The US Government will take over Ohio’s high risk health insurance program administered by Medical Mutual. Initially, the special “pool” was created to assist persons that could not obtain healthcare because of medical issues, or were not eligible for Medicare or Medicaid. More than 3000 state residents are currently covered under these “risk pool” plans. Although prices are high, provided benefits pay for most expenses.
But unfortunately, in most states, the amount of money provided to fund the program ran out, since the number and dollar amount of submitted claims was much higher than anticipated. Here in Ohio, the request for financial aid to save the program was denied by Kathleen Sebelius, the Secretary of the US Department Of Health And Human Services. Sebelius insisted that at least $10 million additional dollars be spent by the state.
As a result, it is likely that benefits will no longer be as comprehensive compared to the previous available policies. Network participation is expected to reduce, and out of pocket expenses,such as copays and deductibles, may be increasing. And since there are no alternatives until 2014, consumers in the “high risk” category will have to find a way to pay the extra money. It’s expected that a covered $100,000 claim could increase maximum out-of-pocket expenses between $1,000 and $2,500.
Medicare Not Affected
Medicare recipients will not be impacted by this transition. The fraud unit will continue to monitor payments and other administrative activities in an effort to reduce the overall cost of service. Each year, hundreds of millions of dollars are wasted, and hopefully, more of these funds will be recovered. A small increase in the percentage of returned money will make a big difference.
Starting in October, Buckeye state residents can take advantage of Open Enrollment to the 2014 Guaranteed Approval plans. Ohioquotes.com is a leading website resource for individuals and families to apply for coverage without paying any fees. The new US federal subsidy will also be offered to persons whose income is lower than 400% of the Federal Poverty Level (FPL).
Contracts will also be offered outside of the official Marketplace. Rates are expected to be released within the next 60 days and it is possible that these options will be very attractive to families with household incomes above $95,000 that do not qualify for tax breaks. Network provider lists (especially specialists) may be larger for plans that do not pay subsidies.
For persons that will be covered under the federal government starting the end of July, Medical Mutual will continue to administer their policies until that date. They will also assist in transitioning from a state-sponsored policy to a federally-sponsored policy. It is possible that many families will qualify for Medicaid coverage at the end of the year since requirement are being loosened.