Humana individual health insurance plans in Ohio are available at attractive prices. Both on and off-Marketplace coverage can be applied for during Open Enrollment. Once the OE period ends, coverage can be purchased by qualifying for one of several SEP (Special Enrollment Period) exemptions. You can view free quotes on our website, compare multiple plans and apply for benefits in less than 15 minutes.
Senior Medigap (Supplement and Advantage) contracts are offered to persons that have reached age 65 and are Medicare-eligible. Since MedSup plans are standardized (no difference in benefits from one carrier to another), the specific plan will have to be available in the County where you reside.
Under age-65 Exchange coverage is offered in the following Counties: Miami, Preble, Montgomery, Greene, Butler, Warren, and Hamilton. Medicare Supplement, Medicare Advantage, dental, and vision benefits are available in additional areas. Plans can be purchased on an individual or group basis.
On And Off-Exchange Plans Available
All on and off-Exchange policies cover qualified preventive benefits at 100%. There are no copays or deductibles to meet. Another cost-saving feature is the network-negotiated price reductions you receive when utilizing in-network facilities. Whether it's a small or large claim, savings can be as much as 80%. Although inpatient and outpatient hospital expenses are heavily discounted, smaller items also receive reductions, including x-rays, blood tests, and Urgent Care visits.
A total of 10 plans are offered. Several HMO plans are available both on and off the Marketplace. Additional PPO options are offered only off the Exchange. Coverage is transferable to other states if you move and are eligible for a "Special Enrollment" exclusion. Prices, however, will vary, depending on the area of service.
Important News: Aetna purchased Humana (subject to regulatory approval) for more than $34 billion. Once the Justice Department's antitrust trial is concluded, and regulatory approval is completed, the merger should be completed by 2018. Much of the revenue from the new company will come from Medicare and Medicaid-related products.
Available Plans For Individuals And Families
Humana HMO plans are offered as Exchange contracts and are therefore available for federal subsidies. A local network of physicians, specialists and hospitals is available and should be used to secure the lowest costs. Drugs are administered through the "Select RX" network, which includes Walmart, CVS, Sams Club and RightSourceRX.com. During Open Enrollment in Ohio, many low-cost options are offered. The subsidy is offered in the form of an instant tax-credit and automatically reduces your premium. Comprehensive Gold-tier plans will provide lower out-of-pocket costs.
A Primary Care Physician (PCP) helps coordinate your treatment and recommends specific specialists that can provide the best medical care. Staying "in-network" reduces your healthcare expenses, since other than emergencies, out-of-network expenses are typically paid by the subscriber.
The three available networks for Ohio are:
Dayton HMOx - Anchored by Premier Health Partners. Covers Butler and Warren counties.
Dayton HMOx - Anchored by Premier Health Partners. Covers Greene, Montgomery, Preble and Miami counties.
Cincinnati/ Northern KY HMOx -Includes TriHealth and St. Elizabeth Healthcare (Children's, Good Samaritan, and Bethesda North Hospitals).
NOTE: Aetna's merger with Humana (should be completed and integrated by 2018) will change network availability for 2018 Marketplace plans. However, it is not expected to impact plans in 2017. Also, you can utilize our prescription and provider lookup link, that will easily find doctors, hospitals, and other facilities in your area.
Available HMO Plans
Basic 7150 is the "catastrophic" tier contract. Thus, you must be under age 30 to apply for coverage unless you qualify for a "financial hardship" exemption. The deducible is $7,150 with no coinsurance. Therefore, once the deductible has been met, all covered expenses are paid without any additional out-of-pocket costs. Three office visits are allowed each year (primary care physician) with only a $15 copay applicable. And yes, the person pictured below will only pay $15 when she visits her physician! NOTE: Behavioral, mental, and substance abuse outpatient service visits also receive the $15 copay.
Non-emergency ER visits are not covered. Examples would be seeking treatment for a common cold or flu, when a pcp or urgent-care visit would be more suitable. All covered drugs are paid at 100% after the deductible has been met. Children 19 and younger can receive one vision exam and a pair of glasses each year, after the deductible has been met.
Bronze 6550 is the cheapest non-catastrophic plan offered and is thus available to all ages. The deductible is $6,550 with 0% coinsurance. Thus, once the deductible is met, all covered claims are paid at 100% with no out-of-pocket expenses. Negotiated discounts will help reduce out-of-pocket expenses for many common procedures.
Silver 4150 features a $4,150 deductible with office visit copays of $20 and $40. The maximum out-of-pocket expenses are $7,150 with 20% coinsurance. Since Silver-tier plans are eligible for "cost-sharing," if you qualify for a subsidy, this option must be strongly considered. Generic and brand drugs are subject to $18 and $50 copays. Non-preferred brand and specialty drugs are subject to 50% coinsurance. ER visits must meet a $600 copay along with the deductible. Out-of-network treatment does not count towards your deductible.
Gold 1400 - $1,400 deductible with $20 and $40 office visit copays. Maximum out-of-pocket expenses are $6,000 with 20% coinsurance. Tier 1, 2, and 3 drugs receive $5, $10, and $20 copays respectively. Tier 4 and 5 drugs are subject to 35% coinsurance.
There are no Platinum-tier plans offered by Humana in Ohio.
PPO plans utilize the ChoiceCare network, which is the largest collection of providers that Humana offers. With more than 600,000 doctors and practitioners, almost 4,000 hospitals and 60,000 pharmacies, you won't have trouble finding treatment anywhere in the state. Out-of-network benefits are provided, but you will incur a much higher cost.
However, PPO contracts are only available "Off The Marketplace," so federal subsidies can not be used with these plans.
Humana Senior Health Insurance Plans In Ohio
Annual enrollment (AEP) occurs between October 15th and December 7th each year. Your effective date of changes or new policies you purchase is January 1st. You can change from one Medicare Advantage or dug prescription plan to another, and also return to conventional Medicare coverage and purchase a Supplement (Medigap) policy. NOTE: From January 1 to February 15th, you can return to original benefits provided by the Federal Government (MA Disenrollment Period).
Typically, about 15 or 16 plans are available in areas of the Buckeye State. Medicare Supplement (Medigap), Medicare Advantage, and Drug Prescription policies are offered to eligible applicants. Generally, you must be age 65 or over, unless you have a qualified exception.
Medicare Supplement - Available plans include Plan A, Plan B, Plan C, Plan F, Plan F (High Deductible), Plan K, Plan L, and Plan N. Plans K and L pay the Part A deductible, but because of higher-out-of-pocket costs, premiums are often the lowest of all available options. However, there is a maximum cap on your total expenses for the year. Plan N also features lower rates.
Medicare Advantage - Available plans include Gold Plus HMO, HumanaChoice PPO (with or without prescriptions), and Gold Choice PFFS. The Gold Choice option allows you to use any provider that accepts the terms and conditions of reimbursement. Advantage plans are very popular Senior options because of their low cost (sometimes the premium is $0) and extra benefits, such as dental, vision, and hearing.
One of the most popular and highest-rated (US News & World Report) Medicare Advantage plans in the state are the Humana Gold Plus plans that also include drug prescription benefits. $0 premium contracts are available in many counties, including Butler, Carrol, Clark, Clermont, Delaware, Fairfield, Franklin, Hamilton, Licking, Mahoning, Portage, Stark, Summit, Trumbull, Warren, and Wayne.
The deductible ranges from $100 to $360 (depending where you live), and the maximum out-of-pocket expenses range from $3,900 to $6,700. in-hospital expenses range from $295-$350 for 1-6 days. Generally, the office visit copays are $10 and $45. RX benefits will vary, but typically, Tier 1 and Tier 2 drugs (Preferred Generic and Generic) are 100% covered when 90-day mail-order cost sharing is used.
The Choice PPO and Gold Plus HMO plans include the following additional benefits:
Routine hearing coverage
Over-the-counter drugs and related supplies
Fitness program with helpful supervision
Prescription Drug Plans
WalMart RX Plan - For WalMart and Sam's Club - $1 copay for preferred generic drugs and $4 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have 20%, 35%, and 25% coinsurance respectively. For other network pharmacies - $10 copay for preferred generic drugs and $15-$20 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have 25%, 44%-50%, and 25% coinsurance respectively.
Preferred Rx Plan - For WalMart and Sam's Club - $0 copay for preferred generic drugs and $1 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have 20%, 35%, and 25% coinsurance respectively. For other network pharmacies - $0 copay for preferred generic drugs and $1 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have 20%, 35%, and 20% coinsurance respectively.
Enhanced Rx Plan - For WalMart and Sam's Club - $3 copay for preferred generic drugs and $7 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have $42 copay, 44%, and 33% coinsurance respectively. For other network pharmacies - $3 copay for preferred generic drugs and $7 copay for generic drugs. Tier 3, Tier 4, and Tier 5 drugs have $42 copay, 44%, and 33% coinsurance respectively.
Areas Of Ohio That Feature Lowest Rates
Each individual and family scenario is different, especially considering that subsidy amounts will greatly differ. But typically, the areas in the state that feature the lowest rates for PPO policies are listed below. NOTE: One reason that Cincinnati is high on the list is the presence of the College of Medicine and Academic Health Center (pictured above) and its contribution to the community. The combination of education, research and patient care contributes to keeping treatment prices down.
Six Available Dental Plans (Monthly Premiums Shown Per Individual)
$15 Value - HMO plan with no deductible or policy maximum. $10-$15 office visit copay. Small discount for orthodontia if you utilize specific providers.
$21 Preventive Plus - $50 and $150 deductibles per person/family. $1,000 annual maximum coverage per year. However, benefits offered in and out of network. 100% coverage for preventive services.
$22 Smart Choice - $100 deductible and $1,000 maximum per year benefits. 100% preventive coverage with outside network coverage.
$31 Smart Choice Pediatric - $35 annual deductible with no maximum benefit.
$34 Loyalty Plus - $150 per person deductible (maximum $450 per family). Annual maximum increases from $1,000 to $1,500 after two years. Both basic and major service coverage also increase after the first two years.
$37 Traditional Plus - $50 deductible and $1,000 annual benefit maximum. Preventive services covered at 100% (in-network), non-network coverage is included.
Humana Vision Plan In Ohio
Coverage is available "off-Marketplace" in most parts of the state. Dilation-needed exams are covered with only a $10 copay. Single vision, bifocal and trifocal lenses are covered with only a $25 copay. Contact lenses are allocated $115 per year (both conventional and disposable).
An examination, and purchase of lenses or contact lenses (and a frame) are covered once per year. Possible discounts may lower the price for scratch-resistant and anti-reflective coatings. Lasik procedures done at LasikPlus, TLC and QualSight Lasik will receive discounted prices.
The HumanaOne Vision Care plan is also accepted at many major participating providers including LensCrafters, Sears, JCPenney, Target and Pearle Vision. Also, more than 30,000 ophthalmologists and optometrists accept Humana vision insurance.
Group Benefits Through Employer
Large and small group coverage is offered to Ohio groups. Unlike private healthcare plans, options are available in most areas of the state, with a wide variety of deductible and out-of-pocket expense options. Flexible billing arrangements can be made and broad nationwide networks allow customers to choose among many facilities. Listed below are the most popular employer-sponsored benefits:
Health - Humana Simplicity shows costs upfront and makes budgeting much easier. "Total Health" provides options for companies with 100 or more employees. Level funded premiums (10 or more employees) is designed for catastrophic coverage. Coinsurance, copay, and high-deductible (HDHP) options are also offered.
Dental - 100% preventative benefits are included with optional orthodontic coverage. Advantage Plus, Prepaid/DHMO, Dental PPO, Preventative Plus, and Traditional Preferred plans are offered.
Vision - Rates are typically inexpensive, and not as costly as dental coverage. Vision Exam Plus (annual eye exam included) and Materials Only (lenses, frames, and contact lenses) plans are available.
Disability - Conventional and alternative treatment is available.
Life - Group term life insurance provides small and large face amounts of tax-free benefits to beneficiaries of employees. Term contracts are the least expensive policy and are ideal if you need large amounts of coverage for the least cost. Basic coverage is provided as a multiple of your annual compensation, with up to $10,000 of additional benefits available for your spouse. Supplemental coverage is offered in addition to the Basic amount, and is generally paid by the employee.
Group Medicare - Retired employees may be able to consider a Medicare Advantage plan, which often provides more comprehensive benefits than original Medicare. The insurer administers the plan instead of the federal government. Prescription plans are also offered with mail-delivery pharmacy available (see below).
Pharmacy - Plans can be set up to provide separate coverage or work with existing in-force prescription drug benefits. Both small and large companies are eligible, and specialty medications can also be ordered. Printable drug lists are regularly updated. Thousands of pharmacies are available, including several mail-order options. Printable drug lists are provided to help consumers understand choices, and coordinate prescriptions with the primary-care physician.
Wellness - Healthy employees are more productive, and several programs are offered to improve workplace culture and satisfy needs of workers. Personal health coaching (smoking cessation and weight loss) and employee assistance programs (EAP) can provide a positive rate-of-return for both employee and worker. "Go365" is designed to reduce medical claims and has been very effective. Additional programs include holistic well-being, Goal-Guru, Kurbo, Weight Watchers, flu vaccinations, and Biometrics screenings.
Additional online services are provided to all customers. These free services include access to claim information, online bill-paying, prescription search, and help with enrollment.
Get Quotes Now
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