Ohio health insurance laws are designed to protect Buckeye residents. Whether it’s your individual medical coverage, a plan through your employer, Senior Medicare coverage, or perhaps a guaranteed-issue policy through COBRA, laws and regulations help keep rates affordable and coverage up to date. Coverage is not mandatory, although it is highly recommended to enroll privately during Open Enrollment, or through an employer.
Current laws also help consumers understand the rules. The Affordable Care Act (Obamacare) also aids consumers with mild and serious pre-existing conditions that otherwise would not qualify for coverage. If you lose your job, have a debilitating sickness or illness, or can’t afford to purchase medical benefits, you will be able to obtain a policy. Compliance is not mandatory, since past legislation removed the required mandate to buy a plan. Many carriers offer low-cost plans that allow consumers to customize benefits.
The ODI regulates state business and provides many free services that are frequently utilized. Several of these services include carrier financial information, public records information, company loss ratios and premiums, Agency/broker information, ODI complaints, administrative actions, and, and market share reports. Short-term plans are heavily regulated since they do not cover pre-existing conditions, and place lifetime caps for specific policy benefits.
ACA (Affordable Care Act/Obamacare)
The ACA healthcare overhaul guidelines (Obamacare) have greatly impacted individual and family medical plans. The full implementation of changes began more than five years ago, both positive and negative. Although more Buckeye State residents have access to low-cost coverage, many other applicants have been forced to pay substantially higher premiums, with average annual rate increases of 10%-20%.
In the Spring of 2012, the Supreme Court listened to testimony (both for and against) regarding the effectiveness of recent healthcare reform changes. The ruling was 6-3 in favor of moving forward with the complete implementation of the legislation. Although a full repeal is unlikely, reducing funding for the ACA, and eliminating subsidies for insurers, may create substantial changes.
Some of the most significant changes include allowing children under age 26 to remain on their parent’s policies, mandating specific benefits (maternity and mental illness), covering pre-existing conditions, eliminating lifetime benefit caps, and forbidding insurers from terminating a policy without due process. Additional changes took effect when the Exchange was created. More tweaks may occur in 2021.
The Ohio Exchange is a marketplace where legal residents of the state can purchase health insurance. The live rates you see on our website are the lowest available direct prices, so you can apply for a policy with the confidence of knowing you’re getting the “best deal.” There are no enrollment fees, and personal medical and financial information does not have to be provided. We also offer a simple 10-minute phone enrollment.
Although the number of options is not as robust as pre-ACA Legislation, you will not be asked any medical questions. We help you choose the most cost-effective plan and help you apply during Open Enrollment. If you miss enrollment deadlines, you can purchase coverage. Short-term and limited-benefit policies are popular choices, although not all companies offer plans. Temporary contracts can be kept for as long as one year, and light underwriting (several medical questions, but not a physical) is required.
Your smoking status is the only condition that is factored into the underwriting process and specific benefits (10 required “essential” coverages) must be offered. Most members of Congress are required to purchase these identical plans, although each state has different prices and requirements. Buckeye State rates are typically less expensive than most other states, although in many counties, only two or three carriers are available.
Other notable changes you may notice are bundling of bills from specialists, physicians and hospitals. In the past, you often received multiple statements from different providers which is extremely confusing. A procedure will receive one payment from Medicare, for example, and the providers will disperse the correct amount each entity should receive. Thus, your billing statement is now much simpler. Transparency has improved, although more simplification is needed.
Public Medical Coverage
Government healthcare benefits provide low-cost coverage for many residents of the Buckeye State. Medicare is generally offered to applicants that have reached age 65. Federal and state laws help protect consumers, and provide standardized coverage that pays for most out-of-pocket expenses. Local and national programs help Seniors compare options and enroll for coverage. Households with lower incomes can be assisted by the Department of Job and Family Services.
Medicaid and CHIP provide inexpensive medical benefits, which include maternity, mental illness, and coverage for pre-existing conditions. It is possible that parents may be eligible for Marketplace subsidies, while dependents are receiving CHIP benefits.
Current laws do not require consumers to purchase a medical plan. The tax (penalty) was previously $695 per person (only $347.50 per child) or 2.5% of household income, whichever was higher. The maximum penalty was $2,085. The ACA Legislation was changed to eliminate the penalty last year.
However, there were many exemption situations that allowed you to avoid the penalties. Some examples were:
Your religion opposes specific benefits
You are currently incarcerated
You are a member of a recognized Indiana tribe
You are an immigrant without legal documentation
You make too little money to file a tax return
Your least expensive policy option is 8% (or more) of your income
Previously, individuals and families without medical benefits often found it more difficult to find treatment, since many providers requested to be paid for services in advance. Regardless of existing medical issues, obtaining quality coverage is very easy, since rates in Ohio are among the lowest in the US. Applicants who missed an Open Enrollment deadline can also apply for medical coverage. Without an approved exception (SEP), it is possible that pre-existing conditions may not be covered.
Small Businesses offer plans through a separate Exchange – Small Business Health Options Program (SHOP). An important prerequisite is that the number of employees of each company is no more than 50. Non-profit organizations are eligible, and dental benefits are also offered. Since there are no Open Enrollment deadlines, plans can be offered by employers at any time throughout the year.
If you are self-employed and have no employees, you are eligible for coverage through the regular Marketplace. If your company has more than 50 employees, you are classified as a “large” business entity and different rules and provisions apply. Under the law, whether you are self-employed or working for a business, you are required to purchase coverage.
However, exceptions are often made, especially for businesses with 50-99 employees. They were able to wait until 2016 (previously it was 2015) to offer benefits to employees. However, they can not terminate workers just to reach the under-100 employee level. Penalties for non-compliance are strictly enforced.
Companies with 100 or more workers are also getting a break. Instead of having to provide healthcare for 95% of the full-time workforce, the percentage has been slashed to 70%. This is expected to give companies additional time to study potential impacts of the ACA law.
Thus, rates to tend to be more expensive than private plans. You can find information about companies in this article. Of course, if an employer is paying 100% of the premium, your only out-of-pocket cost would be the combination of deductibles, coinsurance, copays and exclusions. Unless the deductible is quite large ($10,000 per family), this situation is ideal. However, most employers no longer pay all or most of healthcare benefits.
Prior To Obamacare
Before 2014, existing health laws protected persons that had severe medical issues. “Ohio Open Enrollment,” which was available through the Department of Insurance, was one option. A second option was the “Risk Pool,” which offered affordable coverage to applicants that had been denied policies by two carriers and had not had in-force qualified benefits for six months. The “Risk Pool” was administered by Medical Mutual. Rates were not cheap, but if you were facing expensive treatment in the future, the “Risk Pool” was not a bad option.
A law that went into effect in 2010 prohibits insurers from rescinding contracts, unless fraud or intentional misrepresentation was committed. Thus, if you answered all of the questions on the application truthfully, your insurance policy cannot be canceled. As an example, if a person unexpectedly developed cancer just a week after a policy was approved, they can keep that policy for as long as they wish. Naturally, when they reach age 65 and become eligible for Medicare, they will have to change plans.
Laws are constantly changing and we will keep you updated as Exchanges and reform legislation continue to evolve. Any significant laws that impact Seniors will also be discussed.