Health insurance for children and young adults in Ohio is available for every budget and is easy to purchase. Preventive benefits and well-child visits are covered at 100% with no out-of-pocket expenses. The cost of coverage is very cheap compared to other types of policies, and broad doctor and specialist networks are available. You can compare the top-selling plans in the state when view your free quotes. Dependents can stay on a parent’s policy until age 26, if certain conditions are met. Children can also be added to a parent’s plan.
Many Ohio companies such as Medical Mutual, Anthem Blue Cross, UnitedHealthcare, SummaCare, Aetna, Ambetter, Molina, Oscar, CareSource, and Humana feature low-cost plans for young persons, either privately, through the Marketplace, or through employer-provided group coverage. CHIP and Medicaid also offer very inexpensive coverage, depending on your total household income. “Healthy Start” and federal subsidies will save money, and help provide comprehensive benefits. “Child only” plans are offered in all parts of the state.
In specific financial circumstances, you may not be able to afford a policy. If eligible, CHIP and Medicaid are two established programs that will provide coverage for a reduced or $0 premium. The typical policy includes preventive, prescription, office visit, major medical, ER, and hospital benefits along with dental. It is possible that the provider network for these programs will not be as robust as other private individual policies offered through the Marketplace. ER and Urgent Care visits will be much less expensive than conventional Exchange plans.
If you become eligible for Medicaid or CHIP, it becomes “qualifying coverage.” Marketplace plans offered will not be eligible for premium tax subsidies (tax credits). However, these Exchange plans may be purchased at the full retail rate.
Prices
Ohio individual health insurance rates for children are extremely cheap compared to other states. Using the least-expensive available Silver-tier plan, we have provided the total monthly rates to provide comprehensive coverage on a five-year old in the seven largest cities in Ohio. Households include a married husband and wife (both age 30) and one child, with $70,000 of income.We are assuming that no household member is eligible for Medicare.
In all cities, the cost of coverage will DECREASE when a dependent is added to the policy. The assumption is that the family is not eligible for Medicaid. Since the newly calculated federal subsidy exceeds the cost of coverage of the dependent, your monthly rates will reduce by the amounts shown below. Adding multiple children to a policy may result in larger decreases.
Dayton Area – $197 Decrease (Medical Mutual Market HMO 9450)
Cincinnati Area – $182 Decrease (Medical Mutual Market HMO 9450)
Columbus Area – $181 Decrease (Oscar Bronze Classic PCP Saver Select)
Youngstown Area – $175 Decrease (Medical Mutual Market HMO 9450)
Cleveland Area – $164 Decrease (CareSource Marketplace Bronze First)
Akron Area – $190 Decrease (SummaCare Bronze 8000)
Canton Area – $172 Decrease (SummaCare Bronze 8000)
Toledo Area – $177 Decrease (CareSource Marketplace Bronze First)
Sample Stand-Alone Children’s Health Insurance Rates In Ohio’s Largest Counties Ages 0-14 (Available Federal Subsidies Could Lower Premium)
Franklin County
$171 – Anthem Catastrophic Pathway HMO 9450
$171 – Oscar Select
$172 – Medical Mutual Market HMO Young Adult Essentials
$213 – Oscar Bronze Classic PCP Saver
$218 – Oscar Bronze Classic Standard Select
$220 – Anthem Bronze Pathway HMO 9450
$224 – Oscar Bronze Classic 4700
$228 – Anthem Bronze Pathway HMO 6000
$233 – Anthem Bronze Pathway HMO 7500/50%
$233 – Anthem Bronze Pathway HMO 5000
Cuyahoga County
$145 – Medical Mutual Market HMO Young Adult Essentials
$176 – CareSource Marketplace Bronze
$180 – CareSource Marketplace Bronze First
$192 – Medical Mutual Market HMO 9100
$194 – Oscar Secure
$195 – Medical Mutual Market HMO 8000
$201 – Anthem Catastrophic Pathway X HMO 9100
$203 – Medical Mutual Market HMO 7000 HSA
Hamilton County
$135 – Medical Mutual Market HMO Young Adult Essentials
$166 – Anthem Catastrophic Pathway X HMO 9100
$201 – Ambetter Clear Bronze
$204 – Medical Mutual Market HMO 9100
$207 – Medical Mutual Market HMO Standard Bronze
$207 – Medical Mutual Market HMO 8000
$209 – Anthem Bronze Pathway X HMO 9100
$210 – Anthem Bronze Pathway X HMO 9100/0% Standard
Summit County
$146 – SummaCare Value
$152 – Medical Mutual Market HMO Young Adult Essentials
$174 – Anthem Catastrophic Pathway X HMO 9100
$169 – SummaCare Bronze 8000
$182 – CareSource Marketplace Bronze
$183 – SummaCare Bronze 8000
Montgomery County
$130 – Medical Mutual Market HMO Young Adult Essentials
$154 – Anthem Catastrophic Pathway X HMO 8550
$172 – Ambetter Essential Care 1
$177 – Ambetter Essential Care 10
$186 – Ambetter Essential Care 2
Lucas County
$131 – Medical Mutual Market HMO Young Adult Essentials
$174 – Ambetter Essential Care 1
$177 – CareSource Marketplace Bronze
$179 – Molina Core Care Bronze 2
$179 – Ambetter Essential Care 2
Butler County
$128 – Medical Mutual Market HMO Young Adult Essentials
$169 – Ambetter Essential Care 1
$174 – Ambetter Essential Care 10
$177 – Molina Core Care Bronze 2
$179 – Molina Core Care Bronze 1
It is possible to obtain “free” medical coverage if your subsidy exceeds the cost of the policy. Depending on the number of dependents you list on your tax return and your modified adjusted gross income (MAGI), you could easily pay between $0 and $50 per month for your policy. Qualified preventative benefits are provided with no out-of-pocket expenses. The following preventative screenings and services are also fully covered under Marketplace plans without meeting a deductible, copay, or coinsurance:
Autism screening
Blood screening
Developmental screening
Fluoride varnish
Height and weight (BMI) measurements
Hemoglobin screening
Hypothyroidism screening
Immunization vaccinations
Iron supplements
Obesity testing and screening
Vision screening
Typically, Medical Mutual, Ambetter, Oscar, CareSource, SummaCare, and Molina offer the most competitive health insurance rates for children. However, each section of the state often has one or two plans that are uniquely price-competitive in that county. For example, SummaCare and Oscar offer very competitive prices in Northeastern Ohio. Oscar also offers plans in the Cleveland and Columbus areas. However, in other parts of the state, coverage is not offered.
Ambetter and CareSource offer plans in most Buckeye State counties. Larger companies, including Humana, UnitedHealthcare, Cigna, and Aetna, offer Medicare and/or Group plans, but not private child plans. Anthem offers plans in several counties. However, many of these companies offer dental or vision benefits, regardless of other existing business in the household.
“Catastrophic” plans are offered to applicants under age 30, or any applicant that qualifies for ‘financial hardship.” However, unlimited office visit coverage is typically not included, and non-generic and brand prescription drugs may have to meet a deductible. ER and Urgent Care visits may also have to meet a deductible. The most common deductible is $9,450, which is the highest allowed deductible for 2024 Exchange plans. The maximum family out-of-pocket expense is twice the deductible. HSA plans have slightly different requirements.
Health coverage for college students is offered by many schools and universities, along with participating carriers in the area. Rates will vary, and many universities do not offer coverage. Since children can remain on a parent’s policy until they reach age 26 (subject to certain conditions), often purchasing a new policy is not cost-effective. Employer-provided coverage may be available for full-time employees. If coverage is offered, an Exchange plan can be purchased, but typically, a federal subsidy is not available.
Low-Income Family Options
For low-income families, Ohio Medicaid offers two options for children to obtain health care. Healthy Families is available to families with income up to 90% of the federal poverty level. “Healthy Start” is available to families with income up to 156% of the federal poverty level. MAGI (Modified Adjusted Gross Income) is now used as the income criteria to determine eligibility for state and financial aid.
Children up to age 19 are eligible to apply. Up to 200% of the federal poverty level is allowed if a pregnant mother is a household member. The expansion of Medicaid in the Buckeye State has increased the number of eligible applicants. Office visit copays are very low (often $3 or less), with many additional benefits included (see below).
CHIP
CHIP is ideal if your income is too high for Medicaid eligibility, and you also can not afford to purchase private coverage. If you apply for CHIP, proof of income and citizenship is required. You can submit paperwork online, in person or through the mail. Uncovered children up to age 19 may apply for coverage with household income up to 206% of the federal poverty level.
Once approved, personal ID cards are usually mailed quickly, and your benefits will be active. You can cancel your coverage at any time and if you move to another state, it’s very likely you can keep coverage. However, a new primary-care-physician may have to be chosen since your provider network will change. Existing specialists and medical facilities may also have to be changed.
Covered CHIP benefits include routine check-ups, physician office visits (flu, virus, stomach virus, and more), ER, lab tests and x-rays, dental and vision coverage, inpatient and outpatient hospital treatment, and prescription drugs. Specific dental benefits include an oral health screening and examination every six months, x-rays (bitewing and full mouth), panoramic x-ray for children six years of age or older, fillings (silver amalgam and composite), stainless steel crowns, and root canals.
CHIP Dental benefits include cleanings (every six months), fluoride treatments (every six months), sealants, and space maintainers. Additional coverage includes oral health screenings, dental examinations, x-rays, bitewings, fillings, crowns, tooth caps, root canals, partial and complete dentures, retainers, braces, and surgical extractions. Silver amalgam and tooth colored composite fillings are covered, although no more than three restorations are permitted per treatment.
Stainless steel metal, metal/porcelain, and porcelain only crowns are covered, subject to policy copays and out-of-pocket maximums. Braces and retainers (above) are also covered with prior authorization.
Healthcheck
When a child becomes eligible for Medicaid, they will be entitled to Healthcheck services. Healthcheck covers 10 medical exams during the first two years of life, and annual wellness exams until age 21. The recommended ages for exams are 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. The program is also known as EPSDT (Early and Periodic Screening, Diagnostic, and Treatment Services). Treatment and equipment that is “medically necessary” is also covered.
By age three, annual exams should be performed. This government plan can also be transferred across state lines if you move residences. The five managed care plans available are through Buckeye, CareSource, Molina, Paramount, and UnitedHealthcare. It is possible that additional carriers can be added to the list. If you move outside of the Buckeye State, alternative companies will likely be available. If you move within the state, but to a different county, the county case worker should be notified within 10 days.
The purpose of Healthcheck is to utilize preventative services and find and diagnose potential medical problems before they become untreatable. Medicaid will pay for subsequent treatment and diagnosis, until the medical issue is resolved. The covered examination includes review of medical history, dental and vision screening, hearing and immunization assessment, lead and developmental screenings, and additional screenings, if needed.
PAST UPDATES:
As of September 23, many Ohio health insurance companies will NOT offer health care coverage to children under 19 that are not covered on their parent’s policy. President Obama’s health care reform initiatives have forced this change by the carriers that is making it much more difficult to obtain children’s coverage. Please call or email us for additional information.
As of September, all companies have eliminated plans that insure children only (under age 19). However, short-term plans are available. Rates are very low although all claims are subject to the deductible. It’s the best option at this time.
Assurant still offers a “short-term” plan that will cover children under age 19. Rates are very inexpensive but a deductible applies to all claims. With a favorable Supreme Court ruling next month, there is a slim chance that most insurers will begin to offer “child only” plans again.
The Supreme Court did rule favorably to impose a tax on consumers that do not purchase coverage in 2014 (and beyond). But you will have to wait until that time for a plan that covers a single person (only) under age 19.
Also, this month, the Centers for Medicaid and Medicaid Services offered more than $30 million of aid (in the form of grants) to reach out and make programs like CHIP and Medicaid more visible to parents of Ohio children that may be able to qualify. Proposals to distribute funds must be received by February 1st and the awarded money will be distributed around June 1. Outreach and enrollment is the goal.
During this year’s Open Enrollment, it’s estimated that about 300,000 persons in the state added medical coverage, with many obtaining CHIP or Medicaid benefits. Most hospitals are also reporting that a lower percentage of patients did not have existing coverage. This trend is expected to continue over the next few years.
Open Enrollment begins in 3 1/2 months and the application process will be more streamlined than last year. Through a combination of software enhancements from the Department of Health and Human Services, and increased functionality of the subsidy calculation software, we’ll have you covered quicker than ever before.
