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US Government Will Take Over State High Risk Program

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The US Government will take over Ohio’s high  risk health insurance program administered by Medical Mutual. Initially, the special “pool” was created to assist persons that could not obtain healthcare because of medical issues, or were not eligible for Medicare or Medicaid. More than 3000 state residents are currently covered under these “risk pool” plans. Although prices are high, provided benefits pay for most expenses.

But unfortunately, in most states, the amount of money provided to fund the program ran out, since the number and dollar amount of submitted claims was much higher than anticipated. Here in Ohio, the request for financial aid to save the program was denied by Kathleen Sebelius, the Secretary of the US Department Of Health And Human Services. Sebelius insisted that at least $10 million additional dollars be spent by the state.

As a result, it is likely that benefits will no longer be as comprehensive compared to the previous available policies. Network participation is expected to reduce, and out of pocket expenses,such as copays and deductibles, may be increasing. And since there are no alternatives until 2014, consumers in the “high risk” category will have to find a way to pay the extra money. It’s expected that a covered $100,000 claim could increase maximum out-of-pocket expenses between $1,000 and $2,500.

Medicare Not Affected

Get Guranteed Approved Ohio Healthcare

Ohio Children Health Insurance Is Still Available

Medicare recipients will not be impacted by this transition. The fraud unit will continue to monitor payments and other administrative activities in an effort to reduce the overall cost of service. Each year, hundreds of millions of dollars are wasted, and hopefully, more of these funds will be recovered. A small increase in the percentage of returned money will make a big difference.

Starting in October, Buckeye state residents can take advantage of Open Enrollment to the 2014 Guaranteed Approval plans. is a leading website resource for individuals and families to apply for coverage without paying any fees. The new US federal subsidy will also be offered to persons whose income is lower than 400% of the Federal Poverty Level (FPL).

Off-Exchange Options

Contracts will also be offered outside of the official Marketplace. Rates are expected to be released within the next 60 days and it is possible that these options will be very attractive to families with household incomes above $95,000 that do not qualify for tax breaks. Network provider lists (especially specialists) may be larger for plans that do not pay subsidies.

For persons that will be covered under the federal government starting the end of July, Medical Mutual will continue to administer their policies until that date. They will also assist in transitioning from a state-sponsored policy to a federally-sponsored policy. It is possible that many families will qualify for Medicaid coverage  at the end of the year since requirement are being loosened.

Ohio High Risk Pool Plans – Affordable Health Care Coverage For The Uninsured

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Medical Mutual Of Ohio has been selected by the Ohio Department Of Insurance to administer and manage the “High Risk Pool.” They will manage claims, handle the application process and provide customer service support. The Federal government has provided $152 million to subsidize costs that exceed premium payments collected by new enrollees. It is possible that there will be a waiting list if enrollment limits are met. A separate “Open Enrollment” option is also offered but rates are higher.

You should NOT apply for High Risk Pool coverage unless you have major health conditions. Since prices are significantly higher than standard rates, an underwritten contract is a better option if there are no ongoing medical issues.

The Ohio Risk Pool and Medical Mutual of Ohio, provide affordable healthcare to Buckeye State residents that have major pre-existing conditions and that have previously been denied coverage. The two available plans have no annual or lifetime limits and no exclusions. Also, out-of-pocket costs will be limited to comply with recent national healthcare reform.


To qualify for the Ohio High Risk Pool, some of the eligibility requirements include:

  • Ohio resident at the time you apply for coverage
  • Be without coverage for six months
  • Have a qualifying pre-existing condition
  • Not be eligible for coverage for Medicare, the Ohio Medical Assistance program,  CHIP program or individual/group coverage.
  • Be a citizen of the US and also reside in the United States.

Plan Details

Two plans are available with either a $1,500 deductible or a $2,500 deductible. Each plan includes prescription drug benefits, health and wellness coverage, office visit and prescription benefits, maternity services and emergency service protection. Network coverage is provided by Medical Mutual’s SuperMed Network, one of the largest groups of providers in the state. Whether you live in the Northern part of the state (Akron, Cleveland, Canton) or closer to Dayton and Cincinnati, many physicians, specialists, and hospitals are located within your service area.

Many preventive benefits are covered at 100%. Some of these coverages include routine medical exams, well child care exams, routine mammograms and pap tests and standard immunizations. Additional benefits include mental health and substance abuse coverage, home health care and maternity services. However, many non-preventive items are subject to a deductible.

Once a policy is approved, coverage will begin on the first of one of the following two months. The effective date depends upon when the application was received. Billing can be monthly, and at any time, a policyholder can cancel coverage. When applying for coverage, a check or money order must be submitted for the first monthly premium, along with the completed application.

If you do not have major health conditions, then you should NOT attempt to apply for this type of coverage. Instead, you should provide your zip code at the top of the page and compare the best available plans in your area.