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2017 Ohio Health Insurance Plan Rate Projections – Individual/Group

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Ohio health insurance companies are required by the Affordable Care Act legislation to provide rate increase requests of more than 10% to the federal or state government. These price increases will be studied and reviewed, to determine if the changes are fair and warranted. Consumers can voice their opinion regarding the evidence the insurers have provided to justify the premium hikes.

Below, we have provided ACA-compliant plans in Ohio and their requested (from the insurer) rate increases for January 1, 2017 effective dates. It is unlikely that the Department of Insurance will approve all premium increases in their entirety. Information is imported from “Rate Review,” which is managed by the Center for Medicare and Medicaid Services.



13.19% – HMO Small Group

9.02% – HMO Sam’s Small Group

7.28% – Indemnity Plan Small Group

12.57% – PPO Small Group

12.97% – Managed Choice – PD – Individual

11.37% – Managed Choice Individual



9.95% – Small Group HMO

10.43% – Small Group

24.09% – Individual


Anthem BCBs (Community Insurance)

12.04% – HMO Individual

9.48% – PPO Individual

4.96% – PPO Small Group

2.5% – PPO Off-Exchange


Buckeye Community Health Plan (Ambetter)

-0.79% – Ambetter Individual

-1.14% – Ambetter Individual Plus Vision



13.29% – HMO Enhanced Individual

13.53% – HMO Basic Individual


Consumers Life (MedMutual)

1.86% – Off Exchange Individual

1.88% – HMO Individual


Federated Mutual

20.61% – Small Group


Freedom Life

9.98% – Individual



7.39% – Small Group

12.45% – Cincinnati/No.KY HMOx Small Group


Medical Health Insuring Corp. (Medical Mutual)

-17.13% – MedMutual HMO Individual

-17.17% – MedMutual HMO Off-Exchange

18.32% – MedMutual Connect Small Group


Medical Mutual

18.36% – MedMutual Small Group



2.36% – Molina Healthcare Individual



9.88% – Individual Exchange

2.22% – ALLC OOA Small Group


Pekin Life

5.11% – Choice Plus Small Group

6.47% – Flex Plus Small Group

5.92% – Classic Choice Small Group


Premier Health

39.82% – Premier Individual

39.23% – Premier PD Individual



1.51% – QHP Group Small Group

4.78% – QHP Group Qualified Small Group

6.22% – QHP Individual Qualified


Health Plan Of The Upper Ohio Valley

7.92% – Silver HMO Small Group

9.04% – Gold HMO Small Group

7.90% – Platinum HMO Small Group

16.64% – Bronze Individual

13.46% – Bronze HMO Small Group


THP Insurance Company

5.40% – Gold PPO Small Group

8.19% – Bronze PPO Small Group

5.64% – Silver PPO Small Group

5.84% – Platinum PPO Small Group

5.92% – Gold HRA Small Group

6.57% – Silver HSA Small Group

18.30% – Bronze HSA Small Group



6.55% – Heritage Plus Small Group

5.91% – Choice Plus Small Group

6.68% – Navigate Small Group


US Health And Life

6.61% – PPO Small Group

6.65% – HSA Small Group

Paramount Health Insurance Plans And Rates In Ohio

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Low-cost health insurance in Northwest Ohio is offered by Paramount. Plans are available to individuals and groups, both on and off the Marketplace Exchange. Residents can choose affordable HMO, Elite, and Advantage options that provide quality coverage at a competitive price. The rates you view on our website from your free quote request, are the lowest offered prices since the Department of Insurance regulates pricing.

Paramount has offered policies for more than 25 years, and features popular consumer-driven products to applicants under the age of 65, along with Seniors that are eligible for Medicare. A National Committee for Quality Assurance (NCQA) accreditation was originally awarded in 1995. A “Quality Improvement Program” has been implemented, and is designed to improve patient treatment and service, and review the effectiveness and efficiency of their providers. Affiliated with ProMedica, plans are also offered to small and large companies that are providing group benefits to their employees.

Policies are offered in 4o counties in Northeastern Ohio and Southern Michigan. Partial benefits are provided in Delaware, Hardin, Knox, Allen, and Paulding counties. If additional areas are added to their network coverage area, we will update the map below.

Paramount Health Insurance Ohio Network

Paramount Ohio Service Area

Available Individual And Family Plans – Under Age 65

Exchange (and off-Exchange) coverage is offered during Open Enrollment, and after the OE period has ended (with a special exemption). A large Paramount Ohio Insurance Provider Network (doctors, specialists, hospitals, and medical facilities) gives state residents many local options for treatment. Shown below are single and family policies that are not medically underwritten.


Bronze 1 HSA – HSA-eligible plan with $6,500 deductible and 0% coinsurance. You may choose a financial institution to administer your tax-free deposits that can pay for qualified medical, dental and vision expenses. Generally, this option is most cost-effective if there are no major medical conditions, and you do not anticipate that any family member is likely to meet the deductible. One annual eye exam and a pair of glasses each year are provided at no cost.

Bronze Standard – $45 primary care physician (pcp) office visit copay with no limit on the number of allowed visits. Specialist and Urgent Care visits are subject to 50% coinsurance. Deductible is $6,650 with maximum out0of-pocket expenses of $7,150 and 50% coinsurance. Preferred and non-preferred generic drugs are subject to a $35 copay. Other drugs are subject to 35%-45% coinsurance.

Silver 1 – $30 and $75 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,250 deductible with maximum out-of-pocket expenses of $7,150 and 40% coinsurance. $10, $20, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance.

Silver Standard – $30 and $65 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,500 deductible with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. $15, $15, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance. Very similar to previous plan, but slightly more expensive.

Silver 3 – Same rate as Silver 2 plan but with a $500 higher deductible ($3,500), but also a higher specialist copay ($75 vs. $65).

Gold 1 – Low $1,000 deductible with $20 and $30 office visit copays. Generic drug copay is only $7, and Brand drugs do not have to meet a deductible.

Gold 2 – Slightly more expensive than previous plan. $1,500 deductible with $10 and $20 office visit copays. $6 generic drug copay with $5,000 maximum out-of-pocket expenses. Specialty prescriptions are subject to a 20% copay.

Sample Rates (Under Age 65)

Since the cost of coverage varies, depending on several factors, we have illustrated below monthly rates for specific household situations. If a federal subsidy is available, it has automatically been applied to reduce the premium. However, any applicant can choose to decline the Obamcare subsidy. This federal aid is only offered during Open Enrollment and SEP situations. If you missed Ohio Open Enrollment, many options are available, including inexpensive (but non-compliant) short-term plans.


25 Year-Old Male Living In Zip Code 43617 – $15,000 Income (Sylvania – Lucas County)

$78 – Bronze 2

$107 – Silver 1

$153 – Gold 1


40 Year-Old Couple Living In Zip Code 43608 – $27,000 Income (Toledo – Lucas County)

$176 – Bronze 2

$250 – Silver 1

$366 – Gold 1


50 Year-Old Couple Living In Zip Code 45840 – $45,000 Income (Findlay – Hancock County )

$219 – Bronze 2

$326 – Silver 1

$492 – Gold 1


45 Year-Old Couple With Two Children Living In Zip Code 44870 – $55,000 Income (Sandusky – Erie County )

$195 – Bronze 2

$318 – Silver 1

$508 – Gold 1

 Medigap Plans In Northern Ohio

Affordable Senior Ohio Health Plans Are Available

Senior Medicare Plans And Medigap Supplements

Medigap coverage can help policyholders pay deductibles, and reduce out-of-pocket expenses. Typically, you can choose and physician, specialist, or hospital that accepts Medicare patients. Four plans are available to eligible applicants residing in the service area. The monthly rates shown below are for selected ages that do not use tobacco products.

Age 65

$102 – Plan A

$119 – Plan N

$147 – Plan C

$155 – Plan F

Age 70

$122 – Plan A

$142 – Plan N

$175 – Plan C

$185 – Plan F

Age 75

$148 – Plan A

$172 – Plan N

$213 – Plan C

$224 – Plan F


Advantage Plans

Three Ohio  options are shown below. “Advantage” contracts are issued by private carriers who have contracted with Medicare to provide Parts A and B coverage. Depending on the company, HMO, PPO, Fee-For-Service, and Medicare Savings Accounts are available. If you have End-Stage Renal Disease (ESRD), unfortunately, you are not eligible. The official enrollment period begins on October 7th and ends on December 15th.

All three “Elite” plan options include an annual routine vision exam, 100% preventative benefits, health and wellness programs, and a Silver Sneakers membership. The negotiated network discounts should always be used for any expenses that are subject to a deductible and/or out-of-pocket expenses. The Elite contracts also received a 4-Star rating from Medicare for 2016. An overall and summary star rating is assigned.

Dental Benefits

An optional Delta Dental rider is available for $18.50 per month. Two exams and cleanings are covered each year. The annual maximum benefit is $500 and Full-Mouth x-rays are covered every three years. Emergency palliative benefits and a brush biopsy (for oral cancer detection)are also included. NOTE: Delta dental plans are not offered outside of the Open Enrollment period.

DentaQuest and EyeQuest Networks are used with Advantage contracts. Elite plans are available in the following counties: Allen, Cuyahoga, Defiance, Erie, Fulton, Henry, Lake, Lorain, Lucas, Medina, Ottawa, Sandusky, Williams, and Wood.

Elite Standard Medical And Drug – $36 per month.  Office visit copays are only $5 and $40 with maximum policy out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $5 and $20 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.

Elite Enhanced Medical Only – $0 per month. Yes, that premium is correct. Office visit copays are $20 and $45 with maximum out-of-pocket expenses of $6,100. There is no deductible to meet and most lab tests, diagnostic tests and x-rays must only meet a small copay of $0-$10. The hospital outpatient copay is $200 and the Urgent Care copay is $45.

Elite Enhanced Medical And Drug – $78 per month. Office visit copays are $5 and $40 with maximum out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $2 and $15 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.

2016 Healthcare Changes In Ohio – What To Expect

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2016 Ohio health insurance plans will look different in 2016. The rates will change. Some plans will be added, while others will be eliminated. New carriers may enter the Marketplace, while others, such as Assurant, will exit the Exchanges. Federal tax subsidies will be different, depending on your projected household income.

Who knows what Ohio healthcare will look like in 2016. Well, We think we do! Our tongue and cheek predictions below may not come true, but we had a lot of fun writing them!


January – In an unprecedented move, all major Ohio health insurance companies offer to slash their 2016 rates by 60%. However, there is a big caveat. The stipulation is that the Cleveland Browns must win the Super Bowl on February 7th if prices are to decrease.

The problem is that the Browns finished the season with a  7-9 record, missed the playoffs, and aren’t even playing in the Super Bowl! When asked to comment, a Humana spokesman stated that  they will extend the offer to 2017 since the risk would still be “incredibly low.” Thankfully, the Bengals were not included in this offer.

February – Open Enrollment ends on January 31st, and millions of Americans, including many households in the Buckeye State, are still without coverage. However, on February 1, the Department of Health and Human Services announces that OE will be extended until December 31st.

To ease the burden on Department employees, consumers must apply for coverage only during designated times. These times are between 3:00 am and 4:00 am Tuesdays and Fridays, and only on odd-numbered days. General maintenance is expected to be performed between 3:10 and 3:50 am on these designated days.

March – Of course, that means March Madness, so during the NCAA Basketball Tournament, no new applications will be taken, no claims will be paid, no payments will be processed, and phone calls and emails will not be returned from any health insurance company in Ohio.

Funny Health Insurance Websites

Ohio March Madness!

However, there’s some good news! If any Ohio University (Ohio State, Miami, Xavier, Toledo, Kent State etc…) makes it to the “Final Four,” a $250 rebate will be given to all customers. If they win the National Championship, a $1,000 rebate will be given.

April – Is it an April Fool’s joke? Nobody seems to know. Apparently, Ohio grocers are offering to pay 50% of your health insurance bill on the first day of April. Your only requirement is to bring in your statement, and 16 forms of identification and the bill is instantly paid.

Ah. OK. It’s quite clear now. 16 forms of identification. Well…if you have plenty of aliases, multiple personalities or you tend to keep old college ID cards and driver’s licenses, you may catch a break. Otherwise, it appears to be an April Fool’s joke gone bad.

May – April showers bring….You know…May flowers.  So, to commemorate the upcoming warmer weather, each insurer has assigned itself to a specific flower, and all corporate and local offices must reflect that motif.

Some of the selections made by the carriers are listed below:

Aetna – Carnation

Humana – Snapdragon

Medical Mutual – Rose

Premier – Marigold

Anthem Blue Cross – Daffodil

Ambetter – Geranium

UnitedHealthcare – Hydrangea

SummaCare – Daffodil

NOTE: Anthem and SummaCare both selected the same flower and subsequently sued each other to determine who has the exclusive flower rights.

June – Ohio’s newest health insurance company is under investigation for allegedly not paying a single claim during the first five months of the year. “No Pain No Claim” is the name of the carrier that started to offer policies in 2016. Approved by regulators, they offer coverage in 12 Counties located near the Indiana border.

When asked to provide claim records and payout information, an official of the company said, “We don’t have any documentation regarding claims. Our operational expenses were too high this year although by 2020 we hope to start reimbursing a few policyholders.”

July – An enormous data breach hits the Midwestern states as a rogue hacker believed to be living in Cincinnati infiltrates many large financial institutions. Oddly, no personal or sensitive information is taken. But every policyholder receives new ID cards with their first-grade teacher’s name on it. Very strange.

Funny LeBron Stories

LeBron’s Marketplace!

August – In an effort to increase market share, surprisingly, Medical Mutual and Humana decide to change their corporate names and logos. The move is effective on October 1, and all stationery and business cards will also be changed.

Medical Mutual will become “LeBron’s Marketplace” and Humana will become “Buckeye Nuts And Guts.” Both companies are obviously attempting to capitalize on  the Ohio theme. Of course, it may not be so popular in other states.

September – A special Open Enrollment period has been approved for the entire month by the Department of Health and Human Services (HHS). To qualify, you must file your 2016 and 2017 federal tax returns before the end of 2015 and agree to pay applicable back-taxes of all immediate family members. Although it is not anticipated that any person will take advantage of this newly-created SEP, many Department employees are praising this idea as an “act of kindness.”

October – Halloween tricks and treats from the healthcare industry. In an effort to promote responsible eating, employees are encouraged to give out raspberries, beet juice, or broccoli spears to children, and forgo the traditional candy items. However, the city of Cleveland quickly responds to the idea, by extending Beggars Night to the entire month of October and requiring all treats consist of a minimum of one pound of chocolate, and two dozen Rice Krispies treats..

November – Open Enrollment officially begins with a massive advertising campaign designed to increase the number of Americans that sign up by 40%. As a special inducement, if you enroll in a plan during the first 15 days of November, a frozen turkey will be sent in time to enjoy before next July 4th.

However, for individuals or families that enroll AND refer a friend, a small mobile home that is completely furnished, will be sent. The value of this inducement is $11,500 and is unfortunately, taxable.

December – Keeping with the “Holiday Spirit,” during this month, insurers are offering potato latkes and pumpkin pie to all policyholders that schedule a preventative colonoscopy. Of course, the food is served after the procedure has completed. The evening before the colonoscopy, a tasty concoction of bowel-cleansing Miralax is provided.

If You Missed Ohio Open Enrollment – 10 Things You Need To Know

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Open Enrollment to purchase subsidized health insurance in Ohio typically occurs between November and February each year. During that time, no medical questions are asked, and single and family plan rates are  reduced by the federal government by using a subsidy in the form of an instant tax-credit. On and off Marketplace coverage is available, so if your income is high, you can still enroll in an affordable plan.

However, if you didn’t watch the news or read a newspaper, procrastinated too long, or simply didn’t have money set aside to buy a policy, you probably missed the OE period. But you can still obtain affordable healthcare benefits. Here are 10 items that will help you secure coverage now, and ensure you won’t miss Open Enrollment next year!

1. Don’t miss Open Enrollment this year! There’s always plenty of advertising in both the print and online media. Generally, if you want your policy to be effective January 1, the deadline is December 15th, so don’t wait after the Holidays to do your healthcare shopping. November 1st is the first day, and it runs through January 31st. If you miss the cutoff, you will probably need an “SEP” (discussed later) to receive favorable treatment.

2. Consider purchasing a temporary Ohio health insurance plan. No, it won’t match the office visit and prescription copays that an Exchange policy offers, but it will provide a very inexpensive stopgap option that is easy on your pocketbook and can be placed in-force within 24-36 hours. UnitedHealthcare is one of many companies that offers low rates. Medical Mutual also offers competitive pricing.

Although temporary policies are ineligible for Obamacare subsidies, for most individuals and families, prices are still less than most Marketplace contracts. And, up to $1 million of coverage can be purchased  “per claim” or per “policy period.” You can terminate your benefits with a phone call and utilize a nationwide provider network.

Ohio Open Enrollment Missed

Having A Baby Qualifies For A Special Enrollment Period

3. Determine if you qualify for a “Special Enrollment Period.” Commonly referred to as an SEP, specific life events that cause a change in family status, allow you to take advantage of this special period of 60 days to secure either subsidized or unsubsidized Exchange coverage. It doesn’t matter if it occurs in January, July, September, or any other month.

Several of the most common “Life Events” include getting married or divorced, reaching age 26, losing existing employer-provided benefits, moving to a different residence, and becoming pregnant. However, in pregnancy situations, the newborn may enroll in a policy, but not either parent. Therefore, prenatal and delivery expenses will not be covered.

4. Be aware of changing OE dates. For example, for 2014 effective dates, the starting date was October 1 2013, and the ending date was March 31 2014. That was six full months for consumers to take about 25 minutes and purchase their coverage. For 2015 effective dates, the starting point was November 15th and it ended on February 15th. The application time plummeted to about 90 days from about 180 days.

And as previously mentioned, the OE period for 2016 is once again, only three months. Although extensions are possible because of occasional glitches and delays, January 31st is the expected last day to enroll. If you already have a policy, you can either keep your plan, or consider switching to a different option.

5. Don’t go without coverage. Just because you didn’t sign up in time doesn’t mean you have to remain uninsured. Although you won’t be able to duplicate Marketplace plan benefits and prices, you can still obtain a medical plan. Major medical expenses are the most important item to cover, and many available contracts will reduce your potential risk against these types of claims.

Short-term contracts won’t eliminate the special non-compliance tax. However, if you develop a serious illness, or have an accident that results in thousands (or hundreds of thousands) of medical bills, you’ll be able to easily cover the vast majority of expenses. And the cost of temporary plans is extremely cheap.

6. Find out in advance which companies accept your physicians and specialists. The most time-consuming and frustrating part of the process is finding a plan that meets your coverage and budget objectives, but doesn’t include your providers.

By contacting doctors and medical facilities in advance, you can ensure that the plan you purchase (even after the OE period) will provide in-network” benefits for routine and scheduled treatment. Since network provider lists change, it’s important to verify your doctor is not dropping the carrier you are using.

Health exchange Enrollment

If You Miss Open Enrollment, Eat Your Vegetables!

7. Stay healthy, and eat your vegetables, especially if you don’t plan to purchase any major medical or catastrophic coverage throughout the year. Don’t go outdoors, don’t answer the door, don’t eat raw meat, and don’t travel in any vehicle with the possible exception of a golf cart.

Of course, we’re being a bit satirical, but any major disease or accident could have a dramatic impact on your financial health. Postponing your medical coverage to January 1st may be too late to treat a serious ailment.

8. Negotiate lower medical bills with your physician, specialist, hospital, and any other facilities you receive treatment. Often, by paying directly in cash, you can reduce your expenses by as much as 50%. And why not? There’s no claim form, insurance company, or approval process that the healthcare provider has to pay for. So everyone is a winner.

Unless, of course, you incur a huge hospital bill you can’t pay. In those situations, you may be able to negotiate a favorable billing alternative that works within your budget. A $10,000 obligation could result in only monthly payments of $100 or less.

9. Do NOT buy a “Limited Benefit” plan. Generally, these are the policies that are underwritten by a company you may not be familiar with. Obtaining specific benefit details are almost impossible, and a mysterious “application” or “enrollment” fee  is included. Often, it can be as much as $150-$200. Preventative benefits are not covered at 100%, and a large claim could easily result in tens of thousands of dollars of out-of-pocket expenses.

These contracts are often peddled from boiler rooms that are located outside of Ohio. Your payment information (credit card or check) will be requested on the first contact. Obtaining a refund will be practically impossible, and speaking to a live person becomes much more difficult after they have processed your initial payment.

10. Watch for changes to the ACA legislation from the latest Supreme Court challenge such to Obamacare, such as King Vs. Burwell.The government sided with the original legislation in this decision, although future challenges may also reach the Supreme Court.

The King Vs. Burwell verdict ruled in favor of the legality of federal subsidies offered to residents of states that have not set up their own Exchange.  Ohio (and most other states) were at risk of losing these subsidies, which would have effectively doomed the future of Obamacare, unless drastic changes were made.

Premier Health Insurance Plans For Individuals – Low Southwestern Ohio Rates

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Dayton’s biggest hospital network offers private health insurance plans in Ohio. Premier Health’s private and employer-sponsored policies are available through and outside the Marketplace. Open Enrollment for 2017 effective dates began November 1st and continues through January 31st. Special enrollment exceptions (if qualified) are available throughout the year. Plans are offered in the Dayton area and the Southwestern portion of the Buckeye state.

For seniors, Medicare Advantage contracts are offered when their Open Enrollment begins on October 15th and continues through December 7th. However, if you turn age 65 or become eligible for Medicare, you have a special  “initial” enrollment period at any time throughout the year. It lasts for a total of seven months, beginning three months before your eligibility.

Pre-Medicare Healthcare In Ohio

The Gap Between Retirement And Medicare Can Be Easily Covered

Note: Often, there is a gap between retirement and Ohio Medicare eligibility. In these situations, a private plan can act as a bridge for this period of time, which may be only a few months, or  as long as 5-10 years. Subsidized policies are available. “Short-term” contracts can be approved in 24 hours but receive no government assistance.

Some of the popular and most-utilized services offered  include emergency and trauma, cancer care, maternity, sports medicine, neurosciences, orthopedics, cardiology,  gynecology, primary and after-hours treatment. Additional resources that are available to patients and their families are an online health encyclopedia, online patient registration, comprehensive risk assessment availability and wellness classes throughout the Dayton area.


Who Is Premier?

Located in Dayton, with more than 12,000 employees, they are a large network of hospitals, specialists, doctors and other facilities that specialize in treating the Southwestern Ohio community. The insurance company operates as a separate business entity and offers policies that conform and meet the requirements of the Affordable Care Act legislation. Short-term and limited-benefit options will not be available. Comprehensive copay policies are the most popular option.

With more than 3,000 network providers available, access to quality treatment is not be a concern for patients. 2,000 of the providers are doctors specializing in cardiology, orthopedics, preventive treatment and neurosurgery. There are also several rehab locations including  the Rehabilitation Institute Of Ohio (RIO) which is on the grounds of Miami Valley Hospital. RIO treats more rehabilitative patients in the Miami Valley than any other similar company.


Additional Services

In addition to the standard coverage, such as inpatient and outpatient hospital treatment, ER, and others named above, many other services (and facilities) are available through local providers and the Miami Valley Hospital network. It is possible that some exclusions, deductibles and coinsurance may apply. Some of these options include:

Blood And Marrow Transplants

Burn Center

CareFlight Air

Diabetes Services

Electrophysiology Lab

Genetic Testing And Counseling

Homeless Clinic

Movement Disorders

Neuro Rehabilitation

Pain Center

Pelvic Services

Spiritual Care

Sports Medicine


Available Network Providers

Five large hospitals surrounding the Miami Valley serve area patients. They are:

Atrium Medical Center (Middletown) – For more than a decade, Atrium has been a Level III trauma Care Center. Previously known as Middletown Regional Hospital, they have been treating the community for more than 90 years! They earned many “Healthgrade” awards including treatment for cardiac, pulmonary, critical care and neurosciences.

Good Samaritan Hospital (Dayton) – “Good Sam” has been around since 1932. The Sisters of Charity vision is still recognized by the hospital. Now a member of Catholic Health Initiatives (CHI) with more than 100 similar organizations, this hospital is very active in the Dayton community and well-recognized for its generosity. Gastrointestinal treatment is one of the many available specialties.

Upper Valley Medical Center (Troy) – Upper Valley is a fairly new facility. Serving the Miami County area since 1996, they are one of Dayton’s leading healthcare facilities North of I-70.  In addition to the diverse types of treatment that is available, local charity programs are available for local residents that are not currently insured.

The partnership with Edison Community College also provides comprehensive nursing programs including  college scholarships for area students. The outdoor fitness center at Edison is also available to the public at no cost.

Premier Healthcare Plans Ohio

Miami Valley Hospital Is Part Of Premier’s Provider Network

Miami Valley Hospital (Dayton) – MVH is the flagship hospital of the area. More than 100 years old, it is now a regional trauma center facility with more than 800 available beds and 1,000 doctors and specialists. Also recognized as having one of the top nursing  practices, Miami Valley is recognized as a “Magnet” facility.

Recently, “US News And World Reports” recognized MVH as one of the top hospitals in the US. The combination of the Adult Burn Center, Level 1 Trauma Center, Care Flight ambulance availability and marrow transplant program makes this hospital one of the most recognized landmarks in Southwestern Ohio.

Miami Valley Hospital South (Centerville) – is located in the Dayton Mall area and was built in 2007. It serves southern Montgomery County, Northern Warren County and surrounding areas.  Currently, more than 50 beds are available, and obstetrics and orthopedics are a few of the specialties.

A comprehensive cancer care center along with many physician offices are located on the property. It has become a very convenient location for residents that live South of Dayton, including Centerville, Kettering, Springboro, and Franklin.


Available Under Age 65 Plans

For  2017 effective dates, many individual/family policies are available as Marketplace subsidized plans. If your household income meets Federal Poverty Level guidelines, part (or all) of the premium will be paid by a subsidy. Financial aid is only offered during Open Enrollment and SEP (Special Enrollment Periods). Common SEP  situations are divorce, birth of a child, moving to or from a different state, and losing existing benefits from an employer.

Platinum, Gold, Silver, Bronze and Catastrophic tier contracts are available for private purchase. Typically, carriers such as Anthem Blue Cross, Medical Mutual, Aetna, Cigna, UnitedHealthcare, and Humana do not offer options for all tiers. However, the Silver tier, because of its special cost-sharing features, is the most popular.

NOTE: A Medicare Advantage plan and  a Dual Eligible Special Needs (DSNP) contract are also available (see several paragraphs below). The Open Enrollment period is different than under-65 market. For Medicare-eligible plans, as previously mentioned, the sign-up period begins October 15th. Medigap (Supplement) coverage is also government-regulated and the available contracts are standardized to help in the consumer-comparison process. Advantage contracts (usually a PPO or HMO) are Medicare alternatives issued by insurers.

Listed below are 2017 policies offered to persons under age 65:


Bronze Tier 

Health One Bronze 7150 – $7,150 deductible with 0% coinsurance. Once deductible has been met, covered benefits are paid at 100%. This plan is the least expensive Premier option.

Health One Bronze 6550 – $6,550 deductible with 0% coinsurance. Similar to previous plan, but with lower deductible and maximum out-of-pocket expenses.

Health One Bronze 6250 – $6,250 deductible with 45% coinsurance. Primary-care physician (pcp) office visit copay is $50, although specialist office visits must meet deductible. Generic drug copay is $21.

Health One Bronze 6500 – $6,500 deductible with $7,150 maximum out-of-pocket expenses and 40% coinsurance. Pcp office visit copay is $40, but specialist visits must meet coinsurance and deductible. Generic drug copay is $21.


Silver Tier

Health One Silver 5000 – Least-expensive Silver-tier plan (by only a few dollars) features attractive $25 and $50 office visit copays, with $75 Urgent Care copay.  Deductible is $5,000 with  30% coinsurance. Low-cost generic and generic drugs subject to $5 and $20 copays only.

Health One Silver 3000 – $50 pcp office visit copay with $75 Urgent Care copay. Specialist visits, however, must meet deductible and coinsurance. $3,000 deductible with $7,150 maximum out-of-pocket expenses and 20% coinsurance. Prescription drug benefits are identical to previous plan.


Gold Tier

Health One Gold 1500 – $1,500 deductible with low $10 and $40 copays. $12 generic drug copay. 10% coinsurance with $5,500 deductible.

Partnership With CVS Pharmacy

Premier Ohio Health Insurance And CVS Pharmacy

Premier And CVS Working Together

Premier customers can utilize prescription counseling, monitoring of chronic disease, electronic records, and several wellness programs at CVS and MinuteClinic locations. Providing a current identification card will allow access to many additional services at the more than 7,000 locations throughout the US.

There are nine CVS stores located in the Dayton area with possible future expansion within the next five years. The nine stores are located in Union, Trotwood, Oakwood, Moraine, Miamisburg, Kettering, Centerville, Huber Heights, and Germantown. The emphasis on outpatient treatment should become more noticeable in these locations.


How To View Rates

Our website is considered by most consumer watch groups to be one of the most reputable and reliable resources for providing health insurance prices in Ohio…both on and off-Exchange. We feature a “free quote” box at the top of every page that is available at any time. You can also call or email us if you would prefer a more personal response.

Plans are available both “on” and “off” the Marketplace. If you qualify for a subsidy, “on” policies will be your best choice. However, if your total household income exceeds the benchmark needed for subsidy qualification, an “off” policy should be considered. We’ll show you the best of Premier’s portfolio along with any other company that can offer an equally or more competitive product.


Premier’s Ohio Medicare Advantage Plan

For Seniors, a single plan provides benefits for Medicare Parts A,B, and D. The insurer contracts with Medicare to provide benefits. Alternatively, a Medicare Supplement policy may be purchased which complements, but does not replace Medicare. Shown below are specific details.

Health Advantage HMO – Monthly premium is $0. The maximum out-of-pocket expense is $3,900 for all Medicare-covered benefits. Copays are $10 and $40 for primary-care-physician (pcp) and specialist visits respectively. Urgent Care and ER visit copays are $40 and $75. Inpatient hospital expenses are $250 per day for six days $295 for acute mental health).

Skilled nursing facilities are covered with no copay for the first 20 days. However, for the next 80 days, the copay is $160. Outpatient rehab costs just $40 while an outpatient procedure costs only $275. An ambulatory surgery center visit is an included benefit with a $250 copay. Durable medical equipment is covered at 80% while Diabetic supplies have a $0 copay.

Lab services ($10) and x-rays ($15) are only subject to small copays, while a $200 service fee applies to MRIs, MRAs, PET scans, and radiology CT scans.

Preventative visits are always covered at 100%, and like many other Advantage contracts,  one free annual  eye exam is included. Additional exams are subject to a $40 copay and $100 is allocated each year for frames and glasses. Dental benefits include one routine oral exam, fluoride treatment and an x-ray with no out-of-pocket cost.


Group Medical Coverage

Employer-provided medical plans are also available. Customized coverage specializes in developing a close relationship among physicians, specialists, and their patients. The most current techniques, technology, and information is used to allow business owners to provide comprehensive benefits at a price both business and employee can afford.

Both HMO and PPO plans are offered along with or without with high-deductible Health Savings Account options. Generic and Brand medications are covered with access to most local pharmacies, such as Walmart, CVS, Sam’s Club, Target, Rite Aid, and Kmart.


October  2014 – MediGold Medicare Advantage policies will no longer be accepted by Premier. Notification was sent two weeks ago to all impacted policyholders. Since Open Enrollment has just begun, affected customers can shop and apply for a plan with another carrier without answering any medical questions. Acceptance is virtually guaranteed.

One of the reasons for the change is that their own Medicare Advantage contract will be offered beginning in 2015. A per-capita payment is made by the federal government to help administer and manage claims,billing, and benefits.

November 2014 – Premier and CVS Health will be working together with the integration of  pharmacies in the provider network for 2015. CVS  MinuteClinic walk-in clinics will also be part of the network. Collaboration will also take place with improved and updated electronic medical record information.

Customers will notice medication counseling and management of chronic disease as two areas that are impacted immediately.  It’s also possible that the new merger will also reduce the cost of prescriptions to current and future policyholders.

December 2014 – 2015 prices have been released and plans are very competitively priced in Montgomery, Warren, and Greene counties. The “Silver One 3500” plan is one of the most  attractive options, and along with Molina and Ambetter, gives consumers in the area many affordable choices. The higher-deductible “One Bronze 5500” plan is one of the cheapest available policies, especially for persons over the age of 50. Typically, Premier offers plans that are less expensive than Anthem, Medical Mutual, Aetna, and UnitedHealthcare.

February 2015 – About 2,000 customers purchased Premier plans for 2015.  Considering that policies are only available in a handful of counties in the Dayton area, the number is quite impressive. It’s expected that next year, quite a few more members will enroll in coverage. 2016 policy designs are not released yet, but may involve slight changes.

October 2015 – Welcome TriHealth! Starting the first of the year, their physicians and facilities will be considered “in-network.” This will increase the number of total Commercial providers to more than 3,000.  Business Value and HealthOne customers will now have access to many more choices. TriHealth began operating in 1995 and is now the 4th-largest employer in the Cincinnati area. Good Samaritan and Bethesda Hospitals are the cornerstones of their network.

November 2016 – Premier has slowly expanded their provider network towards Mason, Loveland, and West Chester.

March 2017 – Premier has a new President! Welcome Renee George, who replaces Josh Martin, who served as President since 2015. George has worked for the hospital since 2008.