How To Compare Ohio Health Insurance Exchange Plans

The Ohio Health Insurance Exchange is here. Pre-existing conditions are now covered and Open Enrollment has commenced.Through a combination of federal legislation, tax law changes and a total overhaul of the type of available medical coverage you can buy, Obamacare has arrived.

The Marketplace helps some persons and hurts others. If you qualify for a financial subsidy, you're likely to be very satisfied with your premium. If your household income is more than $100,000 per year. it's possible your premium will increase, and perhaps substantially.

But what does that mean for Ohio residents? We'll tell you how to best understand and adjust, and what benefits will help you the most. We'll also explain how you qualify for the new federal tax subsidy and how you can maximize those savings by selecting specific plan choices.

What Is The Exchange? 

Pre-Existing Conditions Are Covered

It's actually a "Marketplace" for consumers where you buy affordable healthcare. Well...not "affordable" for everyone. But if you can qualify for a federal subsidy, your cost will be low. If you make too much money to receive a subsidy (or a significant portion of a subsidy), the price may not be right.

Although Open Enrollment ends on April 1, you can still qualify for special situations that allow you to receive a subsidy, even if you attempt to enroll after that date. For example, divorce, job termination and a dependent turning 26 could qualify for a special enrollment. There are also additional situations that will allow you to purchase a Marketplace plan regardless of the time of year.

However, you can also buy coverage "outside" of the Exchange. This may be an attractive option if you make too much money and can't qualify for a subsidy. Prices on these plans are competitive and the actual number of network providers (doctors, specialists, hospitals and medical facilities) may be more extensive than "inside" plans. UnitedHealthcare, for example, offers plans off the Exchange, but does not participate with "on" Exchange plans. The same is true with Aetna in our state.

How Is It Different Than Before?

Perhaps the biggest difference is that you can not be denied coverage for a pre-existing condition. Cancer? Heart Disease? Diabetes? Multiple conditions? It won't make a difference since insurers must insure all applicants.

As previously mentioned, financial aid is offered to persons who have household income between 100% and 400% of the Federal Poverty level. For example, for a family of four (two adults in their 50s with two teenagers), a subsidy is credited if the total income is less than $95,000. Of course, a single person could make much less and still qualify for the subsidy.

Plan availability is much different. Instead of picking among dozens (and often hundreds) of different policy options, there are four "metal" plans. Platinum, Gold, Silver, and Bronze are the benchmark policies and are differentiated by cost and out-of-pocket costs. A "Catastrophic" option is offered to young persons under age 30, and some older adults that have special financial needs.

For example, the Bronze option is the cheapest, but will also cover the least amount of medical expenses for larger claims. As long as you rarely utilize your coverage, this plan may be ideal. But if you have ongoing conditions that require expensive treatment, it may not be the best option, since you are expected to pay approximately 40% of anticipated medical expenses.

Conversely, Platinum plans are the most expensive, since you take the least risk. If you are in excellent health with no pre-existing conditions, this may not be the best choice for you. If you did develop a chronic illness throughout the year, you can switch to a more appropriate choice during Open Enrollment, which will take place the end of every year.

What's Special About The Silver Plan?

The "Silver" option allows the individual or family to dramatically reduce deductibles and copays, based on household income. This special "cost-sharing" does not impact any other benefits of the policy. It's a great way to reduce out-of-pocket expenses for a fraction of the cost of purchasing another "Gold" or "Platinum" plan.Ohio Metal Plan information can be found by reading this article that we edited and constantly update.

Here's an example:

We'll create a family of four that lives in Butler County (between Dayton and Cincinnati). Each spouse is 40 years-old and there are two children ages 10 and 14. The total household income is $47,000 which generates a monthly federal subsidy of $468. This means that $468 is deducted from the monthly cost of coverage.

The Humana Connect Silver 4600 plan cost approximately $178 per month ($646-$468 subsidy). The deductible is typically $4,600 and the maximum out-of-pocket expense is $6,350 per person. But because of the "cost-sharing" benefit earlier mentioned, the deductible amounts reduce to $900 and $1,450 respectively. That's the power of the "Silver" plan.

2014 Federal Poverty Level Guidelines

In fairness, this example assumed a household income between 150% and 200% of the Federal Poverty Level, and thus, qualified for an 87% level of reduction. Higher incomes could generate lower levels.

Buying Health Insurance In Ohio After Open Enrollment Ends

Yes you can! Many of the big reputable companies offer various policies that can be easily purchased. Perhaps the most common (and ironically, the cheapest) is a short-term plan from UnitedHealthcare. Marketed under the "Golden Rule" brand name, it's the cheapest medical coverage option you can purchase, and approval often takes less than 24 hours.

OK...Is there a catch? No"catches." but pre-existing conditions are not covered and you can only keep a policy for up to a year. But that will give you plenty of time to catch the following year's Open Enrollment.

Also, if you qualify for a special event, which includes divorce, child reaching age 26 and many other situations, you can apply for Exchange coverage and receive the federal subsidy and select an Exchange option.

Top Ten Tips To Get The Best Healthcare For The Lowest Price

Get the best healthcare for the lowest price. That's what we would all like to do. Affordable health insurance from top-rated companies is possible. Our Top-10 tips will hopefully make it easier for you to find quality medical coverage.

Utilize the free services of an experienced broker/agent. Believe me, it will save you time and money (and frustration), as you compare the best plans online in minutes and receive clear unbiased advice. The broker should represent multiple carriers, not just on company.

If your household income is under $95,000, you may be eligible for a federal tax subsidy during Open Enrollment later this year (October). This tax break could easily save you thousands of dollars each year so don't leave it on the table. Also, if your income exceed what you projected in the previous year, you may have to pay some of your tax credit back to the IRS.

Consider buying policies "outside of the Exchange." If you don't qualify for federal tax credits, it may be worth considering. Anthem and other carriers are expected to offer options that re not officially part of the new Marketplace.

The Bronze medal plan will be the least expensive policy offered in every state. Yes, you do have to pay the highest projected percentage of your expected expenses (40%). However, if you are in excellent health, it will save you thousands of dollars each year. If your health suddenly changes, you can switch to a different policy during the annual Open Enrollments.

Baby Well-Checks Are Covered at 100%

Remember that most preventive services are free. You don't have to wait 30 days or meet a deductible. Regardless whether it is a child or an adult, there are may benefits that can be utilized, and all are designed to keep you in good health!

Don't be afraid of higher deductibles. Yes, a $10,000 deductible is very high, but a $5,000 deductible, compared to a $1,000 or $2,500 option is likely to save you premium dollars over the length of time you have coverage. Review the differences, understand the risk and you will be rewarded.

Eat your vegetables. Sorry. I had to slip that in there. I can't tell you how many times I was told that, so I had to mention it. And admittedly, I hate broccoli.

Negotiate with your provider. Yes, you can do that. For example, if you have an MRI scheduled at a hospital, the retail cost could easily be in the $3,500 range. Your insurer's provider discount could reduce that amount to about $1,500, which is still a large amount, especially if it is subject to a deductible.

Your next step is to locate a stand-alone facility (make sure it's reputable) and request their pricing. You may be shocked to learn that your MRI may only cost $500-$900, including the reading. Assuming it's the exact same MRI, that's a lot of savings.

Join a Fitness Club, YMCA or other exercise-related facility. Many insurers will pay for up to 25% of your annual membership fees every year. Although, the annual reimbursement is often capped between $250 and $500, it's free money to you!

Don't be afraid to change policies during Open Enrollment. As your personal medical profile changes, you may need to adjust the type of benefits you have. You don't want to pay for benefits you don't need, but you also don't want to miss adding benefits that you can utilize.

Who Are The Best Health Insurance Companies In Ohio?

Finding the best health insurance companies in Ohio depends on the criteria that is used. Lowest rates? Fastest at paying claims? Quickest to approve policies? Cheapest Exchange options? Most physicians and providers in their network? And I could probably add about 50 additional factors.

Since I have been a broker for more than 33 years, my insight may be better than most others. I will offer you my unbiased opinions and ratings regarding different sets of criteria. As you will see, there is clearly more than one correct answer since there are many reputable and reliable Ohio health carriers.

Lowest Rates

Actually, it depends what part of the state you live in and the type of policy. But generally, Medical Mutual has very strong prices in the Cincinnati area for most types of plans. In the Central part of the state, including Columbus and Dayton, Medical Mutual, Anthem And UnitedHealthacre (Golden Rule) have solid rates. UHC is especially strong in Franklin county.

Preventive Care Is Covered at 100%

In the northern portion of the state, including Cleveland, Akron and Canton,  any of the three carriers previously mentioned will be in the mix. Kaiser and SummaCare would also have to be considered. Having the Cleveland Clinic in close proximity probably helps area prices.

Healthspan is offering plans on the Exchange and can be considered in the upper half of the state. But they also are offering competitive prices south of I-70, assuming your physician is a member of their Network.

However, for temporary plans anywhere in Ohio, UnitedHealthcare is usually the best choice. Underwriting is quick (less than 24 hours) and completing the application takes less than 20 minutes. These policies are not ACA-compliant, so you may pay a special tax at the end of the year if you did not secure alternative coverage.

HSA prices are typically the lowest with Medical Mutual or Anthem. Humana, however, has a low-priced Silver Metal plan that can be purchased on the Exchange. In most areas of the state, it is one of the best HSA options offered.

Best Plans

Getting a great price is always preferred but if your coverage is lousy and simply excludes all the benefits you need, it's not a very attractive situation. Fortunately, all non-temporary policies will pay for your qualified preventive benefits. Not just 80%. But 100% with no waiting period or deductibles to meet. This feature was  enacted as part of  "The Affordable Care Act," and will continue in 2014 and beyond.

The extent of your office visit and prescription coverage depends on the policy you select. Many plans offer unlimited visits (specialists included) with small copays. Other less expensive plans will cost less, but cap the number of covered visits to three or four (and sometimes two). But the savings often makes theses types of offers a "good deal." If you make the wrong decision regarding the selection of plans, an Open Enrollment allows you to switch coverage regardless of any health issues.

The HSA

An Ohio HSA is always an option that should be considered if there are relatively few (and minor)medical conditions, and you don't have a history of over-utilizing your healthcare coverage. Although the risk exists of high out-of-pocket costs if you suddenly need some expensive treatment, it is often offset with the savings accumulated inside the policy from previous years.

Ohio HSA Rates Are Very Low

Just as importantly, you have a "friend" that is looking out for you by negotiating substantial discounts/repricing on the services you receive.  And the savings is not going to be minuscule. Expect major savings from your friend...the insurance company!

For example, suppose you needed physical therapy for a shoulder injury. Typically, there would be an initial consultation followed by two-eight weeks of treatment, depending on the severity of the injury.Every hour of treatment would cost approximately $500-$900, depending on the facility.

With an HSA, your insurer would authorize approximately 50%-60% of that amount so your obligation would be heavily discounted. This type of plan will be very popular with the Ohio Health Insurance Exchange (Marketplace) in 2014. The only variable will be which carriers choose to participate and which ones elect to sit out.

Summary

As you may have surmised, the question of "who is the best" does not have just one answer. If you're single and living in Akron, it may be one answer. If you're married with children (No...Not the TV show!)and living in Portsmouth, it may be another carrier. Each situation is different. Only an experienced broker and their website can determine which Ohio health insurance companies are best for you. And that's what counts.