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Everything You Need to Know about the Health Insurance Exchange in Ohio

English: US Citizens with Private Health Insur...

US Citizens with Private Health Insurance in %; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

Ohio now has its own  Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone. The Marketplace is mainly for:

  • People who don’t have insurance
  • People who aren’t insured by their employer
  • People with pre-existing conditions who may have had trouble getting insurance before
  • Small businesses

In Ohio, the federal government is running the health insurance Marketplace.

When You Can Enroll: October 1, 2013, to March 31, 2014. Coverage will begin in 2014.

Ohio Plans, Benefits, and Costs

Companies can offer four levels of plans: bronze, silver, gold and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here’s how it works:

  • Bronze Plan: You pay 40% and the plan pays 60%.
  • Silver Plan: You pay 30% and the plan pays 70%.
  • Gold Plan: You pay 20% and the plan pays 80%.
  • Platinum Plan: You pay 10% and the plan pays 90%.

Catastrophic plans may be available. These plans cost less up front, but they don’t give as much coverage. They generally require you to pay more out-of-pocket costs.

You must have at least a bronze-level plan to meet minimum requirements under the Affordable Care Act and avoid the penalty for not having health insurance.

Costs: Here are the average monthly premiums across Ohio for all age groups. Specific premiums will vary from these averages based on the region within the state, the specific insurance plan selected, and age.

  • Lowest cost bronze: $263
  • Lowest cost silver: $304

Tobacco Surcharge: Ohio allows insurance companies to charge tobacco users 50% more than non-tobacco users.

Who Is Selling Insurance in the Ohio Marketplace?  The companies that will offer coverage through the Marketplace were to be released October 1.

What’s covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Ohio, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care
  5. Mental health and substance abuse services
  6. Prescription drugs, including  generic and certain brand-name drugs
  7. Rehab services that help people recover from an accident or injury and those that help with developmental issues, including physical rehabilitation, speech and language therapy, applied behavioral analysis, and mental health services for children with a diagnosis of autism spectrum disorder.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions. This includes biofeedback and chiropractic care.
  10. Services for children,  including dental and eye care

Some services not included: infertility treatment, long-term nursing home care, and weight loss surgery.

Will These Benefits Be in All Plans? Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another.  Ohio allows substitutions, so make sure to read the summary of benefits of the plans to see if they include the coverage you need.

Financial Aid

You may be eligible for financial aid. Here’s what Ohio will offer:

Medicaid Expansion: Ohio has not yet decided whether to take part in the Medicaid expansion for low-income Americans.

Premium Subsidies (also known as Tax Credits): You may qualify for money to help pay your health insurance premium if bought in the Marketplace. The subsidy may be sent to your health insurance company. In general, you’ll be eligible if you’re single and make $45,960 or less a year, or if you have a family of four and make $94,200 or less a year. Depending on your income, you may also qualify for cost-sharing subsidies that will cut your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.

CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid.

Check with  Healthcare.gov to see if you are eligible for these programs.

Other Resources

  • Navigators will teach you about the Marketplace and guide you through your insurance decision. They are impartial helpers who cannot take money from insurance companies.  Here are the organizations approved to run Navigator programs and the expected amount of their federal grants:
    • Ohio Association of Foodbanks, $1,958,961
    • Children’s Hospital Medical Center, $124,419
    • Clermont Recovery Center, Inc., $44,938
    • Helping Hands Community Outreach Center, $230,920
    • Neighborhood Health Association, $684,630
  • Certified Application Counselors (CACs) work for community-based programs and will help you fill out insurance applications. In Ohio, the federal government will set up these programs.
  • Consumer Assistance Programs will help you understand your rights under the new law. They can help you with problems, complaints, and appeals.
  • A Call Center is available at 800-318-2596, twenty-four hours a day, seven days a week for information about your state’s Marketplace.
  • The Web Site is also available at HealthCare.gov.

Via WebMD.

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