Affordable Ohio Health Insurance Plans

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Health insurance rates in Ohio have increased for 2016, although the price hikes are relatively modest for most of the major companies with the largest market share. 2016 prices have been filed with the Oh Department of Insurance, and will be subsequently approved, or sent back for revision. The Department of Health And Human Services (HHS) must also approve any changes to Obamacare policies. Only three companies have requested price increases of more than 10%.

Free or low-cost medical coverage is still available in our state. With the availability of subsidized plans, dozens of policies from reputable carriers such as Medical Mutual, Anthem, Aetna, Premier, Ambetter, and UnitedHealthcare can be compared and purchased in minutes. It’s not unusual to find a family plan that costs between $40 and $150 per month. And the King Vs. Burwell Supreme Court decision ensures that federal subsidies will continue to be available.

Predicting Future Rates

There is great uncertainty when attempting to project the most appropriate price to charge consumers for their medical coverage here in the Buckeye state. There also is not a  a substantial amount of data that is available from the 2015 Open Enrollment since it ended less than one year ago. And very few claims have been processed and studied. However, a plethora of data has been gathered from the first year of the ACA legislation (2014), and carriers have been able to utilize the information to help determine future rates.

Eighteen carriers  filed to do business in the Buckeye state for 2016. This represents one of the largest number of companies in any state. Premier (SW Ohio only) now has a year of experience, and will continue to offer some of the most competitive prices in Montgomery, Warren, and Greene Counties.

Information on enrollee demographics, popularity of plans and market share can be easily studied. But the impact of offering every applicant guaranteed coverage may not be known for a few years. So although it’s not a crap-shoot, it’s safe to say it was an educated guess when determining what rates to charge in 2015. But with more claims experience on Obamacare coverage readily available, 2016 rates were easier to determine.

We researched all state filings and carrier information in predicting what to expect next year:

Anthem Blue Cross – Although their initial request is a 4% increase, many of the most popular plans will probably see lower price hikes. For example, although some Bronze plans might see double-digit increases, others will rise by less than 3%. The popular Silver plans offer the unique “cost-sharing” feature that substantially lowers your deductible if you qualify for federal subsidies.

The catastrophic option, one of Anthem’s cheapest plans in Ohio, and which is available to applicants under age 30, or anyone else that can show they can not afford other available options, will remain inexpensive, although benefits are limited and the deductible is above $6,000. In many situations, choosing a “Bronze-tier” instead of a catastrophic plan will actually save money.

The least expensive plans in each tier are: Pathway X PPO 6600/0% (Catastrophic), Pathway X PPO 6000/0% HSA (Bronze), Pathway X PPO 3500/25% (Silver), and Pathway X PPO 1250/10% (Gold). NOTE: Anthem’s Pathway network  includes fewer doctors and specialists than prior to the passage of Obamacare.

Medical Mutual – Non-profit MM is asking for an increase just under 17% which brings its average monthly premium to about $425 for all plans. Of course Catastrophic and Bronze policies are the least expensive. The Northeastern portion of the state is where Medical Mutual is the most competitive. In many parts of Montgomery County (and South), MM is “in the ballpark,” but not one of the cheapest options.

Medical and prescriptions costs have risen about 6%, and are expected to continue the upward trend. Of course, these expenses are largely passed onto the consumer. The combination of more persons using these services, along with the fact that they are more expensive, contributes to the premium increases on many plans. Last year, MM paid about $50 million more in claims and expenses than revenue that was received.

Some enhancements for 2016 include better mental health and cardiac rehabilitation benefits. However, like many carriers, MM will discontinue covering ER visits that are not a true emergency or if the treatment occurs outside the US. Also, skilled nursing facility benefits will reduce.

Their cheapest options include: Market Young Adult Essentials (Catastrophic), Market HSA 4000 and 6000 (Bronze), Market Classic 2000 (Silver), and Market Classic 1000 (Gold). Fortunately, many less-expensive “grandfathered” plans are being renewed. Often, their premiums are as much as 20%-40% less than newly-offered policies.

UnitedHealthcare –  UHC  previously marketed Ohio plans under the “Golden Rule” trademark, although they are back to using the UHC brand name  for 2016 “on-Exchange” policies. In 2014, they did not participate in the Marketplace festivities.  In 2015, they offered policies both “on” and “off” the Exchange.”Compass” is the brand name for their policies.

For 2016, the requested price increase is 22% for plans issued “off” the Marketplace. Depending on the policy, the rate could go up as much as 39%, or actually reduce by 3.3%. More than 2,000 policies are impacted. UHC’s earned incurred loss ratio (claims paid vs. premiums) dropped from 142% in 2014 to 117.7% in 2015. However, expenses still exceeded revenue, resulting in a net loss.

Their “short-term” plan has been very popular for consumers that either forgot to enroll or simply wanted the cheapest option, regardless of non-compliance issues. They remain available for purchase throughout the year, regardless if you qualify for a special approved enrollment exemption. Policies are approved in less than one day and provide a cheap stop-gap solution.

Although UHC rates were a bit high in the Buckeye a few years ago, by sitting out a year and observing, they may have learned a few things. Their Bronze and Silver offerings are the most popular. The new products are sold under the “All Savers” brand name. Recently, “Golden Rule” has been the brand used locally and in many other states. Golden Rule will still offer other plans (besides temporary) that are available as non-Marketplace plans.

The least expensive 2016 policies are Bronze Compass HSA 4900, Bronze Compass 5500, Silver Compass HSA 2600, Silver Compass 2000 and Silver Compass 3500. Plans are now available in many more counties compared to the first year of the Exchanges in 2014. The Columbus and Cincinnati areas (including Franklin and Hamilton Counties) are well-represented.

HealthSpan – If you don’t recognize their name, you’re not alone. HealthSpan purchased Kaiser Permanante’s block of business in 2014 year and began selling products under their own name. They are projecting a 17%  price increase for 2016, which will impact about 10,000 persons. Group pricing is increasing about 11%.

HealthSpan’s HSA product is once again, one of their best available products, and typically, despite the price hike, they offer very competitive rates in most areas of the state. In many areas, their combination of coverage and price is more attractive than major companies such as Anthem, UnitedHealthcare, and Aetna.

The vast majority of policies are issued as individual and family plans, not group contracts or SHOP-eligible options. The number of network providers is increasing and we anticipate HealthSpan to remain competitive for the next several years (or longer).

Their most affordable options are: Bronze 4000-70 HSA, Bronze 5000-80, Silver 1500-70 HSA, Silver 3000 HSA, Silver 2500-80, and Silver 2000-70. In many areas South of I-70, their Silver-tier options are among the best choices. By adding the “cost-sharing,” you’ll enjoy low rates, low deductibles, and low copays. That’s a winning combination!

Aetna – Welcome back Aetna! For many years, especially from 2009-2011, Aetna was very active in the individual Ohio health insurance market, and featured extremely competitive rates. Smokers and females age 50 and over were their best niches. But they did not participate in the 2014 Exchange in most states including ours.

However, they continue to maintain many “grandfathered” policies that were written in 2010 (or earlier) and are still in-force. For 2015, they concentrated on Cuyahoga County and the Cleveland area, and also reduced prices by approximately 6%-8%. This made them an attractive option, especially considering its large provider network.

2016 coverage has expanded to a larger portion of the state although rates are generally increasing. For example,  average premium hikes for the three most popular Metal tiers are 16.5% (Gold), 12.2% (Silver), and 13.4% (Bronze). About 20,000 existing customers will be impacted when their policy renews.

Higher treatment costs for physician services, emergency treatment, and pharmacy prescriptions are the principal reasons for higher premiums. Transitional reinsurance and enhanced network access standards also are a factor. NOTE: Coventry, a company they recently purchased, will concentrate on other states. But it is still undetermined if the Cleveland Clinic will eventually be part of the network.

Aetna’s most affordable 2016/2015 plans include Bronze Deductible Only HSA, Bronze $20 Copay, Silver $10 Copay, Silver $5 Copay 2750, and Gold $5 Copay. In several counties, Aetna’s Oh rates are the lowest available option. NOTE: Their prices in the Southwestern counties are VERY attractive (Montgomery, Warren and Butler).

Assurant –  Recently, Assurant’s rates have not been competitive. In fact, from 2010-2014, often their prices for standard plans were about 40%-80% higher than most other companies. In 2013, they did not offer on-Exchange plans, although several off-Marketplace policies were available.  However, for many years, Assurant (also known as Time) was one of the few carriers to offer “child only” plans on a short-term basis.

Not surprisingly, Assurant is shutting down their individual operations by the end of 2016. Existing policyholders will be able to change to other carriers. They also offer policies in 16 other states, so Ohio customers are not the only persons looking for alternative policies.

CareSource – Based in Dayton, CareSource  used to be known as “Dayton Area Health Plan.”  They specialized in managed-care coverage for Medicaid recipients prior to the 2013 Exchange, which saw them offer numerous plans to consumers. No information is available regarding their projected 2016 pricing.

They don’t utilized brokers and seem rather uninterested in expanding. Customer-service, from our initial observation, is cordial, but not very effective. Just our hunch but 2016 prices will be substantially increasing.

SummaCare – Although only a regional carrier, (Northern portion of the state), SummaCare offered competitive prices in 2015 through four plans (Individual 6450-LD, 5000-LH, 2750-LK, and 750-LT). They were all fully-compliant (Gold, two Silver, and a Bronze plan) and often priced slightly less than Medical Mutual.

For 2016, an average increase of 3.7% is expected, with a maximum increase of up to 14% on selected plans. Less than 5,000 current customers will be impacted by the changes.

Molina Healthcare – Most persons haven’t heard of Molina since they don’t participate in all portions of the state. Although they only started offering coverage in 1980, they have grown to become a Fortune 500 company. They offer a Bronze, a Gold, and four Silver plans at reasonable rates. For 2015, they have increased prices in some states, and projected decreases in others (Washington State).

Molina’s rates next year should remain about the same, with increases in certain counties. They do not offer coverage in all areas and typically are not competitive in most counties. However, in selected counties, they are one of the two or three best options.

InHealth – Based in Westerville, this small company made its Marketplace debut in 2015. Although they offered selected plans to consumers last year privately, like Molina, they are not a widely-known company.As a non-profit CO-OP, any excess income (if there is any!) must be used to lower prices or improve benefits.

InHealth is expected to raise prices by about 10% compared to last year’s rates. However, they will still be extremely competitive with most other carriers, and probably  one of the least expensive companies in some parts of the state. Their Silver-2000-3070 plan is very popular because of the relatively-low $2,000 deductible and $30/$50 copays on physician/specialist visits.

Aultcare – Offering plans mostly in the Northern portion of the state, this regional carrier writes a lot of business in Summit, Medina, Stark, Tuscarawas, Mahoning, Carroll and Holmes counties. Their anticipated 2016 price increase will average about 5.5%. However,  depending on the policy and tier, increases could be as much as  13% and decreases of up to 6% are also possible.

In addition to individual products, Aultcare also offers Workman’s Compensation, Accidental Death & Dismemberment, and Short-term Disability policies. Also available are Medicare-related options.

Premier – Available in the Dayton area, last year, it was difficult to predict pricing when it was their first year of offering coverage, either on or off the Marketplace. But  their rates were extremely competitive for consumers that wanted an office visit copay instead of paying the entire amount out-of-pocket. In many situations, they were the best choice, taking into consideration price and provider availability.

In many situations in Warren and Montgomery County, Premier will be the best option for purchasing a comprehensive plan. The provider network is Miami Valley Hospital-based and there is a wide selection of physicians and facilities in the area. NOTE: For 2016, Premier’s requested price increase is less than 10%. Therefore, they do not have to publicly announce the specifics.

Ambetter – Part of the Buckeye Community Health Plan, Ambetter’s pricing will be among the lowest in many counties, including Hamilton and Montgomery. However, there coverage area is limited, although in Indiana, they also offer policies in many counties. Several inexpensive Bronze plans allow you to add three primary care physician (pcp) visits for a nominal charge.

The big variable regarding whether to consider Ambetter is whether your current physicians and medical facilities are part of their network. If they are, you will be rewarded with very affordable premiums. Otherwise, another company should be considered.

We will keep you informed on any changes or projections for Ohio Health Insurance Exchange plans for 2016.  Additional Marketplace information regarding prices or policy availability will be regularly updated.


October 2014 –  Although Open Enrollment begins in a month, it is not expected that rates for all carriers (for the upcoming year) will be released until the first or second week of November. Although many consumers feel this delay is political-motivated, in fairness, many states have not completed their examination and approval process of carrier rate-change requests.

November 2014 – Prices have been officially released, and as expected, some carriers substantially increased rates, while others were able to match 2014 plan costs. Enrollment times have been drastically cut with the help of redirect software. The quickest way to compare 2015 Ohio Marketplace plans is to use our Direct Enrollment Link that will save time, money and perhaps a lot of frustration!

December 2014 – Even if you don’t change coverage for 2015, it’s still important to verify that your primary care physician (PCP) is still considered “in-network” from your current carrier. Each years, may physicians add and delete companies from their “do accept” and “do not accept” lists.  Since the online directories may not be updated until after Open Enrollment ends, a quick verification call may save you money.

February 2015 – When you file your taxes, if you received a federal subsidy, you must complete IRS Form 1095-A. This new addition to the IRS code is the official Marketplace Statement verification and works with Form 8962, the Premium Tax Credit statement. Form 8962 must be used when premium assistance has been received.

September 2015 – Open Enrollment begins in about a month.  Our direct linking reduces the time to apply for coverage to about 10-20 minutes. Yes, it’s fast!

December 2015 – More than 40,000 Ohioans have enrolled since the OE period began on November 1st. More than half of the applicants have selected policies that cost less than $75 per month.  For persons not eligible for subsidies, many “off-Exchange” options are offered.