ohio Public Exchange plan, Medical Mutual’s  provider  network includes the Cleveland Clinic. However, several other companies are also listed, including Coventry (Aetna), InHealth, and UnitedHealthcare. If you buy a non-Obamacare policy, many companies and managed-care contracts are listed, including Aetna, Anthem BCBS, AultCare, CareSource, Cigna, HealthAmerica, Humana,  Kaiser, Kohl’s, Lowe’s,  MultiPlan, Paramount, SummaCare, and UnitedHealthcare.

Medicare Advantage plans participating in the Cleveland Clinic network include AARP Medicare Complete, Anthem BCBC Medicare Preferred, Aetna (Golden Choice), Buckeye Health Plan Advantage, Humana Choice, Paramount Elite, and UnitedHealthcare Complete Essential and Complete Choice.


Why Does Medical Mutual Only Offer Five Plans?

It is true that MM only offers 5 plans while other carriers (Anthem) offer more than 20! We don’t necessarily consider the lack of available options in a negative way. Quite the contrary, it’s much easier for consumers to review and compare benefits and prices. The five available plans are:

Market Young Adult Essentials (Catastrophic)

Market 6000 HSA (Bronze)

Market 5000 (Bronze)

Market 2400 (Silver)

Market 1000 (Gold)

If I Decide NOT to Buy A Policy, Am I Breaking The Law?

Yes, although you aren’t going to go to jail or get arrested. The “individual responsibility requirement”  is the portion of the ACA legislation that requires you to buy qualified benefits. As earlier discussed, if you are not enrolled, you must pay the higher of $695 per adult ($347.50 per child) or 2.5% of your income. The federal tax filing threshold ($10,000/ single filing or $20,000/ joint filing) applies, and the amount continues to increase each year.

Many persons choose to purchase non-compliant contracts (temporary plans, for example, as discussed below), and it is possible to pay less throughout the year utilizing this technique. However, the risk of incurring thousands of uncovered medical bills is possible if a serious accident or illness requires extensive treatment.

Are Short-Term Policies Still Available In Ohio?

These types of policies are typically used when you only need temporary benefits. The period of benefits is less than 12 months and often only a few months. Sometimes…just one month. Since they don’t comply with the minimum essential health benefits requirement, they can not be purchased through Exchanges.

However, plans can be purchased (UnitedHealthcare  usually has the lowest prices) through our website. They are not guaranteed renewable and pre-existing conditions are usually excluded. Although you can apply at any time, federal financial aid is not available to help lower the premium. However, if you need to secure coverage quickly, a ST policy may be your best choice.

Can I Drop COBRA During Open Enrollment And Enroll In A Different Plan?

You can apply for a different policy, even if you are presently covered under COBRA. However, it’s important to properly compare the differences in benefits, since it’s likely there are existing medical conditions that are being treated. Also, if you initiate the termination of benefits, you will have to wait until Open Enrollment the following year to change plans. The exceptions would be special approved situations, such as birth of a child or termination of a group contract.

What Is The Average Smoking Penalty For Marketplace Policies?

The law allows companies to charge up to 50% extra for nicotine users. However, here in our beloved Buckeye state, typical increases will vary from about 5%-30%, depending on which carrier that is writing the policy. Since it can often change the amount you pay by hundreds (or thousands) of dollars per year, please contact us for a comparison of the cheapest plans.

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