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Essential Health Benefits For Exchange Plans

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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.

2013 Ohio HSA Contribution Guidelines And Information

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Ohio HSA accounts in 2013 will continue to be one of the most affordable options for securing affordable medical coverage. Single and family policies can be purchased from almost every large insurance company in the state. We  make it easy for you so you can apply directly through our website. The IRS has also changed some of its contribution and deductible limits for Health Savings Accounts contracts.

In 2013, the minimum deductible allowed for an individual contract is $1.250. This is $50 higher than in 2012. An HSA with more than one person included (considered a “family”) is now $2,500, which is a $100 increase from last year’s limit. Keep in mind that these are “minimum” deductible amounts, and typically, you will benefit more when you select a higher deductible. However, you may not be able to change deductibles if you can’t qualify medically.

Why You Should Consider A Higher Deductible

For example, while a $2,500 family deductible would mean less potential out-of-pocket cost for a serious hospital claim, you are likely to lose money in the process. Here’s how: Almost every time, the extra cost associated with a $2,500 deductible plan is substantially higher than a $6,000 or $7.000 deductible. That is, you may pay between $2,000 and $3,500 more per year for a benefit you hardly ever use.

Examining this over a period of five years, you pay $10,000 (and often more) in premiums. It is unlikely that you will meet or exceed your deductible the necessary two or three times needed over the five-year period to break even. I base that analysis on my 30+ years of experience in the business along with my first-hand knowledge of owning an HSA! Although there is no guarantee you won’t have many huge claims, the odds are simply against that occurring.

HSA Plans In Ohio Save Money

Ohio HSA Contribution Limits 2013

Contribution maximums have also increased for 2013. For individual accounts, the new limit is $3,250, an increase of $200. For family accounts, the new limit is $6,450, which also represents an increase of $200 from last year. The “bonus” or “catch-up” amount remains unchanged at $1,000 if an Ohio HSA owner was at least 55 years old and wanted to make contributions above the stated maximums.

Of course, these are the “maximum” amounts that you can deposit into the savings portion of the policy. The vast majority of consumers do not come close to meeting or exceeding these numbers. Most persons tend to slowly deposit funds, perhaps in the $50-$150 per month range. Of course, more is allowed and you can abruptly stop or start your deposits at any time (assuming you have not reached maximums).

You Can’t Tax-Deduct Everything

It’s important to only use the account for “qualified” deductions. Otherwise, the IRS imposes a pesky 20% penalty! For example, non-prescribed prescriptions (over-the-counter) are no longer deductible due to a ruling change by the Obama administration in 2011. If IRS forms 5329 or8829 are needed, we can help explain details.

High Deductible Plans must accompany this type of coverage and you can view all of the best options live on our website through our quote box. Usually, Anthem, Medical Mutual and UnitedHealthOne feature the most competitive rates. Occasionally, Humana will sneak into the mix. For retired persons, MSA accounts have become very popular and are ideal choices if you tend not to meet your deductible.

For my personal account (my wife and two children are also included), we deposit $200 per month into the HSA portion. Fortunately, we have no health problems and the account has grown to a point where it will reach the ceiling of what we can have in there. And, that’s precisely what you want. Although we use very little of the deposits, we still take the $2,400 tax deduction each year.  It’s a wonderful concept.

We use Chase Bank and have had no problems since we created the account more than a decade ago. All transactions are online although I’m certain there is a local office here in Springboro (somewhere!). Our monthly maintenance fee is $3. I am not endorsing Chase, but simply pointing out that any large reputable bank can probably effectively handle the HSA side account. Credit Unions may also be able to create an account.

There are certainly pros and cons for using any type of Medical Savings Account. You can contact us anytime and we’ll give you an accurate unbiased assessment. You can also view additional HSA plans in Ohio information.

Cheap Temporary Medical Coverage In Ohio From Humana

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Cheap temporary medical coverage in Ohio from Humana will cover yourself and your dependents. Short-term health insurance rates are always very low, and these types of policies can be used if you need to get coverage quickly or only need benefits for a few months (or perhaps longer). In many situations, you can keep your policy for as long  as 12 months. You may also buy a policy for one month, although it will have to be renewed if you need additional benefits.

Humana’s plan covers both accidental and illness claims and is very easy to apply for. Just like any policy on our website, after you view the quote, you can choose to “apply” online for coverage by answering some simple questions. If there are no significant health issues, you may be approved immediately. Otherwise, usually within a day or two, short-term coverage will go into effect. An ID card and policy specimen is typically sent within 7-14 days, although you have access to the policy number immediately after approval.

NOTE: A temporary policy is not designed to replace a long-term Marketplace plan, especially since they do not contain many of the mandated “Essential Health Benefits” that are required under the healthcare legislation that was passed in 2010. However, it will provide stopgap coverage and give you ample time to either enroll in another compliant policy or obtain group benefits through an employer.

Deductible And Coinsurance Options

The three deductible options are $1,000, $2,500 and $5,000. Since it is unlikely you are going to meet that amount during such a short period of time, $2,500 and $5,000 are the most popular choices. Family deductible options are double the individual amounts. Coinsurance (discussed below) will also impact the premium you pay and the potential out-of-pocket expenses you may be responsible for. 50% coinsurance will result in the lowest possible rates.

Cheapest Short-Term Medical Plans

Don’t Roll The Dice By Going Without Coverage

We prefer the 0% coinsurance options with Ohio Humana short term health insurance plans. Coinsurance is the percentage of the claim you pay after the deductible has been met. However, on UnitedHealthcare temporary plans, we prefer the 20% option. One important item that must be considered is that the odds are heavily against you meeting the deductible when you purchase these types of plans. For that reason, lower amounts are often not the best choice.

Most benefits begin after the deductible has been met. Some of the preventive coverage includes child health supervision, pap smears, mammograms, and colorectal cancer screenings. If you visit a non-network facility, you may have to pay a portion of the cost. Routine office visits are covered  along with lab tests and x-rays (including allergy tests). Typical inpatient and outpatient expenses are also included in the policy. You can view specific details here.

No coinsurance simplifies and improves your coverage once a deductible has been reached. For example, prescriptions are covered at 100% after the deductible has been met. The same applies to 30 days of skilled nursing facilities and 40 home health care visits. Complications of pregnancy are also included in benefits, if ever needed. For more comprehensive maternity benefits, another type of policy must be utilized. The Anthem Premier plan provides comprehensive maternity (including prenatal) benefits. Other short term options can be found on this page.

$2 Million Cap

Unlike long-term plans that have no lifetime cap for benefits paid, usually, short-term policies do have an upper limit. This Humana plan has a $2 million lifetime limit per person, which is more than sufficient since the contract isn’t likely to be kept very long. If you were going to use it for long-term coverage, we would recommend higher limits. And if you’re not sure of the length of time you need  a policy, simply pay monthly to give you the flexibility of terminating when you have secured other coverage.

We like the Humana temporary health insurance plan if you live here in Ohio. It is indeed cheap, although sometimes the UnitedHealthcare options are less expensive. You can view additional details here. And you can always instantly view live quotes and apply for coverage at the top of the page.

UPDATES:

January 7 2015 – Humana no longer offers “short-term” plans. If you are under age 30, you can purchase a catastrophic Marketplace contract. Otherwise, a subsidized Bronze-tier policy is the cheapest option.

UnitedHealthcare and a few other carriers (you can view prices on our website) are viable options for keeping coverage only a few months.

Obamacare Upheld By Supreme Court Ruling – How Does This Impact Ohio?

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By a narrow vote of 5-4, the Supreme Court ruled this morning that the federal government can impose a tax on persons that refuse to purchase health insurance. Thus, health care reform (Obamacare) will proceed and move forward and much of the implementation will take place starting in 2014. But what about individuals and families in Ohio? How will we be impacted? We’ll try to answer some of those questions.

Does this change the way health insurance is purchased here in Ohio?

Currently, there is no “Exchange” set up here and there is a chance one may never be set up. However, Ohio can choose to allow the federal government to set it up. The current administration would like to see “Exchanges” in 2014 dictate how coverage is purchased. But the clunky nature of the Exchanges along with their unpopularity have many legislatures and citizens concerned. Additional research information is found here, with additional details on “benchmark plans,” “essential health benefits” and other ACA Legislation features.

So for now, Ohioquotes.com will continue to offer the lowest available rates from all of the top companies. Quotes are free and so is the professional service You can apply online or we’ll fax/email an application.  If Exchanges become the law of the land, we will continue to help you find affordable coverage through these government-run websites, which will also be referred to as “Marketplaces.”

How do most Ohioans feel about the health care law?

Last year, in a referendum (Issue 3), Ohioans voted against the change. Most residents of the state are still against the massive overhaul, and this could affect the candidate they vote for in the upcoming presidential election. If Mitt Romney is elected, it’s possible part or all of the legislation could be repealed or simply have funds withheld for its implementation. If Romney is not elected, the legislation will be fully implented and the healthcare landscape will change.

What are some of the good parts of the law?

Actually, there are many portions of the “Affordable Care Act” that are quite positive. For example, most preventive expenses are now covered with no waiting period and no out-of-pocket expense and dependents can stay on their parent’s health care plans until age 26. Insurance companies also must now spend less money on administrative expenses and more on health care costs. And of course, in 2014 insurers can not deny an applicant coverage because of any pre-existing conditions. However, after an Open Enrollment period ends, alternative coverage will have to be arranged.

Will premiums in Ohio now go up in 2014?

Yes. And perhaps substantially. Since insurance carriers can not decline any applicant for medical conditions, healthy individuals and even fairly-healthy individuals will have to pay more. And maybe a lot more. Look for rates to increase once 2014 arrives. What many people don’t realize is that currently, rates in Ohio are among the lowest in the country and with the Risk Pool and Open Enrollment, almost anybody can qualify for coverage. In 2014, it may be different.

I have a policy right now. Can I keep it in 2014?

The President says you can. Many experts in the field say you can’t. I guess we’ll eventually find out.

Waiting For Ohio Medicare Coverage To Begin – Low-Cost Options

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Are you waiting for your Ohio Medicare benefits to begin? Perhaps you know which policy you’re going to select and you have already selected your Supplement contract. But, it’s getting there that’s the immediate concern since your current private health insurance ends soon and you have a gap to fill.

Fortunately, there are some great “gap fillers” that will provide solid healthcare coverage until you’re ready to enroll in  Medicare,  along with supplement coverage. And these plans are issued by companies you’re familiar with, such as Anthem Blue Cross, Humana, UnitedHealthcare, Medical Mutual and Aetna. Smaller less-recognizable companies also can provide worthwhile options, such as Premier, SummaCare, and CareSource.

Need Coverage For A Month, A Year, Or Longer?

The most important issue you face is the length of time you need coverage. For example, if you are less than six months from becoming Medicare-eligible, a very common and inexpensive option is a temporary policy. This type of plan is very affordable, and is generally considered the most economical type of medical coverage.

Senior Ohio Medical Coverage Before Medicare

Don’t Gamble By Being Uninsured. Get Short-Term Health Insurance

Although existing conditions are not covered, and virtually all benefits must meet a deductible, it’s a great stop-gap type of coverage that works well. However, it’s important to coordinate your pre-65 and your post-65 healthcare plans so there is no lapse in coverage. Also, if you are currently enrolled in a subsidized Marketplace plan, it may be advisable to retain coverage until you are no longer eligible.

Prices For Temporary Coverage

If you are a healthy 64 year-old female in Montgomery County (rates vary by county), a short-term plan from UnitedHealthcare costs about $122 ($5,000 deductible) or $152 ($2,500 deductible). A $1,000 deductible option is also available and costs just $234. These are monthly rates. Anthem and Medical Mutual also offer temporary contracts, although currently, their rates are higher. Naturally, rates will be less if you are younger and medical conditions could impact the rate.

If the gap between when your existing coverage ends and Medicare begins, is more than 12 months, then a conventional policy is recommended. What type of policy? That depends on how much money you want to spend, the type of benefits you need, and the medical conditions you are being treated for. A federal subsidy my help you pay premiums, although the entire household income is considered in the eligibility calculation. Thus, your spouse’s income must be taken into consideration, regardless if they are to be covered under the proposed policy.

Low-Cost Coverage Until You Reach Age 65

If you are reasonably healthy, a simple high deductible plan (perhaps between $3,500 and $6,800) will keep your Ohio rates low, and still provide excellent coverage. Once the specified deductible has been reached, you can have complete coverage with no further cash outlay for healthcare expenses. However, you also won’t have to pay for most preventive services and you’ll receive a negotiated price break on most other treatment, courtesy of your insurer that is negotiating on your behalf. For example, the cost of an MRI might be reduced from $2,000 to $1,400, while the cost of routine lab services may also reduce from $150 to $30.

If you feel you are unable to medically qualify for a new health insurance plan, as long as you apply during Open Enrollment periods, your acceptance is guaranteed. COBRA, although expensive, will continue to provide benefits for any conditions have. And if you develop new health issues, they will not be excluded from your current health care policy.

For persons that are uninsured and still want to buy a policy until Medicare starts,  you can apply for any of the types of policies previously mentioned. Normal underwriting guidelines will be used on any submitted short-term application, and if approved, you won’t have to worry about the gap until Medicare benefits begin. However, no medical questions will be asked for Marketplace coverage, and pre-existing conditions will be covered.

UPDATES:

January 2015 – The Ohio Senior Health Insurance Information Program (OSHIIP) netted savings of almost $20 million in 2014. About 200,000 state residents were helped by the program. OSHIIP has a consumer hotline and helps answer questions about prescriptions, Medigap coverage, financial assistance, long-term medical care, and other state residents that are disabled and eligible for Medicare benefits.