Finding quality, affordable health insurance coverage in Ohio is one of the most important things you can do for yourself and your loved ones. But where do you start? There are so many options that it can be hard to choose. Luckily, you found this page. We’re going to discuss some of the best health insurance options that are available to Ohio residents today and help you figure out which one can get you the best care for the best value. So if you’re ready to learn more, just keep reading.
Major Medical Insurance in Ohio
Most people, when searching for health insurance in Ohio, typically settle on a major medical insurance policy either through their employer or through the Health Insurance Marketplace. The Health Insurance Marketplace has been around since about 2014, 4 years after the Patient Protection and Affordable Care Act was passed into law in 2010. But just so you know, the law has changed several times in the last several years. The coverage you’ve applied for in years previously, if you have gone to the Health Insurance Marketplace, may not be the same as the coverage you are applying for right now.
Because Ohio does not have its own at state-run exchange, it relies on HealthCare.gov in order to help its citizens register for coverage on the federal Health Insurance Marketplace. Open Enrollment starts every year on November 1st, and usually lasts until December 15th. This date does sometimes change, however, based on demand. Outside of open enrollment, you may qualify for a Special Enrollment Period under certain circumstances. Some of these circumstances include things like the birth of a new child or moving to a different zip code.
You should understand the major differences that make major medical coverage special before you decide on whether to purchase through the marketplace or to go with another option. The first and most important difference is the fact that these insurance policies are guaranteed issue. With guaranteed issue insurance, once you get your application approved via HealthCare.gov, you cannot be rejected for any coverage available for sale through the Health Insurance Marketplace. This is true, regardless of your health status or whatever pre-existing conditions you might have. You also cannot be charged more for your monthly premium just because of pre-existing conditions, either. As a matter of fact, only these four factors can alter the cost of your monthly premium:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
The next good thing about major medical through the ACA are the guaranteed benefits. There are 10 of them in all, and they are most often referred to as the Essential Health and Wellness Benefits which are guaranteed as part of the ACA legislation. Most medical experts agree that offering customers these health benefits is how you give them the best care over the long haul, and keep medical costs down with access to preventative care like bi-annual checkups or mental health services. Here are the 10 benefits guaranteed with major medical coverage:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Of course, being guaranteed issue and offering so many benefits can make these insurance policies cost a lot more than most other insurance. But thanks to federal subsidies, these insurance policies are actually highly affordable for most working families. But it largely depends on your income. If you happen to be making at least 138% of the federal poverty limit, then you will likely qualify for a premium tax credit that can make your monthly premiums much less expensive. But you will still be responsible for out-of-pocket costs like co-pays, coinsurance, and any deductibles that apply to your plan. The chart below can help you figure out how likely you are to qualify for subsidy.
|Household Size||Annual Income (138% of FPL)|
For those who make less than 138% of the federal poverty limit, you may have the option to apply for Medicaid in the state of Ohio. Medicaid is one of many states which adopted the federal Medicaid expansion and accepted Federal funding so that the neediest people in Ohio could get affordable health care coverage. But there may be additional qualifications aside from being low income that you need to meet in order to apply for Medicaid in Ohio. Before you apply, make sure you visit the Ohio Medicaid website and follow their directions for applying for Medicaid in the state of Ohio.
Short Term Health Insurance in Ohio
Legislators in Ohio have not made any efforts to regulate short-term health insurance products within the state. Because of this, short-term health insurance gets to follow federal rules, which are much more relaxed than they are in some other states. For people who want short-term health insurance in Ohio, you have the option to purchase a short-term health insurance plan for up to 364 days with the option to renew for a maximum of three years.
But there’s a catch. When you apply for your policy, when you renew it after the initial 364 days, and at certain points thereafter, you will have to undergo medical underwriting before your insurance policy chooses to continue or approve you for coverage in the first place. Medical underwriting is the exact opposite of guaranteed coverage: your insurance company can reject you for coverage if they believe you are too ill or if you have too many pre-existing conditions. Short-term health insurance companies don’t like to insure people with pre-existing conditions because you will likely require more medical care, and cost them more money, eating into their profits. If they don’t reject you for coverage, they may charge you more for your monthly premiums based on your current health status. You may also have to deal with high out-of-pocket deductibles which must be paid before your insurance company starts paying out for your medical care; these deductibles can range into the thousands of dollars or more for some insurance policies. But the good news is that these plans usually cost about 1/3 less compared to unsubsidized major medical coverage through the Health Insurance Marketplace, and come with solid consumer protections. So if you cannot get Marketplace coverage, those are the reasons why short-term health insurance could be a good option for you.
Christian Health Plans/Health-Sharing Plans in Ohio
A few years ago, Christian health plans – also sometimes referred to as health share plans – were much stiffer competition for short-term health insurance. This was mostly due to the existence of the individual mandate on the federal level. But this mandate which required every tax-paying American to purchase qualifying health coverage or pay a financial penalty was no longer a requirement as of the beginning of 2019. This means health share plans are in a much more level playing field with short-term health insurance, but there are some important differences between the two that you need to know before you choose between them.
Let’s start by briefly going over all of the things that short-term health insurance and health share plans have in common:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed essential health benefits
Another good thing about Christian health plans is that they are priced competitively with short-term health insurance – but they do not come with the consumer protections that short-term health insurance does. And there is no legal contract between you and your health share plan provider. So you must hope that they honor their faith and their word that they will pay out your claims as described in your plan. If not, you likely won’t have any legal recourse. But you will have to follow certain participation guidelines like declaring a specific religious faith, attending a specific church, abstaining from tobacco use, or other provisions based on good biblical or health practices. And you’ll have to get used to slightly different language. Health share plans charge you a “monthly share amount” instead of a monthly premium; in that same vein, they charge a “personal responsibility amount” or an “unshared amount” instead of things like co-pays, deductibles, or co-insurance.
Fixed Indemnity Plans in Ohio
Fixed indemnity plans usually work better as a supplement – but with the federal mandate coming to an end and no requirements to purchase major medical coverage, some people may be thinking about purchasing fixed indemnity coverage as a replacement for major medical. This might not be the best idea. Major medical coverage is guaranteed to cover a certain fixed percentage of your total medical costs no matter what. Fixed indemnity plans, on the other hand, pay out a fixed total amount of money instead. They usually pay out on a per day, per week, per month, per visit, or per event basis. If you’re lucky, you may be able to find indemnity plans in your area that cover hospital care, doctor visits, or even some dental procedures.
Like many of the other options we have discussed so far, fixed indemnity plans are not guaranteed issue – so you will be subject to medical underwriting. You could get rejected for coverage because of this, or you could get charged more for your monthly premiums due to pre-existing conditions. You also won’t have any limits to your total out-of-pocket costs with a fixed indemnity plan – but you will have to put up with both annual and lifetime benefit caps if you require a significant amount of medical care. But one good thing about fixed indemnity plans is that you don’t have to restrict yourself to a PPO or an HMO network like you would with most major medical insurance – you can see any doctor or visit any hospital you want without being charged full price. So this can at least give you some more flexibility and choice, which is why these plans are so popular both as a supplement or as a back-pocket, rain-day type of medical insurance coverage for healthy people that don’t want to be surprised by sudden medical expenses.
Discount Cards in Ohio
Then there are medical discount cards. However, if any medical discount card providers try to convince you that these are a replacement for major medical coverage, beware. This is simply not true. At best, they can give you a modest discount off your out-of-pocket costs when you pay at the register. There won’t be any claims for you to file, and you won’t be reimbursed for any of your medical expenses. Most of the time, it works the same way it does for any other discount club: you pay a membership fee, you receive a card in the mail, and you present that card anywhere that those specific discounts are accepted. But some companies may exaggerate the benefits you are eligible for in order to convince you to pay a membership fee and then not deliver on their promises. So be on the lookout for scams like that as you shop around for a medical discount card.
A lot of the time, medical discount cards usually provide you with savings on your prescription drug purchases. But this isn’t always the case. Sometimes these cards can be used to save money on doctor visits, eye doctor appointments, or even some dental services. But you have to do your research before you decide to purchase one of these cards (in case you can’t find any that are available for free near you). You may have to sit down and do a little math to figure out whether paying the membership fee can save you more money in the long run if you are eligible for enough discounts. You also might want to call ahead to the listed providers just to make sure they actually do business with the company offering your medical discount card. If you manage to do all of this and find out that your medical discount card is a good value after all, then it’s definitely a good idea to lower your out-of-pocket medical expenses by taking advantage of such an offer.