Ohio health insurance reform details are regularly updated on this website. We are a local authority for up-to-date information regarding the “Patient Protection And Affordable Care Act,” Senior Medicare plans, and new legislation. We help you understand the potential impact of any changes to the current healthcare system.
In March 2010, the US House of Representatives passed H.R. 3590 – The Patient Protection And Affordable Care Act and H.R. 4872 – The HealthCare and Education Reconciliation Act of 2010. Several updates and changes were also made to Medicare recipients. A year-by-year analysis is below.
Changes For 2010
No Exclusion For Children And Coverage Extended to 26th Birthday
In approximately six months, health insurance companies will be prohibited from adding pre-existing exclusion riders to children’s coverage. This will apply to all Ohioans in 2014. Also, young people, up to their 26th birthday, may remain on their parent’s health insurance plan. Currently, many companies require children (that are not full-time students) to obtain separate coverage by age 19.
No Lifetime Maximum
In approximately six months, lifetime limits will be removed from plans. This part of the reform package will likely never affect you since individuals and families rarely come close to exceeding their maximum limit.
Health insurance companies will not be able to rescind policies when a person becomes ill. This practice is rarely used.
Temporary High-Risk Pool
Within 90-120 days, reform will utilize a temporary national high-risk pool to provide health insurance to citizens with pre-existing medical conditions. If uninsured for the last six months, a high-risk pool will be set up that offers subsidized premiums. Presumably, these premiums will be less than the current “Ohio Open Enrollment” rates. You will not be required to pay more than $5,950 for medical expenses (family limit is $11,900).
Indoor Tanning Tax
Starting July 1, there will be a 10% tax on indoor tanning services. And no…I am not making that up!
Preventive And Wellness Benefit Change
New Ohio plans must offer wellness and preventive benefits without copays or deductibles. Currently, most comprehensive plans have small copays but no deductibles on wellness coverage.
Changes For 2011
Over The Counter Drug Exclusion
Over-the-counter drugs not prescribed by a physician, will not be eligible for tax-free reimbursement through an HSA, HRA or FSA.
Minimum Medical Loss Ratio
80% of individual private plan expenses must be spent on medical services and related costs. Any excess must be returned to consumers in the form of a rebate.
Teaching Health Centers
Primary Care residency programs to be located in 11 areas for ambulatory patient care.
New Labels For Nutrition
Nutritional information for some restaurants and vending machines must be displayed. However, this new regulation does not apply to any establishment that simply sells food “on the side.”
Changes For 2012
Non-profit cooperatives will be created and are expected to offer more competitive prices than many larger “for-profit” companies.
Some payments from Medicare will be made to “accountable care” companies and organizations in an effort to cut costs and reduce waste. Hospitals with high re-admission ratios may lose some reimbursement if the causes could have been prevented.
Fraud And Abuse More registration requirements for Medicare. Many additional initiatives taken for CHIP and Medicaid. There is also a fee that providers must now pay to offset the cost of the new programs.
Better Data Collection
Reporting and collection of information is much more comprehensive. Additional data on sex, ethnic background, race, primary language and disability is now required.
Changes for 2013
Notification To HHS
Each state is required to inform the Department of Health and Human Services whether their Exchange will be operated by themselves or the federal government. If state-run, the estimated expenses will be millions of dollars. Most states opt for the federal option.
Tax Return Change
The unreimbursed medical expenses floor increases from 7.5% to 10%, resulting in less deductions for persons that itemize and have large out-of-pocket medical costs.
FSA Limit Changed
Contributions to Flexible Spending Accounts are capped at $2,500, although inflation adjustments will slowly increase amounts each year.
Medical Device Tax A new 2.3% surcharge was created.
Non-profit companies will now have the opportunity to offer coverage. Seven companies would eventually be offered more than $2 billion.
The popular “CHIP” program for children was extended through 2015.
Changes for 2014
The Ohio health insurance exchange must be created by 2014 and must be administered by a non-profit organization or government agency. The exchange will offer plans that meet stated required guidelines. We do not charge any fees for helping you find a plan in the exchange and the rate we quote for you will be the guaranteed lowest rate allowed by the state.
Essential Health Benefits
Establishes 10 mandatory sets of coverage that must be included in all Metal tier plans. For the first time, comprehensive maternity and mental illness benefits are offered without a waiver or waiting period clause.
No Lifetime Limits
Previously, carriers could cap lifetime limits (often between $2 million and $5 million) along with annual ceilings on the amount of prescription dollars paid. These are no longer allowed.
Change In How Your Rate Is Determined
Pre-existing condition clauses and medical underwriting will no longer be allowed. Health insurance companies will be prohibited from denying coverage or basing rates on any health-related factor such as medical condition, health status or prior claims experience. Premiums will vary by age, smoking status and other factors. However, existing individual plans will not be subject to the new guidelines. You can review details about local companies on this page.
Tax Credits To Pay For Coverage
Tax credits will be given to individuals to help pay their Ohio health insurance premiums. To qualify for the credit, income must be between 100% and 400% of the federal poverty line. For example, a family of four earning less than $88,000 per year would qualify for a partial credit. Lower incomes, of course, would receive larger credits. But you will have to buy a policy to receive the credit.
Get Health Insurance Or Pay A Penalty
Perhaps the most controversial part of health reform is that Individuals must have health insurance coverage or pay a penalty. Starting in 2014 and gradually phased in through 2016, individuals who fail to maintain coverage will be subject to a penalty of $695 per year or 2.5% of income, whichever is higher. Failure to maintain coverage, however, will not result in criminal actions or fines. Penalties seem to be too low and enforcement will have to be modified.
Any health insurance plan issued through the Ohio health insurance exchange must provide medical benefits that include cost sharing limits. Coverage will be available in four benefit categories: Bronze (60% Coinsurance), Silver (70% Coinsurance), Gold (80% Coinsurance) and Platinum (90% Coinsurance). A lower-cost catastrophic plan must be offered to individuals under 30 and any other individual that is exempt from the insurance requirement.
Each state can establish a “basic” policy for lower-income households that are not eligible for a federal subsidy. The implementation will take place in 2015 or 2016.
Employers can offer workers awards as much as 50% of their cost of participation in selected wellness programs. Specific guidelines will be created for all states. Initially, 10 states will participate in the program.
Insurers must pay additional fees imposed by the IRS and Treasury Department. The document that explains the new charges is incredibly detailed and long. If you wish to read the entire legislation, you can view it at the “Federal Register,” which is the daily journal of the US Government.
Changes For 2015
CHIP Benefits Increasing
The Children’s Health Insurance Funding program will receive additional funding starting in October.
Changes For 2016
Compacts Become Available
Compacts are agreements between states that allow the purchase of plans across state lines. It’s possible that in some areas, low-cost choices may become available.
Changes For 2017
CSR Payments No Longer Funded
Cost-sharing reduction (CSR) payments will no longer be paid to insurers. These reductions in premiums will still be available on Silver-tier plans, but carriers will be forced to pay the difference in premiums. Depending on the household income, annual payments can exceed $10,000.
Changes For 2018
Tax On Expensive Plans
Any work (group) plan that costs more than $10,200 (individual) or $27,500 (family) will be subject to a special excise tax.
Short-Term Coverage Expanded
A final rule was issued that expands short-term plans from a maximum of 90 days to 12 months, with an option of renewing benefits for up to 3 years. The cost of temporary policies is significantly less than conventional plans, since pre-existing conditions are not covered, and several benefits are not included, including maternity. Policies are expected to be offered by selected carriers in late 2018 and 2019.
Changes For 2019
Repeal Of Individual Mandate
Beginning January 1, it is no longer a requirement to purchase “qualified” health insurance. The 2.5% household income penalty will no longer apply, and non-compliant ACA plans will no longer result in a tax penalty. It is assumed that many healthy applicants may now apply for 12-month short-term plans, which can substantially reduce premiums. However, households that qualify for a federal subsidy, regardless of medical conditions, should continue to apply for Marketplace plans.
If you have any questions regarding Ohio Health Exchange plans, how to purchase a policy, or how to properly compare benefits, please contact us. We can greatly simplify both the comparison and enrollment process.
March 31 2010– Although the wording in the bill is vague, the health insurance industry agreed with the section in the health reform law requiring them to provide insurance to children with pre-existing health conditions. This coverage will be provided within six months although rates could be very high.
April 20 2010– Fraud alert! The BBB (Better Business Bureau) is reporting several scams involving people going door-to-door selling phony health insurance plans, referencing health reform and saying you have limited amount of time to take advantage of the new health care. Health insurance is never sold door-to-door, so be careful if you are targeted.
April 21 2010– Wellpoint, the parent company to Anthem Blue Cross, announced as of June 1, it will allow dependents under age 26 to remain on their parent’s policies. Even though the new law is not effective until September, Wellpoint is taking steps to prevent a gap in coverage.
May 4 2010– It appears that UnitedHealthCare (Golden Rule) will no longer issue “child only” policies. Mysteriously, UnitedHealthCare’s Ohio health insurance rating software no longer covers children under age 18 unless they are listed under a parent’s policy. As of September, anyone under age 19 can not be denied coverage. It is highly possible that a few other companies may also eliminate “child only” policies.
May 7 2010– The Commissioner of Insurance for the state of Georgia wants no part of the first phase of health care reform and is questioning the constitutionality of the law. We were able to obtain a copy of the letter he wrote to Kathleen Sebelius.
May 7 2010– The “High Risk Pool” for persons unable to qualify for coverage may be ready on July 1. No details on rates and qualifications are still sketchy.
July 7 2010– Under a new law that went into effect on July 1, unmarried Ohio children to age 28 can remain on or be added to their parent’s policy. The federal mandate is only to age 26.
July 7 2010– Ohio’s new high risk health insurance pool will begin in August. Medical Mutual will operate the pool for Ohio residents with major pre-existing conditions such as heart disease and cancer. The program will terminate in 2014 when health insurers will no longer be allowed to deny coverage for health conditions.
July 9 2010– Under health care reform legislation, health insurance policies can be “grandfathered.” Anthem provides a nice explanation regarding “grandfathering.”
July 27 2010– Guidelines for Ohio Health Insurance Risk Pool are listed below:
Ohioans with medical conditions, such as cancer or diabetes, can apply for coverage under a new high-risk insurance pool beginning Aug. 1. To qualify, applicants must:
– Provide evidence of a pre-existing condition: written certification by a licensed physician or nurse practitioner, issued within the past six months; or, copy of documents verifying two carriers have refused to issue creditable coverage within the previous six months, or would issue coverage only with an exclusionary rider.
– Have proof of Ohio residency: valid driver’s license, state government ID, payroll stub, voter registration card, utility bills, rental agreement or income tax return.
– Have proof of U.S. citizenship, a national of the U.S. or lawfully present in the U.S.: birth certificate, passport or visa.
– Be uninsured for six months prior to the date of applying for coverage.
– Be ineligible for coverage under the Medicare program, the Ohio Medical Assistance Program, the Ohio Children’s Health Insurance Program, or an employer-sponsored group health plan, unless subject to a mandatory initial waiting period.
September 3 2010– New insurance pool for those with pre-existing conditions this week and the state announced that 330 Ohioans are currently enrolled (Source: Associated Press via Newark Advocate, Sept. 2, 2010). Of course, more applicants are expected.
As part of national health reform legislation that passed in March, states are required to either set up a special high-risk insurance pool for individuals with medical issues or enable residents to enroll in a national one. Ohio has contracted with Medical Mutual to manage the pool. The state is one of 27 that opted to run its own pool rather than rely on the pool operated by the federal government. Medical Mutual is an old established company with great HSA rates.