If you are enrolling for Ohio healthcare coverage through the Insurance Exchange, you may need free professional guidance to help compare the best medical plans, calculate your federal subsidy, determine eligibility, and enroll online for the best effective date.
Fortunately, we specialize in assisting customers find the most affordable Ohio Marketplace policies, and making it easy to apply and purchase comprehensive benefits at the lowest cost. Although we probably say this on every page…it’s important to state it again – there are no costs or fees when we help you enroll, and thanks to state regulations, you won’t find lower prices on any other website.
How We Help You
Selecting the right plan is perhaps the most important part of the process. There are five types of coverage: Platinum, Gold, Silver, Bronze and Catastrophic. Although finding the least expensive offer should always be considered, it’s equally important to select the policy that pays most (or all) of your current medical bills with as little out-of-pocket expenses as possible.
For example, if you are required to have routine blood work every two or three months along with other diagnostic tests, it could be very expensive if you have to meet a deductible to cover these items. Easily, you could pay $2,000 or more. If you take medications, we’ll review the RX benefits of all available plans and show you the policies that will pay the highest percentage of your prescription costs. Generic, brand, and specialty drugs all have different prices, and it’s critical to consider a policy that ensures you pay low prescription costs.
However, if an alternative plan places a copay on these types of charges, you might pay $40 instead of $400 when you receive treatment. The premium for this type of Ohio Exchange plan may only be $5-$15 dollars more per month. We find and discuss these options with you, so you’re getting maximum coverage for your premium.
Note Regarding Prescriptions – Most carriers differentiate their drug coverage into four separate tiers (1, 2, 3, and 4). Usually, there is a small copay of approximately $3-$10 on the least expensive drugs (tiers 1 and 2). However, depending on the policy, there can be significant differences on the out-of-pocket costs on more expensive non-generic or non-preferred drugs.
If you take prescriptions, it is important for us to review the plan drug coverage so you minimize your copays and coinsurance. If you are prescribed a “specialty” drug, obtaining prior approval and choosing the participating pharmacy in advance will also save you time (and perhaps money).
Tip: Deductibles don’t always tell the whole story. It’s not unusual for a $3,500 deductible plan to have higher out-of-cost maximum expenses than a $5,000 deductible plan. “Co-insurance” must always be compared and understood. Otherwise, you may pay a higher premium, and also pay a higher percentage of your hospital bill than you would have with a cheaper policy.
Mandated ACA Benefits
Also, you will always have “Essential Health Benefits” included in Marketplace plans, since it is now required (mandated). These are 10 coverages that must be included in all policies. Maternity and mental illness are two of the biggest benefits, along with the standard expected benefits for hospitals, Emergency room, inpatient/outpatient, prescriptions etc…
Although policies may have different out-of-pocket maximums, limits on specific types of treatment, and restrictions on how often you receive therapy, the core “essential” coverage must be part of every qualified plan. There will not be a waiting period for these items, including pediatric dental and vision services, substance use treatment, newborn care, and behavioral health treatment.
Unless, it is an approved exception, you may be subject to an IRS fine if you purchase a policy that fails to include them. There are unapproved and unregulated contracts that are typically offered through questionable websites and “boiler-room” call-centers. You can easily identify the plans since they are often issued by unknown companies, a large application fee must be paid, and you are asked to pay your first premium immediately.
NOTE: The current penalty (tax) for lack of required coverage is up to 2.5% of household income. Thus, a family with $50,000 of income would pay a whopping $1,250 when they file their taxes the following year.
Avoiding The Enrollment Nightmare
Although most of the “nightmares” have been eliminated, enrolling for new coverage can still be a challenge for consumers that attempt to secure coverage by themselves. Some of the most common issues are long delays on the phone or online, receiving incorrect subsidy or plan information, not being informed of lower-cost options, and providing financial information to persons that have had no background checks and are newly-hired.
Obviously, we eliminate all of those concerns with a combination of our 35 years of experience, and commitment to simplifying the enrollment process by working and guiding you every step until completion. The bugs and malfunctions of the government healthcare website are challenges we have learned how to avoid. Typically, we can complete the enrollment process in less than 20 minutes. Often, if only one person is applying, it takes less than 10 minutes.
However, if you are Medicaid-eligible, you will have to contact the State Medicaid office (phone or online) to formally apply. There are specific income and citizenship eligibility requirements that they will discuss with you. You can apply for benefits at any time of the year.
For 2016, a new concept (re-direct software) allows you to enroll in a very short period of time. It’s a fairly simple concept and it works like this: Once you know which plan (and company) is being applied for, we create a unique specialized online link that is customized for you (and only you).
Also, as a licensed broker, with many carriers, we offer a direct-enrollment link, so you never have to visit any website other than the broker and insurer links. This typically is available if you do not qualify for any subsidy assistance or you are purchasing an “off-Exchange” policy. These plans are not available through the .gov website or any type of navigator. The application process is also significantly reduced from about 30-40 minutes to 10-20 minutes.
Cadillac Plan Options
Although there are dozens of low-cost high-deductible Marketplace plans available in Ohio, what about the policies that costs a little more, but feature smaller deductibles and coinsurance? Also included are copays that don’t cost almost as much as the actual visit to your primary care physician or specialist. We have listed several example below. NOTE: Not all plans are offered in all areas of the state.
Humana Gold 2500 – $2,500 deductible with $25/$35 copays on primary care physician (pcp)/specialist visits.
Premier Health Gold 1500 – $1,500 deductible with $10/$40 copays on pcp/specialist visits.
HealthSpanOne Gold 1000-80 – $1,000 deductible with $10/$30 copays on pcp/specialist visits. $30 copay on brand prescriptions.
UnitedHealthcare Gold Compass 500 – $500 deductible with $20/$40 copays on office visits.
Ambetter Secure Care 2 – $500 deductible with $50 and $75 copays on office visits.
HealthSpanOne Gold 250-70 – Similar to previous policy with very low $250 deductible but higher out-of-pocket maximum.
Anthem Gold Pathway X PPO 1250 10 – $1,250 deductible with $30 pcp copay and $3,100 maximum out-of-pocket expenses.
Aetna Gold $5 Copay – $1,400 deductible with $5 copay on pcp visits ($40 for a specialist).
Molina Marketplace Gold Plan – $500 deductible with $15 and $35 copays on office visits.
Medical Mutual Market HSA 2000 Gold – HSA-eligible plan with $2,000 deductible.
SummaCare Individual 750-LT – $750 deductible with $20/$40 copays.
InHealth Gold 2 – $1,250 deductible with $20 and $40 office visit copays.
How Long Must I Keep The Policy?
There is no time-period requirement for keeping the plan in-force. So whether you keep it a month, a few months, or a few years, it does not matter. You can cancel at anytime. Billing is usually monthly, so you have time to terminate coverage. For example, if you knew you would qualify for employer-sponsored benefits in four months, of course, you would not want to keep your policy, assuming you liked the group coverages.
Also, although there is a new Marketplace enrollment every year, you don’t have to apply for different coverage if you like what you have. Conversely, if you previously purchased a plan that no longer fits your needs, we can apply (without answering medical questions) for a new policy. NOTE: If you terminate a plan, unless you qualify for a special enrollment exemption, you may not be able to purchase a “subsidized” policy until the following November.
What If You Miss Open Enrollment In Ohio?
You definitely won’t be the first person! Officially, Open Enrollment typically ends in late January. However, the next Open Enrollment begins in about nine months, since it is an annual event. Of course, you may not want to go nine months without medical coverage.
If the deadline is missed, you can apply for a “short-term” plan from several companies through our website. UnitedHealthcare will likely have the lowest rates, and you will be able to keep coverage up to 12 months. Pre-existing conditions would not be covered, since it is not considered an Exchange plan. Premiums are very inexpensive for both an individual and family policy.
Another alternative is purchasing a “limited-benefits” policy. Although it will not contain all of the required 10 essential benefits of an Exchange policy, this type of policy will offer an alternative that provides some financial relief if you incur large doctor and/or hospital bills. Usually, acceptance is just about guaranteed and premiums fluctuate in the $50-$150 per month per person range. Disclaimer: We do not actively sell, promote, or market these types of plans. Typically, customer satisfaction is extremely low.
What Are The “Special Enrollment Periods?”
You can purchase coverage outside of the designated enrollment periods if you have a “qualifying life event.” You won’t have to answer any medical questions and subsidy eligibility will be offered. Approved by the Department Of Health And Human Services (HHS), some of these “events” include:
Adopt or have a child
A change in income that impacts eligibility for cost-sharing or tax credits
Relocation to a different city/state that offers different plan options
Loss of benefits due to divorce, job change, Medicaid, CHIP, COBRA etc…
Loss of coverage because of job termination.
Become a US citizen
If the Government (HHS) makes an error causing you to lose or change benefits
COBRA Is Expensive. Can I Drop COBRA And Apply For An Exchange Plan?
Yes, COBRA is expensive, since it is designed to mirror your prior employer’s benefits. It often includes low deductibles, which raise the cost of coverage. Often, with the help of your subsidy, the Marketplace prices will be significantly lower, and become a very tempting target for enrollment.
This is the best time to apply for new coverage, since you won’t have to worry about any health-related issues, and you can (with our help), compare and select the policy that gives you the benefits you want at a reasonable cost. COBRA can be easily terminated to coincide with the effective date of your new policy.
However, if you miss the deadline, and don’t qualify for any special circumstance exceptions (divorce, job termination etc…), you will have to wait for the next Open Enrollment or purchase an ACA non-compliant plan that may have limited coverages.
November 2014 – Less than 48 hours until the second-ever Ohio Open Enrollment begins. A major upgrade is the direct enrollment link we provide if you live in-state. It reduces the application time down to about 15 minutes and what an improvement that is from last year. Also, Aetna, UnitedHealthcare and Premier are new carriers in the state. At first glance, UnitedHealthcare, as always, appears to offer many attractively-priced options.
December 2014 – Two new companies are doing well in their respective areas. Premier, based in Dayton, offers excellent prices in Montgomery County and the nearby area. In many situations, they’re the lowest-cost option available. Also, Ambetter offers very low rates in Hamilton County and the greater Cincinnati area. Although the cheapest plans have higher deductibles, also available are Silver-tier plans for frugal shoppers that want a low price and a moderately-low deductible.
October 2015 – InHealth is a new company in Ohio for 2016 plans. Although not available in all counties, their prices (especially HSA contracts) are very attractive. Copay plan options also give Buckeye State residents another option for purchasing affordable comprehensive coverage.