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Ohio Health Insurance Marketplace

Guide to the Health Insurance Exchange in Ohio

Beginning Jan. 1, 2014, health insurance is mandatory and most Ohioans will be taxed if they can afford coverage but don’t buy it. As many individuals earn an income that wouldn’t have allowed them to pay several hundred additional dollars each month for coverage, the Obama administration created the marketplace. In each state, an exchange or marketplace is set up to help a larger number of people have access to coverage. The Affordable Care Act established this conduit for lower-cost health insurance where local insurers can sell benefit-rich policies made more reasonable with tax credits. Tax credits, also known as subsidies, are issued by the federal government to people with a low to moderate income, and can be applied to health plans on the marketplace to reduce monthly premiums and cost sharing.

As many Ohio residents are eligible for subsidized health insurance, these plans are highly accessible to their target market: individuals and families without access to employer-sponsored insurance. If you earn between 100 and 400 percent of the federal poverty line, you may qualify for these plans. If you earn more than four times the current poverty level, buying coverage on the exchange isn’t recommended, as you can purchase an individual health plan off the exchange for about the same price. Under the ACA, people with low-to-moderate incomes, pre-existing conditions, and no coverage through their job can find the coverage they need on the Ohio marketplace.

 

Who Is Eligible?

Individuals and Families

Qualifying for the exchange is easy for many people. You must be a U.S. citizen or legal resident between ages 18 and 64 (parents or guardians can apply for children under 18) who isn’t eligible for Ohio Medicaid, Medicare, other government health benefits, or coverage through an employer. However, if group coverage is offered through your job with an actuarial value of less than 60 percent, you may be able to purchase a plan on the exchange.

Income is also considered when applying for the exchanges, as you won’t necessarily want this type of plan if you’re unable to qualify for a subsidy. In Ohio, tax credits are granted to individuals and families with income of at least 100 percent FPL up to 400 percent FPL. The federal poverty line changes each year, and therefore so will eligibility for subsidies.

 

Small Businesses

In addition to individual and family coverage, the exchange is open to small business owners providing coverage to less than 50 employees. The Small Business Health Options Program (SHOP) is an alternative to the traditional small group market for business that may qualify for tax credits. Ideally, your business will have very few workers who don’t earn very much, which enables you to receive a larger tax credit to cover part of your premium contribution.

Individual Health Insurance Plans

Premium and Cost Sharing Tax Credits

For Individuals

Everyone eligible for a tax credit will receive some amount of cost reduction on their monthly premium. A smaller group of earners qualifies for discounted cost sharing on covered benefits, which includes copayments, coinsurance and deductibles. Regardless of which subsidy you qualify for, financial assistance for insurance is a great innovation created by this law. The following income groups may qualify for different subsidies.

100-400% FPL: Premium Tax Credit

100-250% FPL: Premium and Cost Sharing Tax Credit

Subsidies are determined by the full cost of the second-cheapest silver plan on the exchange in your area, taken as a percentage of your income. If the plan costs more than a certain percentage of your income, the subsidy must cover the rest. The table below illustrates the different income groups and percentages used to determine tax credit amounts. For those who earn up to 133 percent FPL, coverage cannot cost more than 2 percent of their income. While the FPL will vary, the premium share will remain the same throughout the years to determine tax credit eligibility. You can also determine eligibility for subsidies and estimate your potential tax credit with the Health Reform Subsidy Calculator. Our agents can also help you find out if you qualify at 888 803 5917.

 

For Small Groups

Small business owners may qualify for tax credits if they have up to 25 full-time equivalent workers who earn $50,000 annually or less. Employers must pay at least 50 percent of employee premiums to qualify, as well. Full-time equivalent means your workers average at least 30 hours per week based on a monthly work schedule. If you meet these requirements, you may be able to purchase coverage that’s reasonable for both you and your workers.

 

Qualified Health Plans and Coverage

Every health policy on the Ohio exchange must meet ACA standards of qualified health plans (QHPs), meaning they cover at least 60 percent of total medical costs, include essential health benefits such as prevention and prescriptions, and do not discriminate against applicants with conditions. QHPs exist off the exchange, as well, but only exchange plans can be reduced in price with subsidies. Additionally, the exchange features four tiers of coverage to specify the actuarial value assigned to each plan. This was intended to make the shopping process easier for consumers, as they can find bronze, silver, gold and platinum plans from every insurer on the marketplace.

Benefits: What’s Covered

Essential health benefits (EHBs) are included in every plan on the exchange, no matter what coverage level you choose. These include ten categories of covered care, some of which were scarcely included in most plans before health reform. Depending on the plan you choose, the cost of these services may vary, but they all must be covered by your plan. Preventive services are the only ones covered at 100 percent, which provide access to annual exams, shots and certain tests for free. View your plan’s schedule of benefits to find out how much it will cost to receive covered care. Many will be covered at a percentage of coinsurance, which is indicated by the tier of coverage you select.

The ten categories that each insurer must cover are:

  • Ambulatory patient services
  • Pediatric services, including dental and vision
  • Emergency care
  • Preventive and wellness services, and chronic disease management
  • Maternity and newborn care
  • Laboratory tests
  • Mental health and substance abuse services, including behavioral health care
  • Rehabilitative and habilitative services and devices
  • Hospitalization and inpatient care

 

Carriers

The health insurance exchange features plans from 12 different carriers throughout the state. In each county, however, only a few companies are available, making the competition quite low. A smaller selection of companies is available for the small group market at six total statewide. The carriers serving the Ohio marketplace include the following:

Individual Market

 

Small Group Market

  • AultCare
  • Community (Anthem)
  • HealthSpan
  • Kaiser Foundation Health Plan
  • Medical Health Insuring Corporation of Ohio
  • SummaCare

 

How to Apply

You can apply for health insurance on the Ohio exchange directly through a licensed agent at 888.803.5917, online at HealthCare.gov, or in person either with an agent or at an enrollment center. Navigators and certified application counselors are staffed at various locations throughout the state to help you apply and find out if you’re eligible for subsidies, though agents can assist you with choosing a policy.

You can also apply over the phone with customer service personnel at HealthCare.gov, or request a paper application be sent to you at 800-318-2596.

The licensed agents at East Coast Health Insurance are certified to sell coverage on the Ohio exchange, and can help you better understand the new laws. Find out if you qualify for subsidies and marketplace coverage by continuing to peruse our site or calling a licensed agent now.

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