Who are the major Ohio Under-65 and Senior health insurance companies?

Many carriers offer competitive rates, including Anthem Blue Cross, Aetna, United Healthcare, Humana, Summacare, Ambetter, Cigna, Oscar,  and Medical Mutual. Other participating companies (not all) in the Buckeye State include Molina, , CareSource, Aultcare, Paramount, Manhattan Life, Medico, Transamerica, AARP-UnitedHealthcare, Medico, Cigna, Oxford Life, Mutual Of Omaha, Accendo, Manhattan Life, Assured Life, Sentinel Security Life, and United American.

What if I only need coverage for a few months?

An Ohio “short-term” policy might be your best option. Premiums are substantially lower than conventional policies and guaranteed coverage is available up to 12 months. Applications are brief, and often approved within 24 hours. UnitedHealthcare (also known as “Golden Rule”), IHC, and National General  offer very low pricing. Office visit and prescription drug coverage can be added to most policies. Urgent Care and online telemed visits are often not subject to a deductible. Note: National General utilizes the Aetna PPO Network.

Temporary policies are not Exchange or ACA-compliant. Therefore, although premiums are low, and coverage is available outside of Open Enrollment periods, some gaps are present. Also, instead of unlimited lifetime benefits, a cap of $250,000 – $2 million is offered, depending upon the plan and insurer. Benefits can be approved within 24 hours, although applicants with major health conditions (cancer, heart disease, or rheumatoid arthritis) will likely be declined. Applicants between jobs, and persons that missed the regular Open Enrollment period are suitable candidates for coverage.

What are the Exchanges?

The “Exchanges,” also known as a “Marketplace,” became available seven years ago. It is one component of the “Affordable Care Act,” which was the overhaul of the US healthcare system. Some of the changes included the elimination of medical underwriting (other than smoking status) and the addition of tax-credit subsidies that could potentially reduce premiums, depending upon your household income. You are no longer legally required to obtain healthcare benefits. A tax penalty will not be assessed if you are uncovered. Previously, the tax was as much as 2.5% of the household income. This tax was eliminated three years ago.

Policy choices are limited, since you only choose between four basic levels – Platinum, Gold, Silver and Bronze. However, there are some variations of each level that we will later explain. And several additional benefits are mandated (meaning that they must be included), which raises the cost for many persons that don’t qualify for the federal subsidy. Persons that are eligible for Medicare or Medicaid typically will also not qualify for a subsidy. However, Medicaid-eligible applicants can purchase coverage, although the rate will be higher than enrolling in Medicaid.

How Do I Buy A Policy Through The Ohio Exchange?

The process is simple. You can continue to use our website as your primary source of information, quotes and applying. We utilize a special enrollment link that allows you to compare plans, calculate your subsidy, apply for coverage, and get approved in approximately 15-25 minutes. We can upload documents and provide proof of coverage, if needed.

There are no medical questions, and we help you calculate the amount of federal subsidy you will receive to lower your premium. Since financial aid is income-based, you could receive $0 to $15,000. The subsidy is issued as an instant tax-credit, and is immediately applied to your premium.

If your household income is below 138% of the federal poverty level, you may be eligible for Medicaid. For example, if you are 55 years old and make less than $15,000, your cost would be very low because of your Medicaid eligibility. It is possible that your household income will change from one year to another, and thus your eligibility may change.

NOTE: Since the amount of financial subsidy is based on your household income, if you anticipate a large change for an upcoming year, modifying your information may save you a large tax bill the following year. Otherwise, a projected tax refund will be reduced to pay for the excess funding you received. Throughout the year, you can request to increase or decrease the subsidy, based on anticipated changes in income. Dependent income must also be included in the calculation.

What is “catastrophic” health coverage and should I consider it?

“Catastrophic” plans are designed to cover major medical expenses, such as hospital visits, surgical expenses and emergency room charges. Ohio premiums are quite low, but office visits and prescriptions are generally not covered. For healthy individuals and families, this type of coverage can potentially save a substantial amount of money and is worth considering.

During Open Enrollment, several carriers offer this type of plan. Federal subsidies are not offered, and applicants must be under age 30, unless financial hardship can be proven. However, many non-Exchange (not qualified) options are available, including stand-alone plans for children.

A common catastrophic plan is a “High Deductible Health Plan,” (HDHP) which works with a Health Savings Account. Preventive benefits are fully covered by the carrier, and additional tax savings is part of the contract. Several popular options (under age 30) include Aultcare Catastrophic, Medical Mutual Market HMO Young Adult Essentials, Oscar Simple Secure, and SummaCare Value.

Are Medicare Supplement Plans Available? 

If you have reached age 65 and are eligible for Medicare, enrolling in a Medigap plan should be considered. Many Senior plans are offered, including high-deductible Plan F and more comprehensive options. Many major carriers offer coverage, and no medical questions are required to be answered at designated times. Often, it’s a very cost-effective method to reduce out-of-pocket medical expenses.

Which Cities Have The Lowest Rates?

Generally, although there are exceptions, many northern counties (Cuyahoga, Lake, Summit, and Trumbull) have higher prices than many counties in the south (Warren, Clermont, Greene, Butler, and Clinton). Often, the cost of medical procedures and general treatment is higher in specific portions of the Buckeye State. This can also impact the cost of Medicare Supplement plans and other products. Two of the state’s largest areas (Hamilton and Franklin Counties) also feature very attractive prices.

What is a PPO?

A PPO is a “preferred provider organization” that negotiates lower rates with groups of doctors, hospitals and other providers. Membership in the PPO provides a substantial discount below their regularly charged rates. Most Ohio companies offer PPO policies, and they are the most popular type of option.

In most parts of the state, there are many available network providers. Anthem has the largest number of providers, followed by Aetna and UHC (Golden Rule). With most plans, you can still be treated “out of network,” although you may have to pay more. Previously, Humana expanded their network (ChoiceCare), which includes more than 500,000 physicians and other practitioners. Carriers that don’t currently offer private individual medical coverage, use their networks for group, Senior, and ancillary coverage.

Will my pre-existing condition be covered?

If you are under age 65 and apply for coverage during an Open Enrollment period (assuming you are purchasing an on or off-Marketplace policy), they will be covered. No extra copay, deductible, coinsurance or waiting period will be applied to the condition. Also, the rate you pay will not be dependent on any aspect of your medical history.

This includes any past, present or projected future condition or procedure. However, most plans have built-in copays and deductibles, so it is still likely that you may incur out-of-pocket costs with your condition. For example, if you are an insulin-dependent diabetic, many Bronze and Silver-tier plans will place deductibles and higher coinsurance on non-generic drugs. Platinum-tier plans may offer lower deductibles, but are not available in all areas.

How much do I have to pay to use this Web service?

There is no cost for our services, and we never charge any fees. We also guarantee that you will receive the lowest allowable premium since the  Department of Insurance regulates rates. And our free service continues after you purchase a policy. When you transition to Medicare or Medigap coverage, we will continue to review products and rates in your area. Each year, new options may become available.

Can I buy a customized Ohio health insurance policy?

Yes, you can. Once we have determined the type of plan you want, we can create a personalized recommendation that features the deductibles, copays and premium that you want. We’ll make sure that your doctors are network-approved, and the company is highly-rated. The benefits and rate will match your needs and budget. Households that qualify for federal subsidies may be able to take advantage of “cost-sharing” Silver-tier plans that provide lower deductibles and copays.

How long do I have to keep my policy?

Fortunately, every policy allows you to cancel the plan at any time. Whether you need coverage for one month or 20 years, you are never required to keep the policy any longer than you need. Cancellation is quick and easy, and refunds are promptly returned by the insurers. Typically, there are no extra charges or fees for early-termination of a policy.  Before terminating a plan, it’s important to understand what alternative options are offered, and how they may differ compared to the policy you are ending.

I already have health insurance but my rate keeps increasing. Should I change?

If you are in good health and there is a substantial savings by purchasing a new policy, it may be advisable to apply. However, it is imperative that you do not cancel the existing policy until you have been approved and have had ample time to thoroughly study the new offer. Also, Open Enrollment restrictions must be considered.