Find affordable health insurance for children in Ohio with the help of CHIP, The Affordable Care Act legislation, or Medicaid. Many low-cost plans are available that provide complete preventative benefits with no deductible, copay, or out-of-pocket expenses. We research and compare all major companies to find the best low-cost options that provide the most comprehensive coverage. Benefits for specialists, therapy, mental illness, dental, and vision are also available.
There are many reasons why you may need to purchase or enroll for benefits for a baby, teenager, or young adult. Often, an employer-sponsored medical plan will cover the employee at little or no cost. But sometimes, dependent coverage is quite expensive, and a “child only” plan will provide richer benefits at a fraction of the cost of group policies. If the Open Enrollment deadline is missed, a non-ACA plan may be the only option, depending upon household income. Coverage can be quickly obtained, and a next-day effective date is generally available.
CHIP is ideal for applicants that earn too much money to qualify for Medicaid. It’s important to provide coverage to younger persons as they develop. Annual physicals, immunizations, prescriptions, dental and vision, lab tests, x-rays, ER visits, and vaccinations will be covered. Applications are accepted at any time, and not subject to Open Enrollment deadlines. If approved, benefits can begin immediately, with no waiting period for pre-existing conditions. Adopted children can also obtain benefits.
Healthy Start is Ohio’s Medicaid and CHIP program for children (to age 19) that reside in households with income up to 156% of the FPL. Uncovered children are eligible in households with income up to 206% of the FPL. Applicants must be a legal US citizen and have a social security number. Non-US citizens may be eligible for benefits through “Refugee Medical Assistance.”
Annual household pre-tax income requirements are listed below:
One-Person – $25,520
Two-Person – $34,480
Three-Person – $43,440
Four-Person – $52,400
Five-Person – $61,360
The four types of coverage offered are traditional Medicaid, home and community-based services, family care, and Medicaid managed care. Traditional benefits provide a large network of physicians, specialists, hospitals, and medical facilities. Preventative and many other services are provided, including prescriptions, transportation, and hospital visits. There is no limit on the number of family members that can obtain coverage. When moving to another state, a new application may have to be submitted. An SEP may become available, which provides 60 days to enroll in a qualified plan with a federal subsidy available.
Missed Open Enrollment?
If you missed the Open Enrollment deadline, temporary coverage may be needed. Although short-term plans lack many popular preventative benefits, they are a viable option to cover major medical expenses. However, maternity and delivery complications benefits are not included. Physical and mental therapy visits may be excluded or limited.
Also, with many group employer-sponsored plans, the child of the employee may no longer be covered if he/she is not a full-time student. There also may be other reasons, such as the status (full-time or part-time) of the employee. Many companies, to reduce healthcare costs, have reduced the number of working hours of their employees, resulting in fewer and more expensive options.
Although benefits may be offered, the cost may be expensive, and deductibles may be quite high. The average deductible for Group plan is between $3,000 and $5,000. Often, many ER and outpatient procedures must meet the deductible before benefits are paid. Preventative benefits are always covered with no out-of-pocket expenses.
Maternal, newborn, and child health coverage are included on all plans.
How Obamacare Affects Children’s Health Insurance In Ohio
The Affordable Care Act (ACA) legislation was designed to provide quality healthcare benefits to children and adults, without having to medically qualify or pass a physical. For lower-income families that don’t qualify for Medicaid, substantial financial relief helps pay most of the premium on all plans (Platinum, Gold, Silver, and Bronze-tiers). Catastrophic plans should not be considered since subsidies are not offered.
You are able to get healthcare benefits for just your child. In most areas of the state, a policy will cost between $40 and $100 per month (stand-alone or added to existing adult plan). Several insurers offer a small discount when more than one child is insured. Coverage can vary with each plan, so it is important to understand the features that are important to you, so we can select the perfect fit. Most plans utilize HMO networks, so out-of-area providers may be limited. EPO (Exclusive Provider Organization) plans are also offered in several areas.
No-Prior Coverage Penalty Eliminated
The rate for uninsured children is no longer higher than those that have prior coverage. Previously, if the applicant was not listed on another policy, a surcharge or reduction in benefits could apply. Also, a waiting period for specific benefits was sometimes imposed. However, during Open Enrollment periods, prior coverage is now no longer a requirement for obtaining a policy. If you miss the OE deadline (which can change each year), you need a special SEP exception to change companies.
Medical Mutual, Anthem Blue Cross, Oscar (in selected counties), Ambetter, CareSource, and SummaCare are very reliable carriers to consider. Office visit copays are available for primary care physician (pcp) visits, and specialists, although specific amounts will vary. Specialist copays are lower on Silver-tier and Gold-tier plans than Bronze-tier options. Urgent Care copays can vary and are typically between $40 and $100. ER visits are generally subject to a deductible. However, if admitted to a hospital, the deductible may be waived.
Required Coverage For Infants And Children
“Essential Health Benefits” must be included in all policies. This requirement was one of the principal mandates from the original Affordable Care Act legislation. It provides features such as newborn care, mental health, many pediatric services, some dental and vision coverage, and prescriptions. Many of these items, including preventive services, often have no copay or deductible to meet.
Covered immunizations (birth to age 18) are provided for diphtheria, tetanus, pertussis (whooping cough), Hemophilus influenza (Type B), hepatitis A, hepatitis B, human papillomavirus (HPV), inactivated polio virus, influenza, measles, meningococcal, pneumococcal, rotavirus, and varicella (chicken pox).
It is customary for a copay to apply for office visits and drugs, without having to meet a deductible. Preventive and well child benefits are always included with no deductible. Immunization and vaccine coverage are generally provided on most policies. If a physical is required for playing sports, typically, you will not have to pay for services, since it is covered at 100%.
Although most child prescriptions are generic, and cost less than $10, non-generic prescription coverage will be included on the policy. Comprehensive policies no longer place a cap on the amount of prescription dollars paid by the plan. Thus, if your child has a chronic illness that requires many brand-name prescriptions, they will be covered. Utilizing a 90-day mail order option will also reduce out-of-pocket expenses.
However, the distinction between “formulary” and “non-formulary” prescriptions must be understood, so you are using the drugs that work best, but are also covered under your policy. Each carrier offers a specific comprehensive guide that explains how they classify drugs. Typically, there are four “tiers.” Both generic and brand drugs are included on the list, and a combination of physicians and pharmacists create the formulary.
This is important if major health condition develops, and the only treatment is an ultra-expensive non-formulary medication. However, a temporary policy will place specific restrictions on RX benefits since pre-existing conditions are not covered.
We research all of your options and present you with the most affordable comprehensive Ohio child health insurance plan at the guaranteed lowest allowable rate. For a quick quote and comparison, you can easily compare different plans on our website. Whether you have a young adult in college or an infant, we can help.
Healthy Start is Ohio’s federally-mandated SCHIP program. Healthy Start is part of Medicaid and is available to children under 19 whose families meet Federal poverty level guidelines.
Healthchek is Ohio’s early and periodic screening, diagnosis and treatment (EPSDT) program. It provides many services to children and teens.
Child & Family Health Services is the community effort to improve birth outcomes, eliminate health disparities, and improve the health status of infants, children and women in Ohio.