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US Government Will Take Over State High Risk Program

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The US Government will take over Ohio’s high  risk health insurance program administered by Medical Mutual. Initially, the special “pool” was created to assist persons that could not obtain healthcare because of medical issues, or were not eligible for Medicare or Medicaid. More than 3000 state residents are currently covered under these “risk pool” plans. Although prices are high, provided benefits pay for most expenses.

But unfortunately, in most states, the amount of money provided to fund the program ran out, since the number and dollar amount of submitted claims was much higher than anticipated. Here in Ohio, the request for financial aid to save the program was denied by Kathleen Sebelius, the Secretary of the US Department Of Health And Human Services. Sebelius insisted that at least $10 million additional dollars be spent by the state.

As a result, it is likely that benefits will no longer be as comprehensive compared to the previous available policies. Network participation is expected to reduce, and out of pocket expenses,such as copays and deductibles, may be increasing. And since there are no alternatives until 2014, consumers in the “high risk” category will have to find a way to pay the extra money. It’s expected that a covered $100,000 claim could increase maximum out-of-pocket expenses between $1,000 and $2,500.

Medicare Not Affected

Get Guranteed Approved Ohio Healthcare

Ohio Children Health Insurance Is Still Available

Medicare recipients will not be impacted by this transition. The fraud unit will continue to monitor payments and other administrative activities in an effort to reduce the overall cost of service. Each year, hundreds of millions of dollars are wasted, and hopefully, more of these funds will be recovered. A small increase in the percentage of returned money will make a big difference.

Starting in October, Buckeye state residents can take advantage of Open Enrollment to the 2014 Guaranteed Approval plans. is a leading website resource for individuals and families to apply for coverage without paying any fees. The new US federal subsidy will also be offered to persons whose income is lower than 400% of the Federal Poverty Level (FPL).

Off-Exchange Options

Contracts will also be offered outside of the official Marketplace. Rates are expected to be released within the next 60 days and it is possible that these options will be very attractive to families with household incomes above $95,000 that do not qualify for tax breaks. Network provider lists (especially specialists) may be larger for plans that do not pay subsidies.

For persons that will be covered under the federal government starting the end of July, Medical Mutual will continue to administer their policies until that date. They will also assist in transitioning from a state-sponsored policy to a federally-sponsored policy. It is possible that many families will qualify for Medicaid coverage  at the end of the year since requirement are being loosened.

Medicaid In Ohio – To Expand Or Not To Expand

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Medicaid in Ohio. To expand or not to expand. That is the question. Governor John Kasich and the Health Policy Institute of Ohio believe the economic benefits derived from expansion far outweigh the risk of federal government funding drying up in the future.

By enlarging the number of Medicaid recipients, it’s anticipated that more than 250,000 residents of the state that make about $15,000 per year (or less) would qualify. Otherwise, these individuals and families would have to try to pay their healthcare benefits themselves, which may be an impossible task. And if they are able to purchase a policy, although preventative benefits would be fully covered, high deductibles would result in potential large out-of-pocket expenses.

Also, more than 40,000 veterans (and family members) would be positively impacted, and more dollars could be utilized for suicide issues, which often plague veterans. Mental healthcare, drug-testing and drug-addiction services are also benefits that would aid many low-income individuals and families. And often, trips to physicians and specialists are quite often.

Can Ohio Afford More Medicaid?

Will Ohio Expand Medicaid?


Senate Bill 17 was recently submitted by Democratic Senator Shirley Smith (Cleveland) that echos Governor Kasich‘s ideas that passage will create many new jobs along with increasing revenue in the Buckeye state. The Governor has mentioned in past interviews that he considers this legislation “personal” and it must be passed.

The critical issue is quite simply the level and amount of funding that will reach the program. The first three years are completely paid by the federal government.  Then it gets tricky. After that, each year, Ohio residents will have to pay for the expansion since the share the state pays increases by 10% until 2020.

Ohio Receives Financial Assistance…For Now

Overall, Ohio would receive more than $12 billion (not million!) in financial assistance. But what happens if there is a shortfall of a few billion dollars? Raising taxes may be the only way to recover the money, which could wipe out many, or all of the gains to be made. And there is no guarantee that the federal government won’t alter the conditions, and substantially reduce their contribution in later years.

The House of Representatives removed it from the budget and it is not expected to return. But an alternative might be possible, that will not interfere with the budget. It’s a bipartisan idea that all lawmakers from the House and Senate will consider in about four months. There also may be some legislation offered before the end of June. But whatever is decided, it will have to be in place by the first of the year when State Open Enrollments begin.


September 2013 –  A new Medicaid website has been created ( that will assist consumers in determining if they are eligible for benefits. Although the criteria for qualifying has not changed, the new website will be more accurate in determining who meets the necessary criteria to be accepted.

October  is the launch date and there may be some synchronization with the Federal Exchange website for persons with higher incomes. Since 20% of Ohio’s residents are considered “low-income,” the new site could potentially help millions of persons. And as an added bonus, personal visits to local offices may no longer be needed.

February 2016 – Federal funding was indeed accepted and Ohio expanded Medicaid in 2014. The federal funding is still flowing and more than 400,000 persons now enjoy coverage, that otherwise may not have had any medical benefits. Last year, it was also reported that  the actual Medicaid spending was about $171 million less than expected. Eligible persons can apply online here.

Improved Electronic Healthcare Systems Coming To Ohio

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Improved electronic healthcare systems in Ohio will help physicians more effectively treat their patients and medical facilities will be able to provide medical records quicker and more accurately. Thanks to half a billion dollars (Yes, that’s right!) of funding, courtesy of the Centers for Medicare and Medicaid Services (CMS), doctors, hospitals and many other facilities in the state are reaping these benefits.

Funding from Medicare (up to $44,000) and Medicaid (up to $64,000) is available to hospitals and professional workers that show effective use of  EHR technology. It is offered in 43 states and has already been distributed to more than 12,000 persons and/or businesses here in Ohio. Only five other states receive more funding and there is more money available between now and the end of 2014.

Ohio Electronic Records

To start an efficient electronic health system in a place of business can often cost between $10,000 and $90,000, depending on the volume of information being processed and how efficiently and quickly the setup process will be. Currently, it is not a requirement for a business to have their medical records recorded electronically. However, after 2014, their reimbursement from Medicare may reduce if electronic records are not in place.

These systems are sold by many companies in the US. However, it’s important that the hardware and software is compatible with other devices and has the capability for the amount of storage space that is needed. And of course, the safety and security of all of the data must meet stringent government guidelines that will be constantly checked.

The Center For Medicare and Medicaid Services is requiring various research data be reported every year to verify the type of treatment administered and additional details regarding patient height/weight and smoking habits. The data will be complied and shared for the benefit of future treatment. However, privacy will not be compromised since  personal information will not be shared.

After the Affordable Care Act is fully implemented (including State and Federal Exchanges), the importance of data-sharing and privacy will increase, as its integrated into the process of comparing and enrolling. Individuals and small businesses will need assurances that their information is safe and secure.

Ohio Kaiser Permanente For Individuals And Families

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Kaiser Permanente health care is both affordable and popular in Ohio. Plans are flexible to meet individual and family needs and participating doctors and hospitals provide superior treatment. However, policies are limited to coverage in the nine counties of Northeast Ohio. Ranked as one of the best 100 plans in the state, it’s a highly respected resource in the Canton and Akron areas. Kaiser is also recognized nationally for their Medicare plan options.

Policy Choices

With more than 100,000 policyholders, it’s not a “small company. There are four HMO policy options including a  qualified high-deductible (HSA) plan. The four policies are part of the “Signature” portfolio. The HSA policy has a $5,000 deductible while the traditional comprehensive contracts offer $3,000, $2,000 and $1,500 choices. Additional HSA Ohio rate information from other carriers is also available.  Conversion plans are also offered for employees that will no longer have their coverage at work. However, the benefits and cost will not be the same as your group policy.

Copays on the comprehensive plans are either $35 or $25 for visits to your primary physician. Specialist visits are $10 higher. As mandated by The Affordable Care Act legislation, all preventive services do not have to meet a deductible or copay. This includes annual physicals for both males and females, child well-visits and many other expenses.

Best Kaiser Healthcare In Ohio

Kaiser Offers 100% Preventive Benefits

Prescription benefits are provided with a $25 copay (Generic) after a $250 deductible must be met. Brand RX must meet a $45 copay (plus the deductible). Like many other plans, non-formulary drugs must be paid by the policyholder. Mail order options are available although they don’t appear to reduce costs.

Since these plans are not PPOs (they are HMOs), you must establish a PCP (Primary Care Physician) to coordinate your care and treatment. If you live in the area, there are many reliable and experienced physicians that will be available. If you’re out of the designated network area, emergency treatment would be covered as if you were being treated locally. This would, of course, include an ER admission.

Three Comprehensive Policy Options

The three comprehensive copay plans fully cover pre and postnatal visits to the doctor. Labor and hospital bill charges are also  an included benefit but are paid after the deductible has been met and are subject to coinsurance (either 20% or 30%, depending on the policy). Currently mental health, chiropractic and  substance abuse are excluded.

However, when State Exchanges are created, those benefits should be included on all policies with any of the participating carriers, including Kaiser. Also, federal financial aid in the form of an instant tax credit will be available. The amount of your assistance will be calculated by determining your Federal Poverty Level (FPL) ratio.


OK. So how affordable are Kaiser’s health insurance rates in Ohio?  There are many scenarios that could be created, but we illustrated a non-smoking 35 year-old male that lives in Canton. Listed below are the monthly rates for the four plan options:

$115 – Signature $5,000 (HSA)

$121 – Signature $3,000

$135 – Signature $2,000

$154 – Signature $1,500

Typically, if you’re considering  an HSA, the higher deductible options will be more cost-effective since the premise behind the coverage is to pay as little as possible and deposit the rest into a separate tax-deferred account. However, you must maintain a qualified HDHP policy, or you will forego all tax-advantages when paying medical, dental, or vision expenses.

Over Age 65 Options

Find Cheap Kaiser Ohio Coverage

Kaiser Ohio Medicare Plans Are Affordable

The Center for Medicare and Medicare Services (CMS) awarded Kaiser their highest available designation for their Medicare Supplement contract. The designation is very-highly respected and takes into account many factors. Currently three MedSup options are available. They are:

Plus I  $144 per month. There is no deductible and the annual out-of-pocket maximum is $2,500. $5 and $20 copays to primary care physician and specialist. 100% preventive benefits and $65 copay for ER.

Plus II  $29 per month. No deductible with $3,400 out-of-pocket maximum.  $10 and $25 copays to primary care physician and specialist. Same preventive and ER coverage as Plus I plan. However, the copay for the first five days of  inpatient hospital care is $200 (The Plus I plan is only $100).

Plus III $0 per month (Really!) No deductible with $3,400 out of pocket maximum. $15 and $40 copays compared to Part II plan but $250 per day for first five days of inpatient hospital care, which is the highest of all three options.

Dental, vision and hearing benefits can often be added as supplemental riders. Typically, the cost is not expensive. Also, prices and benefits can change each year. Additional requirements and mandates may be required due to Department of Health and Human Services reviews.

Although Kaiser offers very competitive rates, they may not necessarily be the lowest priced option in your area. We will show you the best healthcare options in Ohio so you can easily compare policies and also apply for coverage.

NOTE: Kaiser no longer offers individual plans in the Buckeye State.

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.