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List Of Medical Conditions Now Covered Under Obamacare

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Have you been previously denied for a pre-existing condition when applying for health insurance? Or, were you charged a higher premium (perhaps substantially higher) because of a current medical ailment or medication you took in the past? If you have, you understand the difficulty of finding and purchasing affordable healthcare in Ohio before the ACA legislation was passed.

The good news is that the practice of denying coverage, increasing prices or delaying benefits for specific conditions, ended several years ago. Effective with Open Enrollment, you are not required to answer medical questions, take a physical, or pay a higher cost for any medical treatment you ever received. However, “grandfathered” plans (typically issued in 2010 or earlier) are not required to pay for treatment of conditions that have been previously excluded.

Marketplace Ohio Health Plans Cover Medical Conditions

Ohio Exchange Open Enrollment Covers Pre-Existing Conditions

The only variables effecting the cost of your coverage are your zip code, age and smoking status. You also may qualify for a huge federal subsidy to pay your premium. The credit is based on your individual (or family) projected income for the current year. We can review the calculation with you and explain how affordable your prices are.

 

List Of Medical Conditions Now Covered By Ohio Health Insurance Plans:

Acromegaly

Adam’s Stroke’s Syndrome

Addison’s Disease

Adrenocortical Hypofunction And Insufficiency

Aids

Amyotrophic Lateral Sclerosos

Angina

Ankylosing Spondylitis

Aortic Stenosis

Arteriosclerosis

Athritis

Autism

Bipolar Disorder

Buerger’s Disease

Burkitt’s Lymphoma

Bursitis

Cancer

Cardiomyopathy

Cirrhosis

Congestive Heart Disease

Coronary Heart Disease

Crohn’s Disease

Depression

Diabetes

Down’s Syndrome

Endometriosis

Fibromyalgia

Gallstones

Hepatitis C

Herniated Discs

Irritable Bowel Syndrome (IBS)

Juvenile Rheumatoid Arthritis

Kidney Stones

Leukemia

Manic Depressive Psychosis

Marfan Syndrome

Marie-Strampell Disease

Mental Retardation

Mitral Srenosis

Multiple Sclerosis

Muscular Distrophy

Myasthenia Gravis

Myocardial Infarction

Pacemaker

Paranoid Personality

Paraplegia

Parkinson’s Disease

Porphyria

Pregnant (Currently)

Psoriasis

Psoriatic Arthritis

Quadripelgia

Rheumatoid Arthritis

Schizophrenia

Sjogren’s Syndrome

Stroke

Systemic Lupus Erythematosis

Tetralagoy Of Fallot

Tuberculosis

Urinary Tract Infection (UTI)

Wilson’s Disease

Yes, that is quite an extensive list. It’s important to understand that although these conditions will not cause your application for coverage to be rejected, you may still incur out-of-pocket expenses for the treatment and/or any medications that are prescribed. The amount of your portion of the cost will depend on the type of plan you have.

Platinum plans  have the least out-of-pocket costs (about 10% of estimated expenses) while Bronze plans, although the cheapest option, have the highest out-of-pocket costs (about 40%). If your medical bills are extensive and you take multiple medications (and at least one is non-generic), a Platinum or Gold option may be your best option. If you qualify for a subsidy, a Silver-tier plan may substantially reduce your out-of-pocket expenses because of “cost-sharing.”

Our Little Girl Is Attending Ohio State University

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Do you have a daughter? If you do, you understand how precious they are. Whether they’re hugging Minnie Mouse at Disney, dance recitals, her first day at kindergarten or trying on Mom’s clothes, little girls are always special to Daddy.

And then, before you know it, they grow up. Fast. Really fast.  It was just yesterday (or so it seemed) that our daughter talked about how much she enjoyed junior high school. Her seventh grade teachers were all very special and the big school was so neat.

Wait a minute. That wasn’t yesterday. That was more than five years ago. And now, she’s a young lady, less than a week from starting her college life at Ohio State University. THE Ohio State University. Wow. The campus is a lot bigger than her junior high school and all other schools she attended combined. In fact, OSU is bigger than our hometown of Springboro. Well…Perhaps it just seems that way.

At $25,000 per year, OSU isn’t cheap. But a combination of  scholarships have reduced the cost, and with travel time only about 90 minutes to the campus, it’s a lot better than when I lived in Harrisburg (Pa) and went to Miami University instead of Penn State or Pitt. I don’t think my parents ever forgave me for that.

OSU Student Healthcare Online

Happy To Be A Buckeye

Her high-school years just flew by. Not that long ago, I was coaching her 5th-grade basketball team. And yet, just a few months ago, we were watching her deliver one of the commencement speeches at her high-school graduation. The graduation parties are over. Her part-time job, that she so very much enjoyed, has just about ended, and the constant reminder that I need to fill her car with gas, is going to stop. And I’ll miss all of them.

I assumed packing for the short jaunt would be easy. Her room isn’t tiny, but it’s not 1000 square feet either. Actually, it’s less than 200 square feet and a roommate will be joining her. We have three SUVs and surely one would be enough to transport her belongings. That was a wrong assumption. We might be able to fit everything in two vehicles. And a U-Haul. And a small motor-home.

I own about 15 t-shirts. She has 50. I have eight  great pairs of shoes. She has 800. My shaver kit can hold all the essentials I need for an extended trip. She needs a suitcase just for those types of things. Ok…I am embellishing a bit. I just hope I’ll be able to see out of any of the car windows when we head to Columbus. But I do know that her Ohio State student health insurance options have been discussed with her. Of course, as her father and broker, that was easy!

But the point of this short story is simple. When your friends and relatives tell you that “kids grow up fast,” they aren’t kidding. These 18 years just flew by too fast. They were enjoyable and we loved every minute of her living in the house 12 months out of the year. Now, it’s down to about three months out of the year.

And what will happen if she decides to stay in Columbus for part of the summer? Or perhaps the entire summer? Then we will only see her Thanksgiving, Winter Break and a few other weekends. What a revolting development.

Wait a second! Wait a second! I have the solution. Although we can’t move to Columbus, we could visit on weekends. Every weekend. Surely, our daughter would enjoy that. Wouldn’t she?

UPDATES:

August 2013 – We’re back from Columbus and our daughter is nestled in her room, preparing for upcoming classes and getting ready for the arrival of her roommate. The dormitory is new and the Resident Assistants were nice enough to put everyone’s names on the door (two persons per room) before they arrive.

As I walked down the hall, I noticed something strange. It was the name plates that I was seeing on the doors. There was Jack and Mike. Peter and Lawrence. Jeffrey and Rahul.  Ben and Phillip. WAIT A MINUTE! What about Jennifer and Debbie? Or Lisa and Samantha? Something didn’t seem right!

Finally, I did find an Abbie and Rachel sticker on one of the doors, and I assume there were a few more females throughout the corridor. I felt better. A lot better. Ohio State University is a great college. I never had a doubt.

December 2015 – So much as happened in the last two years. Our daughter is thoroughly enjoying her OSU experience and actively interviewing for several summer internships with large respected corporations. She changed her major from Communications to Economics, which has worked out quite nicely.

And of course, the Buckeyes won the National Championship a few years ago. Perhaps Urban Meyer will give her a reference!

December 2016 – No National Championship last year, but the Bucks made it to the Championship Round this year, and will face Clemson in a few weeks. Our daughter will graduate in the Spring and has already been offered employment with a prestigious financial institution upon graduation. Yes, we are very proud of both of our children.

Some Answers Questioned – Some Questions Answered

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I have many answers to questions, and many questions to answers. Here are a few of them and my apologies for straying off-topic for the first time. I think I’m allowed to do this once.

Kathleen Sebelius (Health & Human Services Secretary) said she was talking with the National Football League (NFL) about helping them promote the new healthcare legislation? Of course, we all knew the NFL would have no part of it. And why would they? Obamacare badly need the help of young healthy men, which happen to make up a large portion of NFL viewership.

Not surprisingly, the NFL released a statement directly contradicting Sebelius, saying they had no interest in promoting the legislation, and were never had any discussions regarding the matter.

 

Corn on the cob  is ridiculously cheap. At about 10-15 cents per ear, it has to be one of the great bargains in food. If it were healthy enough to eat all of the time…imagine your grocery bill. About $1 per day. Then again, I love Chinese food too much to try the corn experiment. I could easily eat Garlic Chicken every day.

 

Kings Island, Hershey Park, Disney World and Disneyland. I have been to all of them. Guess which one I prefer? OK, it is true that Kings Island is only 25 minutes away, but if you live within five hours of Mason (Ohio), start planning your trip there.

Some of the newer attractions include the world’s largest animatronic dinosaur, Reds Hall Of Fame Restaurant, and Charlie Brown’s Jungle Journey. Admittedly, our teenagers enjoy the park more than we do, but you could easily spend a few days between the main park and the water park. And, you’re just 25 minutes from Cincinnati, where there are many other activities that the entire family could enjoy.

 

Best Rides In Ohio

What A Beast!

Fantasy Football season is almost here. NFL training camp begins in July, the first pre-season games are in August, and the regular-season games begin in September. Drafts are typically held in late August so the research and information-gathering will shortly begin.

For many males, it’s the time of the year, where nothing else matters. Work, eating, vacation and other daily necessities suddenly no longer matter. For non-playing family members, it’s a time to put up with random questions, such as “Honey…Do you think the Broncos will have a running back by committee this year?”

And when the three-hour draft begins…Don’t bother us, unless the house is on fire. Of course, we will still make our selection and grab our laptop before we exit the house.

 

Ohio State University is a phenomenal college. I never admitted it until we visited the campus with our daughter last year. She was a high-school junior and everybody (including her) thought she was headed to Miami (University) in Oxford. And why not? It’s my Alma mater and I still love the college.

But admittedly, Ohio State was incredibly impressive. And it is indeed a big place. But whether you like academics, athletics, the campus, or many other considerations, it’s hard to say no, once you have visited OSU. I may not root for the Buckeyes when they play Miami in hockey, but other than that, I’m officially a Bucknut.

 

OSU Football Winning Tradition

The Ohio State University

I love golf. However, if anybody reads the “About Me” in my websites and blogs, you may notice a reference to my “One Of  The 10 Worst Golfers On Campus” award I won in college. Well…I’m still awful, probably because I rarely play. I have been an avid tennis player for my entire life and it’s difficult to break old habits.

But I am committed (somewhat) to  becoming a good golfer. I suppose I need to practice more than the current one bucket of balls every other month.  It’s a shame there isn’t a virtual online training session that could knock 20 strokes off my score after an hour of viewing.

 

Vision Insurance. If you have it, keep it. If you don’t own this type of coverage, you may not be missing anything. Most policies cost about $100-$300 per year. The value of the benefits you receive are ironically…about $100-$300 per year. That’s right. A wash. Typically, you get a copay on a yearly preventive exam and perhaps some additional benefits for a frame of glasses every few years.

But many persons choose to simply find seasonal deals for a package that includes an office visit plus frames or contact lenses. Also, Sears, Penneys, Sam’s Warehouse and Costco often offer good prices, flexible hours and licensed Ophthalmologists. A typical exam is inexpensive, and you can choose to buy your glasses at the conclusion of the exam, or order online from several reputable options.

 

That’s enough rambling for now. Back to writing about healthcare, which, although is not quite as fun, is still very challenging since it is constantly changing.

Health Insurance Rates In Ohio Jumping 88% Due To Obamacare

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The Ohio Department Of Insurance (DOI) announced today that health insurance policies sold in the upcoming Exchange will cost (on average) 88% more than current plans. The large increases are due to mandatory essential benefits required by Obamacare and The Affordable Care Act legislation. The  projected were provided by the Society Of Actuaries.

These increases do not take into account federal tax subsidies that many individuals and families may qualify for. Families with incomes under $96,000 and individuals with incomes under $34,000 should qualify for assistance. This cost-sharing formula is based on 400% of the  Federal Poverty Level (FPL). Each year, the income levels and subsidies are recalculated to adjust for inflation. Cost-sharing assistance will also potentially reduce copays, coinsurance and deductibles.

Need Department Of Insurance Approval

The proposed prices still must be studied and approved by the DOI. This process will probably take approximately four weeks. When the rates are issued, they could be different than the original submitted rates. Also, insurers could decide to reduce the number of policies they are offering, or completely withdraw for the Exchange Marketplace.

One of the principal reasons that  individual health insurance rates are increasing so substantially, is because of all the numerous “mandated” (required by law) benefits that must be included for every applicant. For example, prior to 2014, if maternity was not wanted or needed, the benefit could be easily excluded from the private policy you purchased. The savings was often as much as $3,000 per year. Many carriers didn’t offer the benefit.

Get Low Rates For Ohio Healthcare

Obamacare Hits Ohio!

And at a monthly premium of between $270-$800 per month (Just for maternity!), it was a coverage most Ohioans did not want at the time of purchase. Out-patient mental health and chiropractic  visits were also often limited or excluded, saving fairly significant dollars.

It is only fair to point out that many individuals and families will benefit by the new legislation. Applicants from low-income households or with serious medical issues (or both) will probably pay less than what they typically would have been forced to pay. However, if they are still uninsured, the designated Open Enrollment periods are the only times to purchase federally-mandated coverage.

Fewer Choices With Marketplace Plans

But after 2014, you won’t have a choice. That’s one huge reason why prices are going up…and substantially, for many residents of the Buckeye state. The four available types of “medal” plans: Platinum, Gold, Silver and Bronze, will all contain many features that might never be used. But it’s the law now. Obamacare at your service.

There may be some affordable alternatives, such as buying a policy outside of the Exchange Marketplace. Otherwise, by selecting a “Bronze” medal policy, you avoid the most costly Ohio  options. Of course, by qualifying for financial assistance, premiums will reduce.

Kaiser Permanente Out – Catholic Health Partners In

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Kaiser Permanente of Ohio is selling its health insurance operations to Catholic Health Partners (CHP), one of the largest healthcare system in the state and the US. With more than 24 hospitals  and numerous additional facilities, they specialize in providing affordable quality care in the communities they service.

More than 75,000 persons are currently covered by Kaiser in the Akron, Canton and northeastern portion of Ohio. Along with Anthem Blue Cross, UnitedHealthcare and Medical Mutual, CHP has a large market presence in the area. They are highly-respected and are active participants in local community events.

Although it will take a few months for the entire process to be completed, no glitches are expected and patients will be able to make a very smooth transition. The risk of lost jobs (which is not new to the area) is virtually guaranteed although the exact number is not known. Although there are some employment opportunities in the immediate area, many workers will have to move elsewhere are transition to a new occupation.

No Marketplace Plans For Kaiser

Ohio Catholic Health Partners Information

Catholic Health Partners Expanding In Ohio

This move will probably eliminate the possibility that Kaiser participates in the Ohio Health Insurance Exchange Open Enrollment in October. Policy and rate filings must be submitted within the next few months, and already, a few major carriers have decided to sit out 2014 and instead study the success (or lack of success) of their competitors.

CHP has been busy, as earlier in the year, they purchased  a portion of Summa Health Systems, which is also located in the northern part of the state. This purchase will work in conjunction with their hospitals in the area (Lorain, Youngstown, Warren and Toledo). Meanwhile, much of its business in Pennsylvania was sold. Competition was stiff, with UPMC and Highmark dominating the Western Pennsylvania market.

The Size Of CHP

With more than 30,000 work associates in the area, Catholic Health Partners is a “Quiet Giant” that is significantly  larger than most residents realize. In addition to the hospitals previously mentioned, they operate 15 senior living facilities, eight home-health programs and five hospice programs.

Some of the most notable hospital facilities include Mercy Health, Mercy Health Partners, St. Rita’s Health partners and Humility Of Mary Health Partners. Patient satisfaction statistics have always been excellent and the quality of treatment has never been an issue. Equipment also seems to be modernized on a regular basis.

UPDATES:

June 2014: Catholic Health Partners is expanding by building its new corporate head office in Cincinnati (Bond Hill area). Construction will be completed in 2016 and will provide employment for between 900 and 1,100 workers. The existing home office in Mount Adams and the Blue Ash offices will consolidate.

The Cincinnati City Council is expected to approve the move, which will allow construction and planning to quickly begin. CHP specializes in providing medical treatment for the poor and persons that don’t have access to treatment.

July 2014: CHP has changed their name to Mercy Health and continues to be the fourth-largest employer in the state. Currently, the name “Mercy” is utilized in many areas including  Cincinnati, Springfield and Toledo. The Ministry has also changed to a different website domain (Mercy.com) to better reflect the transition.

Company spokespersons said they wished to simplify their operating structure to better utilize existing resources. Ultimately, their customers would be the biggest benefactor. Mercy provides more than $25 million each month to patients that typically can not afford to pay for their services.

February 2016 – Kaiser medical coverage is still not available in Ohio, although they continue to offer individual plans in many states. Unless the existing healthcare system is overhauled, we don’t expect them to return to the Buckeye State.