Find affordable health insurance for children in Ohio with the help of CHIP, The Affordable Care Act legislation, or Medicaid. Many low-cost plans are available that provide complete preventative benefits with no deductible, copay, or out-of-pocket expenses. We research and compare all major companies to find the best low-cost options that provide the most comprehensive coverage. Benefits for specialists, therapy, mental illness, dental, and vision are also available.
There are many reasons why you may need to purchase or enroll for benefits for a baby, teenager, or young adult. Often, an employer-sponsored medical plan will cover the employee at little or no cost. But sometimes, dependent coverage is quite expensive, and a “child only” plan will provide richer benefits at a fraction of the cost of group policies. If the Open Enrollment deadline is missed, a non-ACA plan may be the only option, depending upon household income. Coverage can be quickly obtained, and a next-day effective date is generally available.
Ohio Healthy Start (Federally Children’s Health Insurance Program)
More than three million person have enrolled in the program in the last eight years, and 165,000 providers are available. For ages 0-18, 206% of the MAGI (modified adjusted gross income) is the eligibility level. For pregnant women, the level is 200%. The participating managed care organizations are Buckeye Health Plan, CareSource, Molina, Paramount, and UnitedHealthcare. You can easily review plan differences and provider networks.
Qualifications for Medicaid/Ohio Healthy Start include: US citizenship (or meet Medicaid non-citizen requirements), low-income, children, infants, older adults, disabled, and pregnant women. To be eligible for benefits, applicants must have a social security number, reside in Ohio, and meet specific financial requirements.
CHIP is ideal for applicants that earn too much money to qualify for Medicaid. It’s important to provide coverage to younger persons as they develop. Annual physicals, immunizations, prescriptions, dental and vision, lab tests, x-rays, ER visits, and vaccinations will be covered. Applications are accepted at any time, and not subject to Open Enrollment deadlines. If approved, benefits can begin immediately, with no waiting period for pre-existing conditions. Adopted children can also obtain benefits.
Healthy Start is Ohio’s Medicaid and CHIP program for children (to age 19) that reside in households with income up to 156% of the FPL. Uncovered children are eligible in households with income up to 206% of the FPL. Applicants must be a legal US citizen and have a social security number. Non-US citizens may be eligible for benefits through “Refugee Medical Assistance.” Also, the “Children’s Immunization Initiative” provides free immunization events for children receiving Medicaid benefits.
Apply For Benefits
Applying for coverage is fairly easy. Proof of pregnancy, citizenship, income, and other health insurance is required. A personal visit to a Healthy Start office is not required. Applications are available at job and family services offices. A Combined Programs Application can be found online and completed. An online account can be easily created.
Annual 2024 household pre-tax income requirements are listed below:
One-Person – $29,160
Two-Person – $39,440
Three-Person – $49,720
Four-Person – $60,000
Five-Person – $70,280
Six-Person – $80,560
Seven-Person – $90,840
Eight-Person – $101,120
(Households with more than eight persons should add $10,280 per additional family member. The local managing agency can provide additional information)
The four types of coverage offered are traditional Medicaid, home and community-based services, family care, and Medicaid managed care. Traditional benefits provide a large network of physicians, specialists, hospitals, and medical facilities. Preventative and many other services are provided, including prescriptions, transportation, and hospital visits. There is no limit on the number of family members that can obtain coverage. When moving to another state, a new application may have to be submitted. An SEP may become available, which provides 60 days to enroll in a qualified plan with a federal subsidy available.
Additional benefits and programs offered include:
Agriculture and environmental sustainability
Disaster Relief
Family and children services
Training and education
Financial assistance
Grants
Nutrition And Food
Retirement and Social Security
Loans
Missed Open Enrollment?
If you missed the Open Enrollment deadline, temporary coverage may be needed. Although short-term plans lack many popular preventative benefits, they are a viable option to cover major medical expenses. Urgent Care visits are often covered with only a copay and many generic prescription drugs may also be covered with a small copay. However, maternity and delivery complications benefits are not included. Physical and mental therapy visits may be excluded or limited.
Also, with many group employer-sponsored plans, the child of the employee may no longer be covered if he/she is not a full-time student. There also may be other reasons, such as the status (full-time or part-time) of the employee. Many companies, to lower healthcare costs, have reduced the number of working hours of their employees, resulting in fewer and more expensive options.Working remotely has now become quite popular.
Although benefits may be offered, the cost may be expensive, and deductibles may be quite high. The average deductible for a 2024 Group plan is between $3,500 and $6,000. Often, many ER and outpatient procedures must meet the deductible before benefits are paid. Preventative benefits are always covered with no out-of-pocket expenses. Maternal, newborn, and child health coverage are included on all plans. Dental and vision benefits are typically offered, although a waiting period may need to be satisfied before major procedures are covered.
How Obamacare Affects Children’s Health Insurance In Ohio
The Affordable Care Act (ACA) legislation was designed to provide quality healthcare benefits to children and adults, without having to medically qualify or pass a physical. For lower-income families that don’t qualify for Medicaid, substantial financial relief helps pay most of the premium on all plans (Platinum, Gold, Silver, and Bronze-tiers). Depending on the county of residence and projected household income, it is not unusual to find several Bronze-tier plans with $0 premiums. Catastrophic plans should not be considered since subsidies are not offered.
You are able to get healthcare benefits for just your child. In most areas of the state, a policy will cost between $40 and $100 per month (stand-alone or added to existing adult plan). Several insurers offer a small discount when more than one child is insured. Coverage can vary with each plan, so it is important to understand the features that are important to you, so we can select the perfect fit. Most plans utilize HMO networks, so out-of-area providers may be limited. EPO (Exclusive Provider Organization) plans are also offered in several areas. However, EPO network coverage is more restrictive with lower reimbursement of out-of-network treatment.
No-Prior Coverage Penalty Eliminated
The rate for uninsured children is no longer higher than those that have prior coverage. Previously, if the applicant was not listed on another policy, a surcharge or reduction in benefits could apply. Also, a waiting period for specific benefits was sometimes imposed. However, during Open Enrollment periods, prior coverage is now no longer a requirement for obtaining a policy. If you miss the OE deadline (which can change each year), you need a special SEP exception to change companies.
Non-ACA options, however, are typically available at any time and without an SEP exception. Short-term plans offer immediate coverage although pre-existing conditions are not covered and maximum durations are limited.
Medical Mutual, Anthem Blue Cross, Oscar (in selected counties), Ambetter, Paramount, CareSource, Molina, and SummaCare are very reliable carriers to consider. Office visit copays are available for primary care physician (pcp) visits, and specialists, although specific amounts will vary. Specialist copays are lower on Silver-tier and Gold-tier plans than Bronze-tier options.
Urgent Care copays can vary and are typically between $40 and $100. Many policies do not require a deductible to be met for Urgent Care visits. Telemed office visit coverage provides an effective online tool that often eliminates waiting times and travel.
ER visits are generally subject to a deductible. However, if admitted to a hospital, the deductible may be waived. Out-of-pocket expenses for emergency room visits may also be subject to coinsurance and a separate facility fee. Online virtual office visits have continued to increase in popularity, and are offered by all Exchange carriers. Non-emergency situations can often be handled by a virtual face-to-face visit.
Required Coverage For Infants And Children
“Essential Health Benefits” must be included in all policies. This requirement was one of the principal mandates from the original Affordable Care Act legislation. It provides features such as newborn care, mental health, many pediatric services, some dental and vision coverage, and prescriptions. Many of these items, including preventive services, often have no copay or deductible to meet. Special pandemics (COVID) result in insurers offering testing and some treatment at 100% coverage. Vaccinations are often provided at discounted or no cost.
Covered immunizations (birth to age 18) are provided for diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenza (Type B), hepatitis A, hepatitis B, human papillomavirus (HPV), inactivated polio virus, influenza, measles, meningococcal, pneumococcal, rotavirus, and varicella (chicken pox).
It is customary for a copay to apply for office visits and drugs, without having to meet a deductible. Preventive and well child benefits are always included with no deductible. Immunization and vaccine coverage are generally provided on most policies. If a physical is required for playing sports, typically, you will not have to pay for services, since it is covered at 100%. Complications or additional medical services that may be needed could be subject to copays or deductibles.
Although most child prescriptions are generic, and cost less than $10, non-generic prescription coverage will be included on the policy. Comprehensive policies no longer place a cap on the amount of prescription dollars paid by the plan. Thus, if your child has a chronic illness that requires many brand-name prescriptions, they will be covered. Utilizing a 90-day mail order option will also reduce out-of-pocket expenses.
However, the distinction between “formulary” and “non-formulary” prescriptions must be understood, so you are using the drugs that work best, but are also covered under your policy. Each carrier offers a specific comprehensive guide that explains how they classify drugs. Typically, there are four “tiers.” Both generic and brand drugs are included on the list, and a combination of physicians and pharmacists create the formulary. Specialty drugs are extremely expensive but rarely needed.
This is important if major health condition develops, and the only treatment is an ultra-expensive non-formulary medication. However, a temporary policy will place specific restrictions on RX benefits since pre-existing conditions are not covered. Chronic illnesses may not fully cover all treatment, and renewal of the policy will likely not be possible.
Review
We research all of your options and present you with the most affordable comprehensive Ohio child health insurance plan at the guaranteed lowest allowable rate. For a quick quote and comparison, you can easily compare different plans on our website. Whether you have a young adult in college or an infant, we can help.
Helpful Resources:
Healthy Start is Ohio’s federally-mandated SCHIP program. Healthy Start is part of Medicaid and is available to children under 19 whose families meet Federal poverty level guidelines.
Healthchek is Ohio’s early and periodic screening, diagnosis and treatment (EPSDT) program. It provides many services to children and teens.
Child & Family Health Services is the community effort to improve birth outcomes, eliminate health disparities, and improve the health status of infants, children and women in Ohio.
