The Ohio Health Insurance Exchange, created by the Affordable Care Act (ACA), offers affordable medical plans for you and your family. You can compare the best rates and quotes on our website, and read current information about federal subsidies and how they can lower your premium. You can also apply for Marketplace coverage online and pay no fees or commissions. Single, family and small-businesses will be able to enroll and purchase a policy.
Setting up an Exchange by 2014 was very expensive. So Ohio, like many states, allowed the Federal government to take care of the setup and implementation. Since it saved about $40 million, it made economical sense to let someone else pay the expenses. And that doesn't include the staggering $350 million that the new health care law will cost the state.
With the re-election of President Obama, there may be additional changes in future years. Ultimately, we believe the US Department of Health And Human Resources will be heavily involved in our state. Governor John Kasisch has indicated that there will be a "partnership" arrangement that allows the state to maintain some control over some of the management and consumer relations functions.
How Does It Impact Us?
So what does this mean for you? Until 2014, there will be no changes to the way you purchase your coverage. This website is still the best resource to buy a policy. However, after that date, it becomes the law of the land that you must buy health insurance. This is called "the mandate," which the Supreme Court upheld in June of 2012. Although your age and zip code will still impact your rate, smoking status will no longer make as large of a difference.
The tax is $95 per adult (and $47.50 per child) or 1% of income (whichever is larger). However, by 2016 the penalties will increase this tax to $695 per individual (and $347.50 per child) or 2.5% of income. Thus, if the household income is $100,000, there is a $2,500 tax for not purchasing a policy. After 2016, these amounts increase every year.
You will have to pay these taxes when you file your return the following year. What happens if you don't pay the extra tax? That seems to be unknown. The IRS is actively hiring thousands of extra agents to help enforce the law. But how it is enforced is still being fine-tuned. Currently, there are not enough agents (IRS, not insurance!) to properly monitor activity. However, we assume that in 2015, more agents and field investigators will be hired.
What About The Federal Subsidy?
Depending on your individual or household income, tax credits could lower your premium. Typically, if you have a family of four persons and you make less than $94,000, you will receive some help. If your household income is less than $29,000 (family of four), Medicaid will provide benefits at virtually no cost.
This situation has been debated by members of Congress and no bipartisan resolution has been enacted yet. Each state is able to adjust its own Medicaid eligibility requirements. So it is possible that if you move from one area of the country to another, your benefits could change.
The credit will go to households who can document their income is between 100% and 400% of the "Federal Poverty Level." Older persons will receive higher credits. Naturally, if you are on Medicare or Medicaid, you will not receive the credit.
For example, a family of four with a $51,000 income will pay about $300 per month (including the credit) for their "silver" coverage. This does not include deductibles, copays or coinsurance. This publication provides specific details.The graphic below also shows you the specific FPL levels.
In 2014, the number of available plan options to consumers reduced from about 300 to 12-60 (estimate). The four levels of benefits are classified as platinum, gold, silver, and bronze. These plans are expected to cover 90%, 80%, 70% and 60% of your anticipated expenses respectively. A special low-cost catastrophic option is offered to low-income households.
"Silver"plans have special "cost-saving" features that offer special subsidy incentives (lower deductibles, copays and coinsurance) if you meet the "250%" rule. That is...if your income is less than 250% of the Federal Poverty level, you will be rewarded with these lower out-of-pocket costs. Since the "Silver" plan is considered the "benchmark," option, only this option receives the special treatment.
Please ask us about details regarding the cost-saving features. If you qualify, it can potentially save you thousands of dollars if you incur a large claim throughout the year. And perhpas the best part - It does not cost anything to utilize. But the right plan must be chosen.
So which type of plan will be best for you? Of course, we will help you make the best decision, but HSAs will be very popular if you rarely incur medical expenses. The combination of tax breaks and low prices will make these types of policies more popular than ever before. Deductible and plan availability is limited in some areas. Anthem and Medical Mutual offer the best contracts.
But it is critical to properly compare the most appropriate policies. For example, suppose you (or someone in the household) were prescribed a very expensive medication such as Accutane. At a cost of about $400 per month, the RX benefits must cover non-generic drugs. By spending an extra $30-$40 per month on the right plan, you may save thousands of dollars.
Because of the Department of Health And Human Resources guidelines, you may have to accept some additional benefits that you do not currently have. In that situation, we'll also look at options outside of the Exchange that may cost less.
For example, all policies will have to include pediatric vision and dental benefits, regardless of whether you have children. These are defined as "mandated" coverages and can not be removed. It is hoped that future legislation will be passed that allows consumers to "opt out" of these restrictive, and sometimes costly benefits.
I Own A Small Business
Small business owners will be helped by the Small Business Health Options Program (SHOP). This option will give employees of small business opportunities to purchase coverage. Plan choices will be different than pre-2014 and not all insurers will participate. It is hoped, however, that at least three major companies will be part of the program. And of course, you can count on live experienced unbiased help when you apply for health insurance in Ohio. We work for you, not the government! And all rates and quotes you view are free.
If there are tax ramifications, we'll make sure you are fully informed so you make the correct decision. However, pre-existing conditions will not be considered, so every applicant should be able to qualify for a policy (assuming you are a US citizen).
Tax credits, as previously mentioned, may help reduce your costs. These will be paid directly to the insurance company, who would then reduce the premium.You do not have to wait for a refund or check in the mail. These reductions will be applied directly and immediately.
All rates and plan details you view at Ohioquotes.com are current. You can still apply for plans at the lowest published rate. This includes policies from Anthem Blue Cross, Medical Mutual and every other large insurer. Although the online link we provide is the easiest way to get covered, upon request, we'll fax or email you an application. We will also help you enroll (if needed) through the .gov healthcare website.
However, not all carriers are writing policies in 2014, even though they were very active in 2013. UnitedHealthcare and Aetna are two examples. Both companies have chosen to skip State Exchanges until perhaps 2015. They feel that under the current legislative and fiscal enviornment, it would be difficult to offer competitive prices and remain profitable in the individual marketplace.
Healthspan, (formerly Kaiser) is a "new player" to the Marketplace and they offer many low-cost options, especially in the Akron, Canton, Toledo and Cleveland areas. the "3000-80" plan is one of the cheapest options here in the Buckeye state.
Also, a non-profit co-op, that received funding from the federal government, apparently did not get licensed quickly enough and may have to wait until next year to offer coverage. InHealth Mutual will specialize in plans for persons and businesses that do not qualify for the subsidies, due to high income. They received almost $130 million in loans.
How About Navigators In Ohio?
Recently, many states have been evaluating the effectiveness of "Navigators" who have very limited training of product options and tax ramifications. For those reasons, they are prohibited selling or marketing health insurance plans. They also are not allowed to offer their advice regarding plan selection or description.
About 70 navigators were expected to be hired with either state or federal tax dollars. However, none were certified in time and therefore could not be utilized when Open Enrollment began. However, by 2014, a few may be available.
The "Ohio Association Of Foodbanks" is one of the outreach organizations that will try to to have more than 30 workers certified. But like most "navigators," their level of expertise will be very limited and tax and subsidy issues will not be discussed.
It is expected that most consumers will not utilize their services, especially when websites like ours along with experienced brokers are available. Typically, the average person prefers to work with an experienced agent/broker that can make specific unbiased recommendations and has perhaps decades of training and continuing education.
Now that the Exchange is in effect, most business is done online. We'll keep you completely updated and make it easy for you to apply for health care benefits. Ohioquotes.com is a top private consumer website and is not affiliated with the Department Of Insurance or federal government. We compare all options, find the best plans (price and coverage) and make it easy to enroll.
Update 9-25-2013 - Will the Exchanges be ready for business next week when Open Enrollment begins? It's a mad dash and there may be some glitches and delays along the way.
Mary Taylor (Lieutenant Governor) is not so optimistic and she has tremendous insight and information at her disposal. One of her concerns is the substantial increase in traffic volume that the government website will be facing. Of course, that's only one reason why our website may be much more efficient and direct when purchasing a plan. There is no difference in rates.
UPDATE 12-10-2013 - We have published our "Easy Health Exchange Enrollment Directions" guide that makes it much easier to apply for aMarketplace plan. Once a specific policy is selected, we can provide specific application directions for you.
UPDATE 2-5-2013 - Hearing aids may soon be covered on individual plans, if a state lawmaker gets his wish. SB-257, if passed will provide $1,500 of hearing aid benefits (over a three-year time period). Fittings and other additional expenses would also be covered. About 20 other states already include some type of hearing aid benefit.