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.
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.
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
Genetic Testing And Counseling
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.
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:
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.
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.
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 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.