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?
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| 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.
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| 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.
