Affordable Ohio Health Insurance Plans

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Last Updated on by Ed Harris

Anthem Ohio health insurance quotes are available on our website at the  lowest direct rates provided by the insurer. Anthem Blue Cross Blue Shield individual, small business and family  policies include catastrophic plans, comprehensive plans, and Health Savings Accounts (HSAs). Senior Medicare, dental, vision, travel medical, and prescription drug plans are also offered. Exchange policies include 10 required essential benefits.

ACA-compliant plans (applicants under age 65) are available in 48 counties, and a larger market share in the Buckeye State is possible next year. Supplement plans for persons that have reached age 65 are also very popular choices. The Pathway HMO provider network is used.  Anthem files plans through the name “Community Insurance Company.” Telehealth office visits are included in benefits and often are not subject to a policy deductible. A 24/7 nurse line and the Sydney Health App provide free online assistance for Ohio residents.

The 48 counties offering under-65 coverage are Adams, Athens, Auglaize, Belmont, Brown, Butler, Clinton, Columbiana,  Coshocton, Crawford, Erie, Fayette, Gallia, Gurnsey, Hamilton, Hardin, Harrison, Highland, Hocking, Holmes, Jackson, Jefferson, Knox, Lawrence, Mahoning, Marion, Meigs, Mercer, Monroe, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pike, Putnam, Richland, Ross, Trumbull, Tuscarawas, Vinton, Warren, Washington, Wayne, Williams, and Wyandot.

 

Senior Anthem Medicare Insurance Plans In Ohio (2025) 

Medicare Supplement Plans

Hamilton, Clermont, Butler, Darke, Adams, Warren, and Montgomery Counties

Female Monthly Rates Age 65

$141 – Plan A

$185 – Plan F

$134 – Plan G 

$133 – Plan N

 

Male Monthly Rates Age 65

$155 – Plan A

$204 – Plan F 

$147 – Plan G 

$145 – Plan N

Franklin, Knox, Holmes, Delaware, Licking, Union, Madison, Champaign, Greene, Fairfield, Richland, Wayne, Miami, Mercer, Muskingum, and Shelby Counties

Female Monthly Rates Age 65

$133 – Plan A

$174 – Plan F 

$126 – Plan G 

$125 – Plan N

 

Male Monthly Rates Age 65

$146 – Plan A

$192 – Plan F

$138 – Plan G 

$137 – Plan N

Cuyahoga, Summit, Lucas, Stark, Lorain, Mahoning, Lake, Trumbull, Medina, Portage, Ottawa, Lucas, Wood, Sandusky, and Columbiana Counties

Female Monthly Rates Age 65

$150 – Plan A

$198 – Plan F 

$143 – Plan G 

$141 – Plan N

 

Male Monthly Rates Age 65

$165 – Plan A

$217 – Plan F

$157 – Plan G 

$155 – Plan N

 

Medicare Advantage Plans (Rates And Availability May Vary In Different Counties)

Anthem Medicare Advantage (HMO) –  $0 deductible with maximum out-of-pocket expenses of $4,600. Office visit copays are $0 and $35. The inpatient hospital copay is $310 for the first seven days. Days 8-90 have a $0 copay. The outpatient mental health care copay is $35 for individual or group therapy visits, and Opioid treatment services are covered. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $203 copay for days 21-100.

Outpatient hospital visits are subject to a $0-$285 copay. A $35 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $260 copay. The ER and Urgent Care copays are $90 and $30. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$95 copay, and outpatient x-rays are subject to a $50-$110 copay.

Diagnostic radiology services are subject to a $95-$195 copay. Preventative dental, vision, and hearing services are subject to policy limits. The preferred retail cost-sharing for 30 days is $0 (Tier 1), $0 (Tier 2), $42 (Tier 3), $95 (Tier 4), 33% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $84 (Tier 3), $190 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem Medicare Advantage (PPO) –  $0 deductible with maximum out-of-pocket expenses of $5,500. Office visit copays are $0 and $45. The inpatient hospital copay is $375 for the first five days. Days 6-90 have a $0 copay. The outpatient mental health care copay is $45 for individual or group therapy visits, and Opioid treatment services are covered. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $203 copay for days 21-100.

Outpatient hospital visits are subject to a $0 or 20%. A $45 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $245 copay. The ER and Urgent Care copays are $90 and $40. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$95 copay, and x-rays are subject to a $50-$110 copay.

Diagnostic radiology services are subject to a $95-$195 copay. Dental, vision, and hearing services are subject to policy limits. The preferred retail cost-sharing for 30 days is $0 (Tier 1), $15 (Tier 2), $42 (Tier 3), $95 (Tier 4), 33% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $84 (Tier 3), $190 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem Medicare Advantage (Regional PPO) –  Maximum out-of-pocket expenses of $6,050. Office visit copays are $0 and $25. The inpatient hospital copay is $295 for the first seven days. Days 8-90 have a $0 copay. The outpatient mental health care copay is $40 for individual or group therapy visits, and Opioid treatment services are covered.  Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $203 copay for days 21-100.

Outpatient hospital visits are subject to $0 or 20%. A $35 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $290 copay.  The ER and Urgent Care copays are $90 and $35. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$130 copay, and x-rays are subject to a $50-$110 copay.

Diagnostic radiology services are subject to a $130-$215 copay. Dental, vision, and hearing services are subject to applicable copays, subject to policy limits. The preferred retail cost-sharing for 30 days is $6 (Tier 1), $15 (Tier 2), $42 (Tier 3), 41% (Tier 4), 32% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $84 (Tier 3), 41% (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem Medicare Advantage 3 (HMO) –  $0 deductible with maximum out-of-pocket expenses of $4,100. Office visit copays are $0 and $35. The inpatient hospital copay is $285 for the first six days. Days 7-90 have a $0 copay. The outpatient mental health care copay is $40 for individual or group therapy visits, and Opioid treatment services are covered. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $195 copay for days 21-100.

Outpatient hospital visits are subject to a $0-$225 copay. A $30 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $255 copay. The ER and Urgent Care copays are $90 and $30. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$140 copay, and x-rays are subject to a $50-$100 copay.

Diagnostic radiology services are subject to a $120-$175 copay. Dental, vision, and hearing services are subject to $0-$35 copays, subject to policy limits. The preferred retail cost-sharing for 30 days is $2 (Tier 1), $10 (Tier 2), $37 (Tier 3), $90 (Tier 4), 33% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $74 (Tier 3), $180 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem MediBlue Extra (HMO) –  $505 deductible with maximum out-of-pocket expenses of $7,550. Office visit copays are $0 and $40. The inpatient hospital copay is $310 for the first seven days. Days 8-90 have a $0 copay. The outpatient mental health care copay is $40 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $196 copay for days 21-100.

Outpatient hospital visits are subject to a $0 or 20% copay. A $40 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $260 copay. The ER and Urgent Care copays are $90 and $35. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$90 copay, and x-rays are subject to a $50-$90 copay.

Diagnostic radiology services are subject to a $90-$200 copay. Dental, vision, and hearing services are subject to $0-$40 copays, subject to policy limits. The preferred retail cost-sharing for 30 days is $10 (Tier 1), $20(Tier 2), $47 (Tier 3), $95 (Tier 4), and 25% (Tier 5). The preferred retail mail-order cost-sharing for 90 days is $30 (Tier 1), $60 (Tier 2), $141 (Tier 3), $285 (Tier 4), NA (Tier 5), and $30 (Tier 6).

 

Anthem MediBlue Plus (HMO) –  $0 deductible with maximum out-of-pocket expenses of $4,100. Office visit copays are $0 and $35.  The inpatient hospital copay is $285 for the first six days. Days 7-90 have a $0 copay. The outpatient mental health care copay is $40 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $196 copay for days 21-100.

Outpatient hospital visits are subject to a $0-$225 copay. A $30 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $265 copay. The ER and Urgent Care copays are $90 and $35. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$140 copay, and x-rays are subject to a $50-$100 copay.

Diagnostic radiology services are subject to a $120-$175 copay. Dental, vision, and hearing services are subject to $0-$35 copays, subject to policy limits.  The preferred retail cost-sharing for 30 days is $2 (Tier 1), $10 (Tier 2), $37 (Tier 3), $90 (Tier 4), 33% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $74 (Tier 3), $180 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem MediBlue Access Basic (Regional PPO) –  $50 deductible with maximum out-of-pocket expenses of $6,050. Office visit copays are $10 and $40 ($40 and $60 if not in-network). The inpatient hospital copay is $295 for the first seven days. Days 8-90 have a $0 copay. The outpatient mental health care copay is $40 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $0 copay for the first 20 days, and a $196 copay for days 21-100.

Outpatient hospital visits are subject to a $0 or 20% copay. A $35 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $295 copay.  The ER and Urgent Care copays are $90 and $35. Lab services are subject to a $0-$10 copay. Diagnostic tests are subject to a $0-$130 copay, and x-rays are subject to a $50-$110 copay.

Diagnostic radiology services are subject to a $130-$215 copay. Dental, vision, and hearing services are subject to $0 – $40 copays,  subject to policy limits. The preferred retail cost-sharing for 30 days is $6 (Tier 1), $15 (Tier 2), $42 (Tier 3), $41% (Tier 4), 32% (Tier 5), and $0 (Tier 6). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $0 (Tier 2), $84 (Tier 3), 41% (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem MediBlue Dual Advantage (HMO D-SNP) –  $0 deductible. Office visit copays are $0 and $0. The inpatient hospital copay is $0 per stay.  The outpatient mental health care copay is $0 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $0 copay per stay.

Outpatient hospital visits are subject to a $0 copay. A $0 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $0 copay. The ER and Urgent Care copays are $0. Lab services are subject to a $0 copay. Diagnostic tests and x-rays are subject to a $0 copay.

Diagnostic radiology services are subject to a $0 copay. Dental, vision, and hearing services are subject to $0 copays subject to policy limits. The preferred retail cost-sharing for 30 days is $10 (Tier 1), $20 (Tier 2), $47 (Tier 3), $95 (Tier 4), and 25% (Tier 5). The preferred retail mail-order cost-sharing for 90 days is $30 (Tier 1), $60 (Tier 2), $141 (Tier 3), $285 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem MediBlue Prime Select (HMO) –  $0 deductible with maximum out-of-pocket expenses of $3,450. Office visit copays are $0 and $35. The inpatient hospital copay is $295 for the first 6 days. The outpatient mental health care copay is $40 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $196 copay for days 21-100.

Outpatient hospital visits are subject to a $0-$275 copay. A $40 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $275 copay. The ER and Urgent Care copays are $90 and $30. Lab services are subject to a $0-$10 copay. Diagnostic tests and x-rays are subject to a $0-$150 copay.

Diagnostic radiology services are subject to a $130-$175 copay. Dental, vision, and hearing services are subject to $0-$35 copays subject to policy limits. The preferred retail cost-sharing for 30 days is $2 (Tier 1), $12 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The preferred retail mail-order cost-sharing for 90 days is $0 (Tier 1), $24 (Tier 2), $84 (Tier 3), $190 (Tier 4), NA (Tier 5), and $0 (Tier 6).

 

Anthem MediBlue Service (PPO) –  $0 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $45. The inpatient hospital copay is $295 for the first 7 days. The outpatient mental health care copay is $40 for individual or group therapy visits, and partial hospitalization services. Skilled nursing facility benefits are provided with a $196 copay for days 21-100.

Outpatient hospital visits are subject to a $0-$275 copay. A $40 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $290 copay. The ER and Urgent Care copays are $90 and $25. Lab services are subject to a $0-$50 copay. Diagnostic tests and x-rays are subject to a $0-$110 copay.

Diagnostic radiology services are subject to a $180-$275 copay. Dental, vision, and hearing services are subject to $0-$45 copays subject to policy limits. Prescription drug benefits are not included.

 

Part D Prescription Drug Plans And Rates

MediBlue Rx Standard –  $58.30 per month with $360 deductible. Preferred 1-month copays are $1 (Tier 1), $5 (Tier 2), $47 (Tier 3), 31% (Tier 4), and 25% (Tier 5).  Mail order (3 month) copays are $3 (Tier 1), $15 (Tier 2), $141 (Tier 3), 35% (Tier 4), and N/A (Tier 5). CMS Star rating is 3.5. 6,158 persons are enrolled in the plan in Ohio and 46,908 throughout the US. Monthly payments after “Extra Help” are $24.80 (100%), $33.10 (75%), $41.50 (50%), and $49.90 (25%). Plan ID is S5596-013 and 6,158 formulary drugs are available.

Medicare Rx Plus – $80.40 per month with $0 deductible.  Preferred 1-month copays are $1 (Tier 1), $3 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Mail order (3 month) copays are $3 (Tier 1), $9 (Tier 2), $141 (Tier 3), 50% (Tier 4), and N/A (Tier 5). CMS Star rating is 3.5. 11,822 persons are enrolled in the plan in Ohio and 70,822 throughout the US. Monthly payments after “Extra Help” are $46.90 (100%), $55.20 (75%), $63.60 (50%), and $72.00 (25%). Plan ID is S5596-014 and 11,8222 formulary drugs are available.

 

Applying For Under Age-65 Coverage

Applications are not underwritten (short-term plans are an exception), so medical questions are not required to be answered. A physical is not needed, and no fees are charged. Usually, the underwriting process is very quick and a notification of the offer is provided in writing by Anthem BC. Typically, we can complete a phone or online enrollment in less than 15 minutes.

You do NOT have to accept the offer. And with most submitted applications, you don’t have to pay any money upfront. The final price generally matches the original quoted premium. The main reasons for any variance are that a birthday occurred after the application date, or the federal subsidy was changed by the Department of Health and Human Services (HHS). Adding a spouse or dependent can also change the rate.

You can also use our website to purchase an “Exchange” policy, and replace a plan that you may already have. Or, if you are not insured, (it is  not required by federal law), you can buy an inexpensive option that will keep your costs down. Pre-existing conditions will not be treated any differently than any other new illness or injury, and you will have full access to all network providers.

Anthem Blue Cross Plans In Ohio (Under Age-65)

There are several affordable single/family policies offered with or without a federal subsidy. Each policy covers the mandatory required 10 “Essential Health Benefits” and will satisfy the mandatory coverage requirements of the Obamacare legislation. Maternity, mental illness, office visits, prescription drugs, and hospitalization are several of the most common benefits.

Note: You can view the drug list selection, which will help you determine the appropriate Tier, and approximate cost. More than 70,000 pharmacies are available along with home-delivery options. A policy may have exclusions or limitations, which could impact a drug on the list. Your Certificate or Summary Plan Description can provide additional information.

Once your policy is active, many additional benefits are provided, including “LiveHealth Online,” which provides access to physicians at any time, including weekends. Allergies, flu, fever, rashes, and viruses are popular reasons to utilize this service.  Advice, treatment, and/or prescription drugs can be also provided along with visits with a psychologist or licensed therapist.

24/7 Nurselines (registered nurses) offer immediate assistance with a wide range of concerns and topics. Discounted prices also help you save money on many products, including Jenny Craig, LASIK eye surgery, hearing aids, smoking cessation, and vitamins.

LiveHealth Online allows customers to speak live to a physician 24/7 from a computer or smartphone. The live video session can often eliminate the need for an Urgent Care or ER visit. An Online Psychology option also offers mental health and substance use/therapy counseling. This benefits is offered to plans with the “LiveHealth Online” designation. The copay is only $5.

Catastrophic Plans 

Catastrophic Pathway X HMO 9450 –  $9,450 deductible with $9,450 maximum out-of-pocket expenses and 0% coinsurance. $40 copay for first three pcp office visits.

 

Bronze Plans

Bronze Pathway X HMO 9450 –  $9,450 deductible with $9,450 maximum out-of-pocket expenses and 0% coinsurance.

Bronze Pathway X HMO 9450 Adult Dental And Vision –  $9,450 deductible with $9,450 maximum out-of-pocket expenses and 0% coinsurance. Same plan as previous plan, but with adult dental and vision benefits added.

Bronze Pathway X HMO 7500/50%/Standard – $50 and $100 office visit copays. $7,500 deductible with $9,400 maximum out-of-pocket expenses and 50% coinsurance. Urgent Care copay is $75. $25 generic drug copay ($62.50 mail order).

Bronze Pathway X HMO 7450/0% for HSA – HSA-eligible plan with $7,450 deductible and 0% coinsurance and $7,450 maximum out-of-pocket expenses.  All non-preventative expenses must meet deductible. Tax-deductible deposits into the HSA are permitted for qualified medical, dental, and vision expenses.

Bronze Pathway X HMO 6000 – $50 primary care physician copay for the first three visits only. Specialist visits are subject to deductible and copay. $6,000 deductible with $9,450 maximum out-of-pocket expenses and 35% coinsurance. Urgent Care visits subject to deductible and coinsurance. ER visits subject to deductible, $500 copay, and coinsurance. All prescription drugs are subject to deductible and coinsurance.

Bronze Pathway X HMO 5500 – $50 primary care physician copay. Specialist visits are subject to deductible and copay. $5,500 deductible with $9,450 maximum out-of-pocket expenses and 30% coinsurance. Urgent Care copay is $50. ER visits subject to deductible, $500 copay, and coinsurance. $30 generic drug copay. 

 

 

Silver Plans

Silver Pathway X HMO 5800/40% Standard – $5,800 deductible with maximum out-of-pocket expenses of $8,900 and 40% coinsurance. $40 and $80 office visit copays. $60 Urgent Care copay. ER visits subject to deductible and coinsurance. Level 1 Tier 1 prescription drug copays are $20 and $60, and Tier 2 prescription drug copays are $40 and $120. Tier 3 and Tier 4 drugs are subject to coinsurance and deductible.

Silver Pathway X HMO 3000 – $3,000 deductible with maximum out-of-pocket expenses of $9,100 and 15% coinsurance. Pcp office visit copay is $40 for the first three visits. Urgent Care visits subject to deductible, $50 copay, and coinsurance. ER visits subject to deductible, $200 copay, and coinsurance. Level 1Tier 1 prescription drug copays are $20 and $60, and Tier 2 prescription drug copays are $50 and $150. Tier 3 and Tier 4 drugs are subject to coinsurance and deductible.

Silver Pathway X HMO 3200/10% for HSA – HSA-eligible  plan with $3,200 deductible and $7,450 maximum out-of-pocket expenses. Coinsurance is 10%.  Similar to Bronze HSA options, but with a lower deductible and higher coinsurance.

Silver Pathway X HMO 5400 0 for HSA – HSA-eligible  plan with $5,400 deductible and $5,400 maximum out-of-pocket expenses. Coinsurance is 0%.

Silver Pathway X HMO 4000 – $4,000 deductible with  maximum out-of-pocket expenses of $8,000 and 25% coinsurance. $20 pcp office visit copay. Urgent Care visits also have a copay ($50). For families with many office visits, this plan is also a popular option. Tier 1 prescription drug copays are $3 and $9, and Tier 2 prescription drug copays are $40 and $120. Tier 3 and Tier 4 drugs are subject to coinsurance and deductible.

Silver Pathway X HMO 5000 – $5,000 deductible with  maximum out-of-pocket expenses of $7,950 and 35% coinsurance. No limit on pcp visits subject to a copay of $35. Urgent Care visits subject to $50 copay. Tier 1 prescription drug copays are $10 and $30, and Tier 2 prescription drug copays are $40 and $120. Tier 3 and Tier 4 drugs are subject to coinsurance and deductible.

Silver Pathway X HMO 6000/25% – $6,000 deductible with  maximum out-of-pocket expenses of $7,800 and 25% coinsurance. No limit on pcp visits subject to a copay of $25. Urgent Care visits subject to $50 copay. Tier 1 prescription drug copays are $3 and $9, and Tier 2 prescription drug copays are $40 and $120. Tier 3 and Tier 4 drugs are subject to coinsurance and deductible.

 

Gold Plans

Gold Pathway X HMO 2000/25% Standard – $2,000 deductible with maximum out-of-pocket expenses of $8,700 and 25% coinsurance. Office visit copays are $30 and $60 (unlimited usage) with $45 Urgent Care copay. Tier 1 prescription drug copays are $15 and $45, and Tier 2 prescription drug copays are $30 and $90. Tier 3 prescription drug copays are $60 and $180.

 

Sample Under Age-65 Monthly Rates 

Hamilton, Butler, and Warren Counties Age 35 With Household Income Of $35,000

$60 – Bronze Pathway X HMO 9450

$65 – Bronze Pathway X HMO 9450 Adult Dental And Vision

$73 – Bronze Pathway X HMO 6000

$80 – Bronze Pathway X HMO 7500/50% Standard

$81 – Bronze Pathway X HMO 5500

$93 – Bronze Pathway X HMO 7450/0% For HSA

$159 – Silver Pathway X HMO 5900/40% Standard

 

Hamilton, Butler, and Warren Counties Married Couple Ages 50 (2 Persons) With Household Income Of $49,000

$28 – Bronze Pathway X HMO 94500

$42 – Bronze Pathway X HMO 9450 Adult Dental And Vision

$67 – Bronze Pathway X HMO 6000

$88 – Bronze Pathway X HMO 7500/50% Standard

$89 – Bronze Pathway X HMO 5500

$126 – Bronze Pathway X HMO 7450/0% For HSA

$317 – Silver Pathway X HMO 5900/40% Standard

 

Pike, Lawrence, Jackson, and Ross Counties Age 45 With Household Income Of $30,000

$163 – Bronze Pathway X HMO 9100

$164 – Bronze Pathway X HMO 9100/0% Standard

$174 – Bronze Pathway X HMO 6000

$197 – Bronze Pathway X HMO 5000

$205 – Bronze Pathway X HMO 5500

$205 – Bronze Pathway X HMO 7450/0% For HSA

 

Pike, Lawrence, and Ross Counties Married Couple Ages 55 With Household Income Of $28,000

$288 – Bronze Pathway X HMO 9100

$292 – Bronze Pathway X HMO 9100/0% Standard

$323 – Bronze Pathway X HMO 6000

$392 – Bronze Pathway X HMO 5000

$419 – Bronze Pathway X HMO 5500

$421 – Bronze Pathway X HMO 7450/0% For HSA

 

Belmont, Guernsey, Monroe, Morgan, Noble, and Jefferson Counties Age 45 With Household Income Of $33,000

$129 – Bronze Pathway X HMO 9100

$130 – Bronze Pathway X HMO 9100/0% Standard

$139 – Bronze Pathway X HMO 6000

$161 – Bronze Pathway X HMO 5000

$169 – Bronze Pathway X HMO 5500

$169 – Bronze Pathway X HMO 7450/0% For HSA

 

Belmont, Guernsey, Monroe, Morgan, Noble, and Jefferson Counties Married Couple Ages 50 (2 Persons) With Household Income Of $40,000

$159 – Bronze Pathway X HMO 9100

$162 – Bronze Pathway X HMO 9100/0% Standard

$185 – Bronze Pathway X HMO 6000

$238 – Bronze Pathway X HMO 5000

$258 – Bronze Pathway X HMO 5500

$259 – Bronze Pathway X HMO 7450/0% For HSA

 

Muskingum and Coshocton Counties Married Couple Ages 55  (2 Persons) With Household Income Of $38,000

$156 – Bronze Pathway X HMO 9100

$160 – Bronze Pathway X HMO 9100/0% Standard

$190 – Bronze Pathway X HMO 6000

$256 – Bronze Pathway X HMO 5000

$280 – Bronze Pathway X HMO 5500 

$282 – Bronze Pathway X HMO 7450/0% For HSA

 

Muskingum and Coshocton Counties Married Couple Ages 55 And Two Children (4 Persons) With Household Income Of $65,000

$280 – Bronze Pathway X HMO 9100

$286 – Bronze Pathway X HMO 9100/0% Standard

$326 – Bronze Pathway X HMO 6000

$415 – Bronze Pathway X HMO 5000

$448 – Bronze Pathway X HMO 5500

$451 – Bronze Pathway X HMO 7450/0% For HSA

 

Mahoning, Columbiana, And Trumbull Counties Age 60 With Household Income Of $35,000 

$63 – Bronze Pathway X HMO 8700

$83 – Bronze Pathway X HMO 6000

$97 – Bronze Pathway X HMO 5000

$108 – Bronze Pathway X HMO 6000 0 For HSA

$112 – Bronze Pathway X HMO 6850 0 For HSA

 

Mahoning, Columbiana, And Trumbull Counties Married Couple Ages 60 (2 Persons) With Household Income Of $52,000

$90 – Bronze Pathway X HMO 8700

$132 – Bronze Pathway X HMO 6000

$163 – Bronze Pathway X HMO 5000

$193 – Bronze Pathway X HMO 6000 0 For HSA

$210 – Bronze Pathway X HMO 6850 0 For HSA

 

Provider Networks

Finding a doctor, specialist, hospital, Urgent-Care, dentist, pharmacy, hospital, or other medical facility is easy. Also, there are thousands of providers across Ohio that are “in network,” and will provide a negotiated discount that can save thousands of dollars. You can view options in your area here, or simply contact us, and we will verify that your own provider is on the list. The available categories when you search are: Doctors/Medical Professionals, Multi-Specialty Medical Group, Hearing Equipment and Services, Behavioral Health, Dental Provider,  and Vision Provider.

It’s important to be treated by providers in the Anthem network so your care is professional and the cost of benefits is reasonable and often discounted. Many physicians will accept Medicaid patients. Doctors who accept Medicare patients have agreed to be paid directly by Medicare. Consumers will not receive a bill for any amount exceeding the coinsurance and Medicare deductible.

The two types of networks are described below:

HMO (Health Maintenance Organization) – Unlike most HMOs, you are not required to pre-select a  primary-care physician (pcp). Another popular feature is that referrals are not needed if an appointment with a specialist (chiropractor, allergist, cardiologist, internist, urologist, neurologist, etc…) is needed. Out-of-network services are typically not covered, unless the situation is a medical emergency.

PPO Both in-network and out-of-network coverage is available, and referrals are not needed. The negotiated savings can be significant on both low-deductible and high-deductible plans. Ohio hospitals are designated as either Tier 1 (lower cost) or Tier 2. In several areas, you have the “Tiered” network option.

Anthem Dental Options

A dental policy can also be added for a moderate price. Checkups and X-rays are usually covered with little out of pocket cost. Larger expenses such as root canal or extractions will have a waiting period and higher out of pocket cost. Generally, prices compare favorably to other popular dental plans from Humana, Aetna, UnitedHealthcare, and Delta Dental.

Three stand-alone plans are available. They are: Dental Family Value, Dental Family, and Dental Family Enhanced. You can view additional Ohio dental information here.

Dental Family Preventative – $50 deductible (per person) and no annual in-network maximum benefit for children. For adults, the maximum benefit is $750. The out-of-pocket limit is $350 ($700 per family) and there is no waiting period for preventative and diagnostic coverage. Cleanings, exams, and x-rays are covered at 100%. Basic services are not covered. Fillings are not covered. Tooth removal, scaling, and prosthetics (bridges, crowns, and dentures) are covered with 50% coinsurance (children only). Medically-necessary orthodontia is also covered with 50% coinsurance for children. Annual out-of-pocket maximum for children is $375. International emergency benefits are included.

Dental Family Value – $50 deductible (per person) and no annual in-network maximum benefit for children. For adults, the maximum benefit is $750. The out-of-pocket limit is $375 ($750 per family) and there is no waiting period for preventative and diagnostic coverage. Cleanings, exams, and x-rays are covered at 100%. Basic services have no waiting period for persons under age 19. Adults have a six-month waiting period. Fillings subject to 40% coinsurance.  Complex and major services, crowns, dentures, bridges, and orthodontia are not covered for adults. Tooth removal, scaling, and prosthetics (bridges, crowns, and dentures) are covered with 50% coinsurance (children only). Medically-necessary orthodontia is also covered with 50% coinsurance for children. International emergency benefits are included.

Dental Family – $50 deductible (per person) and no annual in-network maximum benefit for children. For adults, the maximum benefit is $750. The out-of-pocket limit is $375 ($750 per family) and there is no waiting period for preventative and diagnostic coverage. Cleanings, exams, and x-rays are covered at 100%. Basic services have no waiting period for persons under age 19. Adults have a six-month waiting period. Fillings subject to 40% coinsurance. Complex and major services, crowns, dentures, and bridges are covered for adults with a 12-month waiting period. Orthodontia is not covered.  Tooth removal, scaling, and prosthetics (bridges, crowns, and dentures) are covered with 50% coinsurance (children) and 70% (adults). Medically-necessary orthodontia is also covered with 50% coinsurance for children. International emergency benefits are included.

Dental Family Enhanced$25 deductible (per person) and no annual in-network maximum benefit for children. For adults, the maximum benefit is $1,000. The out-of-pocket limit is $375 ($750 per family) and there is no waiting period for preventative and diagnostic coverage. Cleanings, exams, and x-rays are covered at 100%. Basic services have no waiting period for persons under age 19. Adults have a six-month waiting period. Fillings subject to 20% coinsurance.  Complex and major services, crowns, dentures, and bridges are covered for adults with a 12-month waiting period. Orthodontia is not covered.  Tooth removal, scaling, and prosthetics (bridges, crowns, and dentures) are covered with 20% coinsurance (children) and 50% (adults). Medically-necessary orthodontia is also covered with 50% coinsurance for children. Cosmetic orthodontia is covered at 50% for dependents 18 and under. International emergency benefits are included.

 

Anthem Vision Options

“Blue View Vision” coverage can be added to any policy. More than 39,000 locations are network-approved, including Sears Optical, Pearle Vision, Target Optical, and LensCrafters. Online merchants are also available, including Glasses.com, 1-800 CONTACTS, and ContactsDirect. Policy benefits include an annual eye exam, and standard single vision, bifocal, or trifocal plastic lenses every two years.

A $20 copay applies to lenses, and the exam. Allowances of $80 and $130 are provided for contact lenses and frames. A bundled plan can be purchased with a Marketplace dental or medical plan. Bundled plans can not be purchased without other required contracts. Eight plans are offered and approximately monthly rates are shown below:

Blue View Vision Value – $13 per month. $20 copay for routine eye exam and $20 copay for eyeglass lenses.

Blue View Vision Plus – $15 per month. $10 copay for routine eye exam and $20 copay for eyeglass lenses.

Blue View Vision Basic – $17 per month. $20 copay for routine eye exam and $20 copay for eyeglass lenses.

Blue View Vision Progressive Select – $20 per month. $10 copay for routine eye exam and $20 copay for eyeglass lenses.

Blue View Vision Enhanced – $20 per month. $10 copay for routine eye exam and $10 copay for eyeglass lenses.

Blue View Vision Premier – $21 per month. $10 copay for routine eye exam and $20 copay for eyeglass lenses.

Blue View Progressive Preferred – $22 per month. $10 copay for routine eye exam and $10 copay for eyeglass lenses.

Blue View Vision Ultra – $23 per month. $10 copay for routine eye exam and $10 copay for eyeglass lenses. 

 

Anthem Small Group Plan Options (2-50 Employees)

The Pathway Group HMO network provides a large selection of providers along with a “care and cost finder.” This tool helps employees compare quality ratings and costs of physicians and other providers. Many procedures are included and additional pharmacy information can also be viewed. Dental, vision, life, and disability coverage can also be added to plans.

The LiveHealth Online feature offers workers the option of visiting with a physician from their pc, laptop, or mobile phone. Headaches, allergies, colds,the flu, and many other topics can be discussed via video with certified physicians and therapists. The cost per session is approximately $49. Workplace wellness is also provided, including multiple campaigns, motivation webinars, and health education. Available plans and a brief description are listed below.

Gold Blue Access PPO 500/25%/5600 – $500 deductible with $25 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 1000/20%/7000 – $1,000 deductible with $25 and $50 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 1000/20%/7000 – $1,000 deductible with $30 and $70 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 1500/20%/7500 – $1,500 deductible with $25 and $50 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 2000/20%/7400 – $2,000 deductible with $25 and $50 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 2250/20%/7500 – $2,250 deductible with $30 and $50 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 2500/0%/5000 – $2,500 deductible with $30 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 2750/0%/5000 – $2,750 deductible with $30 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Blue Access PPO 3000/20%/6800 – $3,000 deductible with $30 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $60, and $120.

Gold Pathway Group HMO 500/25%/7000 – $500 deductible with $25 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Gold Pathway Group HMO 1000/20%/1000 – $1,000 deductible with $30 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Gold Pathway Group HMO 2500/0%/7500 – $2,500 deductible with $25 and $50 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Blue Access PPO 2500/50%/7500 – $2,500 deductible with $50 and $80 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Blue Access PPO 3500/30%/7500 – $3,500 deductible with $35 and $70 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Blue Access PPO 4500/30%/7500 – $4,500 deductible with $25 and $60 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Blue Access PPO 5500/25%/8150 – $5,500 deductible with $50 and $80 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Pathway Group HMO 2500/50%/7500 – $2,500 deductible with $50 and $80 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Silver Pathway Group HMO 6000/0%/8000 – $6,000 deductible with $35 and $65 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $15, $50, and $90.

Bronze Blue Access PPO 7000/25%/8150 – $7,500 deductible with office visits and Urgent Care visits subject to 25% coinsurance and deductible. Level 1 prescription copays are $15, $50, and $90.  

Bronze Blue Access PPO 7500/25%/8150 – $7,500 deductible with $60 and $90 office visit copays (pcp and specialist). $100 Urgent Care copay. Level 1 prescription copays are $25, $50, and $90.

Bronze Pathway Group HMO 7000/25%/8150 – $7,000 deductible with office visits and Urgent Care visits subject to 25% coinsurance and deductible. Level 1 prescription copays are $15, $50, and $90.

Bronze Blue Access PPO 4500E/50%/6850 w/HSA – $7,000 deductible with office visits and Urgent Care visits subject to 25% coinsurance and deductible. Level 1 prescription coinsurance is 40%.

Bronze Blue Access PPO 5000E/10%/6850 w/HSA – $5,000 deductible with office visits and Urgent Care visits subject to 10% coinsurance and deductible. Level 1 prescription coinsurance is 10%.

Bronze Blue Access PPO 5500EC/0%/6850 w/HSA – $5,500 deductible with office visits and Urgent Care visits subject to deductible and $35 and $70 copays. Level 1 prescription copays are $15, $50, and $90.

 

Small Group Basic Life Rate Match Program

Anthem will match the prices of a previous company’s life, dependent life, and accidental death and dismemberment (AD&D) coverage for qualifying groups. Several requirements include groups with 10-50 employees that don’t have life coverage, must meet underwriting guidelines, 100% employer-paid with 100% employee participation, and $25,000-$100,000 of basic life coverage per individual, subject to income limitations.

 

Small Group Dental Coverage Options

Diagnostic and preventative services are covered at 100% (in-network). Periodontal treatment and extra cleaning is provided for diabetic, pregnant, and other covered members of some Care Management programs. Several online tools are offered, including a dental health assessment, cost estimator, and hygienist email service.

Value – $500 annual benefit with $50/$150 individual and family deductibles. Diagnostic and preventative services covered at 100%, basic services at 80%, and major services not covered. Orthodontic services also not covered.

Classic – $1,000 annual benefit with $50/$150 individual and family deductibles. Diagnostic and preventative services covered at 100%, basic services at 80%, and major services at 50%. Orthodontic services are covered at 50%.

 

Blue View Vision (Small And Large Group Plans)

$150 and $180 frame allowances are offered with an additional $200 option (small group only). Lense copays are $55, with $85 and $175 copays for anti-reflective and progressive lenses. Employers are not required to contribute premiums, and for non-voluntary plans, 50% participation (small group) and 70% participation (large group) is required. Private vision coverage may be purchased, although annual limits and waiting periods may apply.

 

GeoBlue Travel Health Insurance

GeoBlue is an international travel coverage that provides affordable protection while traveling abroad, and expats that are currently living abroad. They are an independent licensee of the Blue Cross Blue Shield Association. Non-BCBS members, however, may apply for coverage. Plan options are listed below:

General plans for short-term and long-term international travel –  Voyager (single international trip), Trekker (multiple trips), and Xplorer (for expatriates).

Specialty plans for educational and group trips, and long-term visits – Voyager (five or more people), Navigator (students and faculty), Navigator (crew members and captains), Navigator (volunteers and career missionaries), and Corporate (travelers and corporate expats). 

 

Review

As an independent trusted broker, we review all of the major Ohio health plans, and only recommend the policies(s) that provide you with maximum coverage at a premium that meets your own budget. Anthem rates are not the same in all areas of the state so we’ll do all of the research for you to help find your best options.

The advantage of using our services vs. “going direct,” is that we compare all of the carriers, not just one. Therefore, if another company has a more affordable option with better benefits, you’ll be able to choose, instead of being forced to select from a single provider.  Business owners and self-employed persons can also view many low-cost options that were not previously available.

UPDATES FROM THE PAST:

Anthem Ohio Exchange plans are available through our website. Catastrophic, Platinum, Gold and Silver options can be purchased at extremely low prices with a full Obamacare federal tax subsidy, which can be calculated by contacting us or directly here.

The DirectAccess policies replace the old portfolio. They are “guarantee-approval” with no required medical questions or physicals needed for enrollment. The availability of doctors and other medical facilities is smaller compared to previous options.

A 24-hour extension has been granted for persons needing coverage by January 1st. The deadline now extends to midnight Christmas eve (December 24th). We anticipate more extensions will be utilized.

Also, Akron Children’s Hospital will remain in the Anthem network, after completing negotiations. This, of course, is great news to residents of the Northeastern portion of the state that utilize the facility.

When enrolling for a new policy, verify with your doctor or specialist that they are included in Anthem’s “X” network. This new provider list was created for Marketplace policies and is narrower than previous networks. It is possible that your physician may be considered “in-network” for one plan but “out of network” in another plan.

A major external cyber attack was reported by Anthem this week. Access to the IT system gave hackers access to names, dates of birth, social security numbers and other personal information. Financial data appears not to be included in the stolen information.

The FBI is now involved along with Mandiant Corporation, a highly-respected cyber security company. This breach also impacted many of the company’s own employees. Credit monitoring and identity protection help will be provided free to anyone that was affected.

Since Aetna, UnitedHealthcare, InHealth, and HealthSpan have exited the Buckeye State (Marketplace plans), Anthem will be increasing their market share.

Anthem’s  individual Ohio business market share will be non-existent, since the Buckeye State’s largest carrier is exiting the state. Although Group and Senior business won’t be impacted, private single and family coverage will no longer be available.

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