Affordable Ohio Health Insurance Plans

(888) 513-6446

Compare and Save

By:

CareSource is a leading nonprofit health insurance company based in Dayton. Ohio medical plans provided include Marketplace coverage to persons under age 65, Medicare Advantage plans to Seniors, and Medicaid benefits to low-income households. Generally, prices are extremely competitive when compared to other carriers. Additional states where plans can be purchased include Indiana, Kentucky, Georgia, and West Virginia.

 

Under Age-65 Marketplace Plans

Individuals and families can apply for coverage regardless of household income. Although a federal subsidy is available, unsubsidized coverage is also offered. When purchased during Open Enrollment, or with and SEP (Special Enrollment Period) exemption, pre-existing conditions are covered.

The Ohio service area consists of the following counties: Adams, Ashland, Ashtabula, Belmont, Brown, Butler, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Defiance, Delaware, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Henry, Highland, Jackson, Jefferson, Lake, Lawrence, Licking, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Paulding, Perry, Pickaway, Pike, Portage, Preble, Ross, Sandusky, Scioto, Stark, Summit, Trumbull, Union, Vinton, Warren, Washington, Wayne, and Wood. 

The network of physicians, specialists, hospitals, and other medical facilities is very extensive. The online provider link allows consumers to locate in-network options that can reduce out-of-pocket costs.

 

Bronze

CareSource Marketplace Bronze -  $7,400 deductible with $7,900 maximum out-of-pocket expenses and 40% coinsurance. Pcp office visits are subject to a $35 copay, but specialist visits must meet deductible and coinsurance. Generic drugs subject to $30 copay ($75 for 90-day mail-order).

CareSource Marketplace Bronze Dental And Vision -  Similar to previous plan with basic dental and vision benefits included.

CareSource Marketplace HSA Bronze -  HSA-eligible plan with $5,200 deductible and $6,650 maximum out-of-pocket expenses and 50% coinsurance.

 

Silver

CareSource Marketplace Low Premium Silver -  $6,400 deductible with $7,900 maximum out-of-pocket expenses and 15% coinsurance. $25 and $50 office visit copays with $75 Urgent Care copay. Generic drugs subject to $20 copay ($50 for 90-day mail-order). Preferred brand drugs are subject to $50 copay ($125 for 90-day mail-order).

CareSource Marketplace Low Premium Silver Dental And Vision -  Similar to previous plan with basic dental and vision benefits included.

CareSource Marketplace Standard Silver -  $5,700 deductible with $7,700 maximum out-of-pocket expenses and 20% coinsurance. $15 and $40 office visit copays with $75 Urgent Care copay. Generic drugs subject to $15 copay ($37.50 for 90-day mail-order). Preferred brand drugs are subject to $45 copay ($112.50 for 90-day mail-order). Non-preferred brand and Specialty drugs are subject to deductible and coinsurance. 

CareSource Marketplace Standard Silver Dental And Vision - Similar to previous plan with basic dental and vision benefits included.

CareSource Marketplace Low Deductible Silver Silver -  $4,400 deductible with $7,500 maximum out-of-pocket expenses and 20% coinsurance. $10 and $60 office visit copays with $75 Urgent Care copay. Generic drugs subject to $10 copay ($25 for 90-day mail-order). Preferred brand drugs are subject to $60 copay ($150 for 90-day mail-order). Non-preferred brand and Specialty drugs are subject to deductible and coinsurance. 

CareSource Marketplace Low Deductible Silver Silver -   Similar to previous plan with basic dental and vision benefits included.  

 

 

 

Gold

CareSource Marketplace Gold -  $2,000 deductible with $6,500 maximum out-of-pocket expenses and 20% coinsurance. $0 and $35 office visit copays with $75 Urgent Care copay. Generic drugs subject to $10 copay ($25 for 90-day mail-order). Preferred brand drugs are subject to $50 copay ($125 for 90-day mail-order). Non-preferred brand drugs are subject to $200 copay ($500 for 90-day mail-order).

CareSource Marketplace Gold Dental And Vision -  Similar to previous plan with basic dental and vision benefits included. 

 

Shop Ohio CareSource plans in Ohio and compare prices and benefits. Easily enroll online and get covered now.

 

Current CareSource Ohio Health Insurance Monthly Rates

 

Age 28 With $21,000 Income In Hamilton County (Cincinnati)

$81 - Bronze

$100 - Bronze Dental And Vision

$100 - HSA Bronze

$196 - Low Premium Silver

$215 - Low Premium Silver Dental And Vision

 

Age 45 With $27,000 Income In Hamilton County (Cincinnati)

$151 - Bronze

$176 - Bronze Dental And Vision

$176 - HSA Bronze

$304 - Low Premium Silver

$328 - Low Premium Silver Dental And Vision

 

Married Couple Ages 40 With Two Children And $55,000 Income In Hamilton County (Cincinnati)

$291 - Bronze

$361 - Bronze Dental And Vision

$362 - HSA Bronze

$723 - Low Premium Silver

$793 - Low Premium Silver Dental And Vision

 

Age 30 With $21,000 Income In Montgomery County (Dayton)

$81 - Bronze

$100 - Bronze Dental And Vision

$100 - HSA Bronze

$200 - Low Premium Silver

$220 - Low Premium Silver Dental And Vision

 

Age 45 With $32,000 Income In Montgomery County (Dayton)

$220 - Bronze

$244 - Bronze Dental And Vision

$245 - HSA Bronze

$372 - Low Premium Silver

$397 - Low Premium Silver Dental And Vision

 

Married Couple Ages 45 With Two Children And $55,000 Income In Montgomery County (Dayton)

$286 - Bronze

$365 - Bronze Dental And Vision

$366 - HSA Bronze

$772 - Low Premium Silver

$851 - Low Premium Silver Dental And Vision

 

Age 25 With $21,000 Income In Franklin County (Columbus)

$6 - Bronze

$21 - Bronze Dental And Vision

$26 - HSA Bronze

$77 - Low Premium Silver

$92 - Silver

 

Age 45 With $32,000 Income In Franklin County (Columbus)

$107 - Bronze

$128 - Bronze Dental And Vision

$136 - HSA Bronze

$209 - Low Premium Silver

$230 - Silver

 

Married Couple Ages 40 With Two Children And $55,000 Income In Franklin County (Columbus)

$7 - Bronze

$60 - Bronze Dental And Vision

$69 - HSA Bronze

$275 - Low Premium Silver

$335 - Silver

 

Age 25 With $21,000 Income In Cuyahoga County (Cleveland)

$32 - Bronze

$45 - Bronze Dental And Vision

$49 - HSA Bronze

$91 - Low Premium Silver

$104 - Silver

 

Age 45 With $32,000 Income In Cuyahoga County (Cleveland)

$145 - Bronze

$163 - Bronze Dental And Vision

$169 - HSA Bronze

$230 - Low Premium Silver

$247 - Silver

 

Married Couple Ages 40 With Two Children And $55,000 Income In Cuyahoga County (Cleveland)

$94 - Bronze

$144 - Bronze Dental And Vision

$162 - HSA Bronze

$334 - Low Premium Silver

$383 - Silver

 

Compare Senior Health Insurance Plans From CareSource Ohio. Medicare Advantage coverage provides many benefits.

 

Medicare Advantage Plans

 

CareSource Medicare Advantage (Part C) plans provide Seniors with affordable medical benefits, and an alternative to the combination of Original Medicare and/or supplement coverage. Premiums are typically less than conventional coverage and several additional benefits are included. All applicants must be eligible for Medicare Part A, and have enrolled in Part B. If you reach your maximum out-of-pocket limit, hospital benefits will continue to be paid for the remainder of the calendar year.

Three Ohio plans are available in the following counties (service area): Brown, Butler, Champaign, Clark, Clermont, Clinton, Cuyahoga, Delaware, Fairfield, Fayette, Franklin, Geauga, Greene, Hamilton, Lake, Lorain, Lucas, Madison, Mahoning, Medina, Montgomery, Portage, Summit, Trumbull, Warren, and Wood. A complete list of benefits and services is provided with the EOC (Evidence Of Coverage).

 

CareSource Advantage Zero Premium (HMO) - $0 monthly premium, $0 deductible, and $6,700 maximum out-of-pocket expenses. Inpatient hospital care copay is $350 for days 1-5, and $0 days 6-90. Outpatient hospital expenses are subject to 20% coinsurance, and the ambulatory surgical center copay is $250. Office visit copays are $9 (pcp), $50 (specialist) and $45 (Urgent Care). ER visits are subject to a $90 copay, which is waived, if admitted.

Diagnostic radiology services (MRIs and CT scans) are subject to a $175 copay, and diagnostic tests and procedures are subject to a $175 copay. Lab services are subject to a $30 copay and outpatient x-rays are subject to a $50 copay. Therapeutic radiology services are subject to 20% coinsurance.

Hearing services include a $50 copay for diagnosis and treatment, and a $0 copay for an annual routine hearing exam. The hearing aid copay is $699-$999 per hearing aid twice per year. Three provider visits are included during the first 12 months when buying a hearing aid, along with a 45-day trial period. Basic dental services are subject to a $50 copay (replacement and removal of teeth not covered). Comprehensive benefits not included. Preventative services include a $0 copay of cleanings, x-rays, and oral exams (every six months).

Vision services include $0 copay for annual routine exam, contact lenses, and eyeglass frames.  A $50 copay applies to eye exams that diagnose conditions and diseases. Eyeglass lenses receive a $25 copay. A $100 allowance is provided for contact lenses and eyeglass frames.

The inpatient mental health care copay is $320 for days 1-5, and $0 for days 6-90. Outpatient and inpatient group therapy are subject to a $40 copay. The skilled nursing facility copay is $0 days 1-20, and $172 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, and speech/language therapy) are subject to 20% coinsurance. The ambulance copay is $225.

Foot care is covered with a $50 copay. Durable medical equipment, and prosthetic devices are subject to 20% coinsurance. Diabetes supplies and services are subject to a $0 copay, although acupuncture is not covered. Chiropractic Care is subject to 20% coinsurance, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $40 copay. Renal dialysis is covered with 20% coinsurance.

Prescription drug 1-month and 3-month copays are: Tier 1 ($6 and $18), Tier 2 ($15 and $45), Tier 3 ($47 and $141), Tier 4 ($100 and $300) and Tier 5 (28% of 1-month supply and not covered). The 90-day mail order copays are Tier 1 ($0), Tier 2 ($37.50), Tier 3 ($117.50), Tier 4 ($250) and Tier 5 (na).

Additional benefits include free memberships at participating fitness centers and home fitness kits provided at no cost. A 24-hour nurse advice line is also available.

 

CareSource Advantage (HMO) - $32.90 monthly premium, $0 deductible, and $4,600 maximum out-of-pocket expenses. Inpatient hospital care copay is $285 for days 1-7, and $0 days 8-90. Outpatient hospital expenses are subject to a $295 copay, and the ambulatory surgical center copay is $250. Office visit copays are $0 (pcp), $49 (specialist) and $35 (Urgent Care). ER visits are subject to an $90 copay, which is waived, if admitted.

Diagnostic radiology services (MRIs and CT scans) are subject to a $150 copay, and tests, procedures, and lab services are subject to a $0 copay. Outpatient x-rays are subject to a $25 copay, and therapeutic radiology services are subject to 20% coinsurance.

Hearing services include a $45 copay for diagnosis and treatment, and a $0 copay for an annual routine hearing exam. The hearing aid copay is $499-$799 per hearing aid twice per year. Three provider visits are included during the first 12 months when buying a hearing aid, along with a 45-day trial period. Basic dental services are subject to a $50 copay (replacement and removal of teeth not covered). Comprehensive benefits are subject to a $1,000 annual limit and 30% (simple extractions and minor restorations) or 50% coinsurance. Preventative services include a $0 copay of cleanings, x-rays, and oral exams.

Vision services include $0 copay for annual routine exam, contact lenses, and eyeglass frames. Eyeglass lenses receive a $25 copay. A $130 allowance is provided for contact lenses and eyeglass frames.

The inpatient mental health care copay is $230 for days 1-7, and $0 for days 8-90. Outpatient and inpatient group therapy are subject to a $40 copay. The skilled nursing facility copay is $0 days 1-20, and $172 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, and speech/language therapy) are subject to $10-$40 copays. The ambulance copay is $225.

Foot care is covered with a $50 copay. Durable medical equipment, and prosthetic devices are subject to 20% coinsurance. Diabetes supplies and services are subject to a $0 copay, although acupuncture is not covered. Chiropractic Care is subject to 20% coinsurance, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $40 copay.

Prescription drug 1-month and 3-month copays are: Tier 1 ($4 and $12), Tier 2 ($10 and $30), Tier 3 ($47 and $141), Tier 4 ($100 and $300) and Tier 5 (33% of 1-month supply and not covered). The 90-day mail order copays are Tier 1 ($10), Tier 2 ($25), Tier 3 ($117.50), Tier 4 ($250) and Tier 5 (na).

Additional benefits include free memberships at participating fitness centers and home fitness kits provided at no cost. A 24-hour nurse advice line is also available.

 

CareSource Advantage Plus (HMO) - $67 monthly premium, $0 deductible, and $4,600 maximum out-of-pocket expenses. Inpatient hospital care copay is $225 for days 1-7, and $0 days 8-90. Outpatient hospital expenses are subject to a $225 copay, and the ambulatory surgical center copay is $100. Office visit copays are $0 (pcp), $30 (specialist) and $25 (Urgent Care). ER visits are subject to an $90 copay, which is waived, if admitted.

Diagnostic radiology services (MRIs and CT scans) are subject to a $100 copay, and tests, procedures, and lab services are subject to a $0 copay. Outpatient x-rays are subject to a $25 copay, and therapeutic radiology services are subject to 20% coinsurance.

Hearing services include a $45 copay for diagnosis and treatment, and a $0 copay for an annual routine hearing exam. The hearing aid copay is $199-$499 per hearing aid twice per year. Three provider visits are included during the first 12 months when buying a hearing aid, along with a 45-day trial period. Basic dental services are subject to a $30 copay (replacement and removal of teeth not covered). Comprehensive benefits are subject to a $1,000 annual limit and 50% coinsurance. Preventative services include a $10 copay of cleanings, x-rays, and oral exams.

Vision services include $0 copay for annual routine exam, contact lenses, and eyeglass frames. Eyeglass lenses receive a $30 copay. A $150 allowance is provided for contact lenses and eyeglass frames.

The inpatient mental health care copay is $225 for days 1-7, and $0 for days 8-90. Outpatient and inpatient group therapy are subject to a $30 copay. The skilled nursing facility copay is $0 days 1-20, and $172 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, and speech/language therapy) are subject to $0-$30 copays. The ambulance copay is $225.

Foot care is covered with a $30 copay. Durable medical equipment, and prosthetic devices are subject to 20% coinsurance. Diabetes supplies and services are subject to a $0 copay, although acupuncture is not covered. Chiropractic Care is subject to 20% coinsurance, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $30 copay.

Prescription drug 1-month and 3-month copays are: Tier 1 ($0 and $0), Tier 2 ($10 and $30), Tier 3 ($47 and $141), Tier 4 ($100 and $300) and Tier 5 (33% of 1-month supply and not covered). The 90-day mail order copays are Tier 1 ($0), Tier 2 ($25), Tier 3 ($117.50), Tier 4 ($250) and Tier 5 (na).

Additional benefits include free memberships at participating fitness centers and home fitness kits provided at no cost. A 24-hour nurse advice line is also available. 

 

Note: Medicare Supplement Plans in Ohio from CareSource are not offered.

 

Low-cost health insurance in Ohio is available through Medicaid. You must qualify to receive benefits. Household income determines if coverage is offered. If not eligible, a Marketplace plan may be an affordable option.

 

Medicaid Benefits

Medicaid managed-care coverage provides medical services to Buckeye State residents that are eligible for Aged, Blind, or Disabled, and Healthy Families, and Healthy Start. All of Ohio is available for coverage. There are no copays for prescription drugs or office visits. Generally, services covered by Medicaid are offered with no out-of-pocket cost. Other features include:

24-hour service that allows you to talk to registered nurses

Network of physicians, specialists, hospitals, and pharmacies

Personalized person-to-person care

Dental care

Vision care

Transport assistance to physician visits

International coverage

 

Other Medicaid Benefits

Eyeglass Frames -  Plastic and wire frames are available, including several Medicare-provided options.

Rides And Transportation -  CareSource pays for your transportation expenses for visits to physicians and specialists. Appointments at the County Department of Job and Family Services are also covered.

Benefits that are not included or covered include: treatment of obesity, unless medically necessary, plastic and cosmetic surgery, unnecessary medical procedures, abortions, infertility treatment, experimental procedures and services, counseling for marriage or sexual issues, acupunture, paternity testing, and prescription drugs not covered by Ohio Medicaid pharmacy program.

CareSource also manages the Ohio Home Care Waiver Program in Ohio. The program allows members in central, southeast, and northeast Ohio to be treated in their homes, or locally in their community. Case managers help arrange services for persons that qualified for a waiver.

 

Dual Demonstration (Eligible For Medicare And Medicaid)

MyCare Ohio from CareSource provides and combines coverage from Medicare and Medicaid to qualified applicants. Long-term and short-term services are included, along with physical and mental benefits. Persons over age 18 can have their long-term care and physical services managed by professionals that effectively coordinate services. Often, chronic conditions need to be treated.

Additional resources provided to patients include skilled nursing facility information, long-term care information, a portal user guide, and easier claim submission. If you disagree with a claim determination, you may appeal the decision and file a complaint. A "Members Handbook" is included to help provide information about the process. A complete listing of covered drugs is also available, with more than 60,000 pharmacies providing service.

 

Community Transition Program

CTP helps Ohio residents who are recovering at home. Addiction Services and the Ohio Department of Mental Health work together to provide support, and recovery assistance. Treatment and recovery services include crisis intervention, housing support, relapse prevention, spiritual assistance, substance use and abuse disorder, ambulatory detoxification, transportation, life skills, peer recovery help, employment assistance, outpatient individual and group services, and prescription drug assisted treatment.

Eligible applicants should contact the Ohio Department of Mental Health and Addiction Services or the Community Mental Health Center. The Case Manager, once assigned, can assist in the recovery process.

Also available in most parts of the state is the "Home Care Waiver" program. This unique service helps patients receive treatment in their homes and/or remain close to their community. Case Managers coordinate services and help arrange the needed waivers. Reimbursement, claims, and billing are handled by carriers and the State of Ohio.