Open Enrollment in Ohio for the Health Insurance Exchange began on November 1st for 2017 effective dates and ended on January 31st. However, SEP exceptions are available the entire year. This Marketplace allows you to buy your private individual, family or small business healthcare without risking denial for underwriting reasons. Pre-existing conditions are covered, and no waiting periods or surcharges will be imposed. Exchange enrollment was higher than last year, despite recent Medicaid expansion.
The effective date of coverage for these policies depends upon when the application was received. However, if you apply after December 15th, it is possible your effective date will be later than January 1st. Although the .Gov website has experienced major delays and glitches in previous years, our website offers identical rates and we have had no software issues. We also provide a much easier enrollment process that will save you hours of time and frustration, since we handle the bulk of the work for you.
NOTE: Open Enrollment for Seniors (Age 65 and older) always starts earlier. Medicare Supplement and Advantage plans (that replace original Medicare) are popular Medigap options that can reduce out-of-pocket expenses, such as deductibles and copays. Part D prescription drug coverage is also offered, although sometimes included in Advantage contracts. An additional enrollment period takes place when you reach age 65, regardless of the time of year. Many companies (UnitedHealthcare, Cigna, Aetna, Colonial Penn, Gerber, Medico, USAA, and Humana) offer Medigap plans to Seniors, but not private individual coverage if you are under age 65.
Three New Companies
Three new companies began participating a few years ago. They were UnitedHealthcare (UHC), Aetna, and Premier. Premier services the Dayton area and surrounding counties. UHC has offered coverage for many years under the brand name of "Golden Rule." 2015 was the first year they offered Exchange plans here in the state. UHC rates are very attractive, especially their HSA prices. However, Aetna and UnitedHealthcare are not offering 2017 Marketplace coverage. Group and Senior plans are not impacted and off-Exchange options are limited, but available. NOTE: Several carriers may be returning in 2018, depending on the Trump Administration's guidelines.
In most areas of Montgomery, Warren and Greene Counties, Premier's pricing is competitive. Typically, they offer the cheapest office-visit copay plan in the area, and the network-coverage is expanding to nearby Butler and Clermont Counties. Several of their least expensive plans are the Premier HeathOne Bronze 6500, Premier HealthOne Bronze 6250, and Premier HealthOne HDHP Bronze 7150, which is HSA-eligible.
Aetna is also one of the largest carriers in the US and offers several low-cost options in four other states. For example, their Bronze-tier "$20 Copay" option is one of the most affordable comprehensive options that was previously offered in the Columbus area (and Franklin County). In previous years, they featured a low $20 copay (only) on primary care physician visits without having to meet the deductible. It was a "point of service" managed care plan.
It is possible that Aetna will begin offering coverage in additional states in 2018 or 2019, depending when specific changes are made to the Affordable Care Act legislation. Currently, popular plans in other areas include Leap Catastrophic POS, Leap Basic POS, Leap Healthy Minds, and Leap Everyday Plus.
What Happens If I Miss The Deadline?
Even though Open Enrollment ends, there are still low-cost plans that will provide quality coverage. And actually, many of the top-rated companies (such as UnitedHealthcare) underwrite these plans. For example, short-term coverage, which can be kept up to 12 months, provides valuable benefits until the next OE period at the end of the year. The application is short and takes less than 20 minutes to complete. If you need the policy quickly, your wait will likely be less than 24 hours. The policy can also be canceled at any time. Additional products (critical illness, disability, life, dental, and vision) can be purchased at any time.
Temporary plans have become extremely popular with consumers who do not want to participate in the Marketplace and prefer to purchase simple major medical coverage that provides "no frills" benefits. "Special" enrollment periods are offered if you qualify for several exclusions. These are discussed later in the article. For example, if you lose existing coverage from a divorce, move to a different service area, leave your employer, or adopt a child, you are generally eligible to apply.
Other benefit-specific policies may be ideal for keeping premiums within your budget after the deadline passes. The range of coverage will vary. First-dollar plans, limited-benefit and more comprehensive policies can be easily compared and designed specifically to fit your needs. Simply ask us about them! However, if a policy does not comply with ACA guidelines, you will be assessed a penalty. Critical-illness and disease-specific (cancer, for example) contracts are more suitable for supplemental benefits, and not primary coverage.
What Impact Will Donald Trump's Presidential Win Have?
There will be very few changes that impact 2017 plans. All changes, including the repeal and replacement of Obamacare, will be effective in 2018 and 2019. The enhancement of HSA plans, and the re-introduction of cheaper major medical policy options is likely. However, major components of the ACA Legislation will remain, including guaranteed insurability, covered pre-existing conditions, and children allowed to remain on a parent's policy until age 26. It is also likely that individual states will be provided a bigger role in policy-making, instead of the federal government.
More customized high-deductible plans, along with HSA enhancements may also be developed. Additional companies are expected to re-join the Ohio health insurance market. Aetna and UnitedHealthcare, who once offered private individual plans in all counties, may begin offering plans again in 2018, or 2019. Additional carriers, including Humana and Medical Mutual, could possibly increase their service area. Cigna and Kaiser are two additional large carriers that could also consider offering private coverage.
What If I Already Have Coverage?
You are required to have "qualified" health insurance that meets specific requirements including the inclusion of "essential health benefits." Previously, if you owned a plan that was issued on or before March 23, 2010, you could probably keep it (if you wish) and would not have to change. This was covered under the "grandfathering of plans" clause. NOTE: Group plans do not qualify for grandfathering benefits.
Your employer or existing company was able to verify its "grandfather" status. However, you still had the option of purchasing a new Marketplace policy. For example, if quickly obtaining maternity benefits was important, terminating a grandfathered policy might have saved you thousands of dollars since it may not have been covered under the old policy. We search for the option that provides the least amount of out-of-pocket expenses, and best covers maternity, and prenatal costs. Grandfathered plans have now all been replaced.
You may also receive correspondence that you have to replace that plan. If you receive a letter or email indicating that the existing policy will terminate, please contact us immediately, so we can review your options, which may include extending the termination date of the contract. Each carrier has the discretion to either continue or terminate private plans. Typically, you are notified in September or October so you have ample time to select a policy effective January 1st. It is not unusual for policies to be replaced by similar plans with very few changes.
Even if preventive benefits (which are mandatory) are not included and pre-existing conditions are not covered, it still may qualify as a grandfathered contract. If it is an individual policy, you will have options that allow you to retain coverage. Typically, you receive a letter from your company notifying you of the status. In some situations, you can renew the policy for an extended period of time. However, as new plans are developed and introduced, many older plans are replaced.
What Companies Are Offering Coverage?
Actually, quite a few. Ten carriers offer policies either on or off the Marketplace. That's tied with two other states for the most options in the US. Available companies include: Ambetter, Anthem BCBS (Blue Cross Blue Shield), Aultcare, CareSource, Humana, Medical Mutual, Molina, Paramount, Premier (Dayton area), and SummaCare.
NOTE: Miami Valley Hospital (pictured below) and its many facilities, are integral to Premier's provider network. Additional hospitals include Good Samaritan, Atrium Medical, Upper Valley Medical Center, Dayton Children's, Cincinnati Children's, and Tri-Health. Premier also offers very attractive Medigap plans for Seniors.
What Are The Cheapest Available Anthem Policies?
Catastrophic contracts are often the least expensive option, but you must be under age 30 to apply, and they are not eligible for a federal subsidy. However, the 12 plans listed below can be purchased by anyone, and a subsidy will apply (if you meet income requirements). You can also request Anthem Ohio Exchange quotes separately (or any other company).
Bronze Pathway X HMO 7150
Bronze Pathway X HMO 5000
Bronze Pathway X HMO 5200
Bronze Pathway X HMO 0 For HSA
Bronze Pathway X PPO 5850
Bronze Pathway X PPO 5150
Bronze Pathway X PPO 0 For HSA
Bronze Pathway X PPO 6800
Silver Core Pathway X HMO 5300
Silver Pathway X HMO 4250
Silver Pathway X HMO 2850
Silver Pathway X HMO 10 For HSA
What Are The Most Expensive Available Plans (All Companies) That Offer The Most Comprehensive Coverage?
Anthem Gold Pathway X HMO 1450
Medical Mutual Market 1200
CareSource Gold Dental And Vision
Molina Marketplace Gold Plan
Humana Gold 1400
Premier Health One Gold 1750
Ambetter Secure Care 1
AultCare Gold 1200 Select
SummaCare Gold 750
Paramount Gold 1
What New Company For 2017 Should I Consider?
Premier Health offers extremely competitive pricing if you live in the Dayton area. They're fairly new to the Marketplace (2016 was first year), and are backed by an extensive local network of hospitals, physicians, and facilities. Miami Valley Hospital and their ancillary locations provide a very strong provider network for both inpatient and outpatient treatment. Their Bronze and Silver plans are typically among the least expensive plans offered.
An additional company available in the Dayton area, and other counties, is Ambetter (affiliated with Buckeye Health). Their prices are very attractive when compared to other major companies, and several of their policies include dental, vision, or both extra benefits. Often, copays and deductibles are small, especially their Silver-tier contracts. Centene Corporation is the parent company of Ambetter, who operates in several states other than the Buckeye State. Molina is also a carrier with very attractive rates, and also features a network that expands in many additional parts of the US.
How Do I Apply?
There are several ways to apply for a policy. We provide a direct link (see below) that allows you to answer the questions online. We can assist you with any of the questions and also help calculate your federal subsidy that will lower your rate (if you qualify). Since we are local and experienced, we are more likely to be able to provide you with quick and accurate answers to your questions. And all of the participating companies are available for individual or family protection.
The federal website is also available. Prices will be exactly the same, although you will have to navigate through the process with limited assistance. Inexperienced "navigators" are available throughout limited sections of Ohio. However, they may not be licensed and they are also prohibited from making specific plan recommendations. Recently, Cincinnati Children's Hospital Medical Center, who had previously received federal funding, realized they were ineligible to act as navigators since they negotiate with insurers. In the future, we expect the federally-funded navigator program to be completely eliminated or drastically changed.
This is why we highly encourage you to use our direct link. You get a dual benefit of the lowest prices and live expert advice. And the amount of time required to activate a plan is much lower than the .gov website. You also will be serviced by a local Agency with 37 years of experience, instead of a toll-free phone number located outside of Ohio.
The subsidy takes the form of an instant tax credit and is based on your household income. For example, a 50 year-old that earns less than $45,000 per year, will receive aid. Of course, for a married couple without children, the amount (about $65,000) is substantially more. Under 400% of the Federal Poverty Level is used as a benchmark. Policies are referred to as "Metal" since the four choices are Platinum, Gold, Silver and Bronze.
The bigger the size of your family, the larger the subsidy. For example, a family of three, including one child (assuming ages in the mid-40s), would receive a subsidy of approximately $365 per month with $50,000 of household income. However, with two additional children (total of three), Medicaid-eligibility is likely. It pays to have a big family under the new legislation. We can calculate your personal subsidy and eligibility in less than a minute. Call or email us any time.
NOTE: If your income is too low, you may have to enroll for a Medicaid plan, since a subsidy would not be offered. When Medicaid requirements expanded to 138% of the Federal Poverty Level, many households suddenly became eligible. For example, a single person that earns about $16,000 is eligible. The approximate limit for a family of three is $27,300 and $33,000 for a family of four.
There Are No Medical Questions. Right?
That is correct. The application asks information regarding where you live, your age, additional dependents, and the type of plan you are applying for. But you will not be asked about your health or any pre-existing condition issues. Your smoking status is the only personal criteria used to determine the rate. Your health, credit, height/weight, and prior conditions have no impact on prices. Also, if you suddenly develop a condition or sustain an injury during the enrollment process, it will not impact your prices or plan options.
Is Open Enrollment The Only Time I Can Buy A Policy?
Actually, there are designated "special enrollment periods" when you are also allowed to apply for Ohio Health Marketplace coverage, even if it is outside of the specified time frame earlier mentioned. Assuming you are a qualified individual, some of the events that qualify for these special periods include:
Losing "minimum essential benefits."
A newly classified citizen.
The result of a permanent move.
Gaining a dependent or becoming a dependent through adoption, birth or marriage.
A major violation of your qualified health plan can be proven.
An error by the Exchange causes an individual to erroneously enroll or be terminated from their qualified plan.
You can buy a "short-term" policy at any time during the year. The premium will be very low since it covers mostly catastrophic events. However, it may not fulfill the requirements of Obamacare and subsequently, a special tax (discussed) will be imposed. Also, the maximum payout will be between $250,000 and $1 million, instead of unlimited benefits.Typically, preventative benefits are not covered at 100%, and non-preferred brand drugs will not be fully covered.
However, since benefits are only kept for less than 12 months, these amounts should be sufficient. You can synchronize the beginning of your personal coverage to coincide with the termination of your short-term plan so there is no lapse in benefits.
What Is The Penalty If I Don't Purchase Coverage?
The penalty is actually a tax, and millions of Americans are expected to ignore the new law and pay the tax, despite the risk. In 2014, the tax (or fine) was $95 per adult and half of that amount per child with a family cap of $285. However, if 1% of your family income exceeded the previous calculated amount, than you paid the 1%. For example, if your household income was $70,000, you paid a $700 tax. Because of numerous glitches in the federal website, additional time has been provided to sign up for coverage.
Two years ago, in 2015, the tax jumped to $325 per adult and $162.50 for each child with a family maximum of $975. However, the 1% household income calculation doubled to 2%. Thus, a household income of $80,000 resulted in a $1,600 tax. However, $40,000 of income resulted in an $800 tax, which is less than the family maximum when adding penalties individually.
In 2017, things have gotten dicey. The adult and child charge changed to $695 and $347.50 respectively with a maximum family charge of $2085. The household calculation is now 2.5%. So, in the previous example, an $80,000 family income would pay a tax of $2,000 for not purchasing qualified Ohio health insurance coverage. However, if coverage was in effect for a portion of the year, the penalty will be reduced accordingly.
After 2017? Since the tax is indexed, the amount of the penalty will continue to increase. Of course, if Donald Trump repeals the ACA Legislation, the legal requirement for purchasing "qualified" healthcare will probably be eliminated. We anticipate this to occur, and an alternative "penalty" may be in place by 2018 or 2019.
Important Note: The IRS has announced it will end the practice of not processing federal tax returns of filers that may not have compliant health insurance. The Trump Administration requested that this action be taken, to soften the financial impact of the Obamacare legislation. Although tax returns will continue to be processed, the penalty for not having coverage is still applicable, and consumers are still required to pay the tax. Only new legislation can eliminate the tax.
Is Single-Payer Universal Healthcare Coming To The US?
Universal healthcare is a system in many countries where all citizens are covered under the same (or very similar) type of policy. Benefits are fairly comprehensive and typically there is no cost to consumers since the government pays for all treatment. The concern of many persons is the quality of treatment and the length of time it takes to receive this treatment. Usually, if you are healthy, you don't mind this type of delivery system. But if you need treatment, delays are expected. Often, knee replacements, and other non-life-threatening operations can have long waiting periods.
Increased taxes usually fund this type of medical coverage, and that would not be a popular option here in the US. In some countries, extra money is raised by citizens that wish to purchase additional services. Also, many type of hybrid plans are available that combine aspects of private and government-provided treatment.
Our political landscape is hard to predict and the Presidential election results will play a major role in forming the direction of our healthcare. Just look at 2008. But for now, the combination of private companies and limited government involvement will probably continue for awhile. With Donald Trump defeating Hillary Clinton, the chances of a single-payer system being implemented have greatly diminished. President Trump has indicated that expansion of HSAs and cross-state selling are likely to occur.
Does Medicaid Expansion In Ohio Affect Me?
If your household income is less than 138% of the Federal Poverty Level (About $16,000 for an individual and $32,000 for a family), each state has the option to offer Medicaid coverage to those persons. Otherwise, Medicaid is available at the 100% level. Here in the Buckeye state, the topic of expansion has been a very contentious topic and was finally approved.
The new reform law had the support of Governor John Kasich. Almost 300,000 persons became eligible. But it could become very costly in later years, which worries many congressmen. Also, the Cleveland Clinic, the biggest Medicaid provider in the state, has eliminated part of its workforce because of anticipated Medicaid cuts. Another variable is that every two years, any previous changes can be voted on again.
NOTE: It is possible that because of a substantial drop in your income, Medicaid eligibility may be available, while in previous years it was not. For example, a reduction in hours at work, a temporary layoff, or early retirement could result in either a larger subsidy, or a low enough household Federal Poverty Level ratio to satisfy Medicaid requirements.
Please contact us if you have any questions regarding applying for coverage during Open Enrollment, or the Ohio Health Insurance Exchange plans. We make it easy to compare prices. Also, keep in mind that Medicare is different than Medicaid, and their Open Enrollments are different.
November 15 2013 - After President Obama's press conference yesterday, the Dept. Of Insurance announced they will support the continuation of non-grandfathered policies for individuals and small businesses. However, each company can determine which plans will be eligible for this change. This means that many consumers, who may have been forced to terminate contracts because they were not Affordable Care Act-compliant, may be able to keep those plans. Yes....It is confusing.
January 2014 - About 40,000 Ohio consumers have enrolled in the Exchange so far. Although we have helped many customers with the enrollment process, we can't take credit for all of the 40,000 applicants! About 30,000 persons have been eligible for a subsidy and the most common plan is the "Silver" option because of the lower deductible features.
March 2014 - 17 days remain in the 2014 Open Enrollment, although consumers can continue to buy coverage after April 1. However, unless a specific exception is granted, a subsidy will not apply to the premium, and key benefits (maternity, for example), may not be included. Nancy Sebelius also visited our state in an attempt to help push final enrollment numbers. With a few weeks left, about 80,000 persons have signed up, which is far below the initial predictions.
April 2014 - The Obama administration has extended the enrollment period by about two weeks for applicants that start the application process but are unable to complete it. There is now a small box (blue) that can be checked that will extend the Open Enrollment. This special period will apply to both online and phone applications and it will allow consumers to avoid the tax that is imposed for not having coverage.
July 2014 - Price projections for 2015 effective dates (OE begins November 15th) have been released. Companies are actively submitting their rate increase (and decrease) requests to the Department Of Insurance. UnitedHealthcare will be joining the Marketplace after sitting out 2014. Anthem has requested price increases of about 8% (average) on their plans. Bronze policies may not go up as much.
September 2014 - 2015 prices have not been released yet, although we expect to see initial numbers within the next month. For persons that need coverage between now and the end of 2014, and you don't qualify for a "special enrollment exception," temporary coverage (off-Exchange) is available. Prices are quite low because of benefit restrictions.
October 2014 - Premier Health will offer plans for the 2015 Marketplace. Based in Dayton, they will serve Montgomery County and the surrounding area in their first venture. Plan selection will be limited, although both under-65 and Medigap options will be offered. Miami Valley Hospital and its vast network will be part of the provider list.
November 2014 - It's here! Open Enrollment has arrived. So far, the process is running smoothly. Our direct link allows you to get a free quote, compare, and enroll in 10-20 minutes. If you need help, contact us. Aetna and UnitedHealthcare made it official by offering Exchange plans. UnitedHealthcare has some very competitive prices in many counties.
December 2014 - A list of medical conditions covered by Obamacare is available. Simply submit a written (email is fine) request. Regardless if you have prior coverage, once your enrolled policy is approved, you can use preventive and elective benefits without waiting. January 1, 2015 effective dates are still possible.
January 2015 - The deadline for securing a February 1 effective date ended yesterday. Any applications or enrollments submitted between today and February 15th will receive a March 1 effective date. The exceptions are Special Enrollments that allow you to purchase coverage at any time.
April 2015 - The American Lung Association concluded a study that determines that the vast majority of Ohio Marketplace plans do not provide the required tools and benefits that assist consumers to stop smoking. The ACA legislation mandates that carriers provide specific smoking cessation drugs (and counseling) at no cost, subject to certain provisions. The Buckeye State has one of the highest percentage of smokers in the US.
June 2015 - The initial 2016 rate filings have been received by the DOI. Most companies will be increasing premiums, although many plans will not see dramatic rises. Listed below are the projected price hikes for several popular policies. The higher prices must be approved before they are actually implemented.
37.6% - Assurant (Time) Individual QHP
19.6% - UnitedHealthcare Off-Exchange
17.8% - Aetna HMO Small Group
17.3% - HealthSpan Individual Plans
16.9% - Medical Mutual Individual Plans
November 2016 - What does Donald Trump's win mean for Ohio health insurance rates? As previously mentioned, a repeal of Obamacare is probable, but a new replacement will have to be created first. Since this will likely take between 3-9 months, major changes may not be implemented until 2019, although 2018 remains a possibility. Senior MedSup coverage should not be impacted by the Trump win.