Ohio individual and Medicare health insurance plans can be purchased online on our website. Many large companies offer a large selection of plans to meet the ever-changing needs of consumers. Regardless if you’re an individual, family, student, self-employed, between jobs, an early retiree or uninsured, we’ll find the right private health insurance plan for you. We simplify the process of comparing Marketplace plans and enrolling online.
And unlike many other online sites, we’re located in the state (Springboro) and are recognized as the top website for affordable Ohio private medical insurance. The rates you view are the lowest prices offered by each carrier, whether on or off-Exchange. If you aren’t offered group benefits by your employer, and you have not reached age 65 yet, you will be able to easily choose a budget-friendly plan and obtain coverage.
In Ohio, UnitedHealthcare, Anthem Blue Cross and Blue Shield, Aetna, Humana, Paramount, Cigna, Molina, and Medical Mutual offer competitive rates (under-65 and Senior products). Attractively-priced options are also available through Ambetter, SummaCare, Oscar, and CareSource. Individual policies are no longer medically underwritten, so pre-existing conditions do not increase the rate.
NOTE: policies are not offered in all counties from each company. For example, Premier previously wrote business in the Dayton area (Montgomery, Warren, Greene Butler County area), while SummaCare writes business in the Akron/Canton area. Anthem offers under-65 plans in selected counties. Medical Mutual offers Marketplace plans in many areas of the Buckeye State. Oscar has expanded their service area, and offers plans in the Columbus and Cleveland areas.
Previous reform changes impact the rate you pay, now that federal subsidies are available to reduce the cost of your policy. We review those changes with you and discuss what specific steps should be taken to maximize your savings. New policies are issued as Exchange (or Marketplace) contracts and updated coverage can add benefits and change deductibles. Newborns can typically be added to existing Marketplace plans.
For example, 10 “essential benefits” are included in all policies. This coverage provides traditional items (office visits, prescriptions, ER, and inpatient/outpatient hospital treatment) along with maternity and mental-illness assistance. Depending on the “Tier” of your plan, you may not have to meet a deductible for many expensive expenses and procedures. Gold tier plans and selected plans in other tiers may not require a deductible for ER visits.
Inpatient and outpatient hospital visits, specialty prescription drugs, and ER visits, generally are subject to a deductible. Maternity benefits, although covered, are also subject to a deductible. Online telemed visits, generic drugs, and preventative office visits typically do not have to meet a deductible. (Qualified preventative visits are provided with no out-of-pocket expenses)
Types Of Private Plans
The three types of private Ohio individual health insurance are “comprehensive,” “catastrophic,” and Health Savings Accounts (HSAs).” All three types of coverage are easily purchased with multiple deductible options. Higher out-of-pocket limits can substantially reduce rates. NOTE: There are many variations of each type of coverage. Deductibles and/or copays may apply to less-expensive options, while smaller and fewer out-of-pocket costs will likely be found in more expensive Silver and Gold-tier plans (and occasionally the Bronze-tier).
Catastrophic plans generally place a deductible ($8,550) on most major medical expenses, and rates tend to be very low. Sometimes referred to as a “High Deducible Plan,” out of pocket expenses are higher, with limitations on office visit and prescription coverage. Preventive benefits are always included and are not subject to a deductible. However, there may be a limitation on the number of primary-care-physician (pcp) office visits that are provided free or with a small copay. Lab tests, x-rays, and outpatient procedures are typically subject to a deductible. The maximum allowed HSA deductible for 2021 is $7,000.
When a “Network” provider is used, out-of-pocket costs are often discounted. Ideally, this type of individual plan is appropriate when you are willing to pay the smaller and routine medical expenses and can easily afford out-of-pocket expenses of $2,500 or more. Since there are Open Enrollments every year, your risk reduces with these types of policies, because you can change to a different option every 12 months. Note: Senior Medicare begins its Open Enrollment period on October 15th while under-65 Marketplace Open enrollment typically begins on November 1.
The number of available “catastrophic options is also very limited. Carriers are not required to offer policies on the Marketplace, and other than several primary-care-physician office visits, a deductible and coinsurance often must be met. Also, unless you are under age 30, or can prove “financial hardship,” you will not meet the eligibility requirements. The Ohio Benefits website provides additional information.
The catastrophic plans that are offered in the Buckeye State include Aultcare Catastrophic, Aultcare Catastrophic Select, Anthem Catastrophic Pathway X HMO 8550, Medical Mutual Market HMO Young Adult Essentials (Mercy, OhioHealth, Dayton, and NE Ohio), Oscar Secure, and SummaCare Value.
Comprehensive plans add office visit and prescription coverage and tend to be the most expensive plans. But raising the deductible can keep the premium quite affordable. Selected plans will offer a reduced rate, by limiting the number of covered office visits. And of course, qualifying for a financial subsidy can reduce rates, and lower deductibles and copays on Silver-tier plans (with “cost-sharing”).
The most desirable features of a comprehensive policy include unlimited office visits for both primary care physicians (pcp) and specialists, elimination of deductibles for some (or most) prescriptions, and large network-negotiated discounts for claims that are subject to a deductible (MRIs, diagnostic tests, x-rays, inpatient and outpatient surgery etc…)
Listed below are popular comprehensive healthcare plans in Ohio:
Ambetter Balanced Care 28 – One of the least expensive Silver-tier options. $50 pcp and $90 specialist copays. The Urgent Care copay is $60. The generic drug copay is $30 ($75 mail-order). The policy deductible is $0.
Ambetter Balanced Care 24 – $40 pcp and $80 specialist copays. The Urgent Care copay is $60. Generic and preferred brand drug copays are $20 and $60. The mail-order copays are $50 and $150.
Ambetter Balanced Care 12 – $35 pcp and $70 specialist copays. The Urgent Care copay is $55. Generic and preferred brand drug copays are $25 and $60. The mail-order copays are $62.50 and $150. The maximum out-of-pocket expenses are lower that the Balanced Care 11 plan.
Molina Constant Care Silver 2 250 – $30 pcp and $65 specialist copays. The Urgent Care copay is $30. $40 copay for blood work. Preferred generic and preferred brand drug copays are $25 and $60. The mail-order copays are also $62.50 and $150. The policy deductible is $5,200.
Molina Constant Care Silver 1 250 – $30 pcp and $60 specialist copays. The Urgent Care copay is $30. Generic and preferred brand drug copays are $29 and $60. $45 copay for blood work. The mail-order copays are also $72.50 and $150. The policy deductible is $0.
CareSource Marketplace Low Premium Silver – $35 pcp and $70 specialist copays. The Urgent Care copay is $75. Diagnostic test and imaging copays are $200 and $20) after the deductible. Low cost and preferred brand drug copays are $20 and $50. The mail-order copays are $50 and $125.
Medical Mutual Market HMO 6500 – $30 pcp and $60 specialist copays. The Urgent Care copay is $60. Generic and preferred brand drug copays are $15 and $45. The mail-order copays are $45 and $135.
Oscar Bronze Classic Next 2– $50 pcp and specialist copays. The Urgent Care copay is $75. The Tier 1A drug copay is $3, and the mail-order copay is $7.50. The policy deductible is $0.
Anthem BCBS Silver Pathway X HMO 4500 – $25 pcp and $60 specialist copays. The Urgent Care copay is $90. Tiers 1 and 2 drug copays are $10 and $40. The mail-order copays are $30 and $120.
HSAs, a popular option, are most effective when major medical and preventative coverages are a priority. Rates are often low, and additional tax advantages help make the HSA an attractive option to consider. The amount of premium saved by purchasing the lower-premium/higher deductible policy can be deposited into an Ohio HSA account, to pay for qualified medical expenses. Unused funds can be carried over to future years. When Medicare-eligible, accumulated funds can be used to pay for long-term health care coverage.
You control the money in the account and have complete access at all times. Preventive benefits are not subject to a deductible and other covered expenses receive a negotiated “repricing” discount. When you retire, you can continue to use (or withdraw) any of your money. Shown below are all available HSA options. NOTE: Several plans are not offered in all areas of the state.
CareSource Marketplace HSA Eligible Bronze
Anthem Bronze Pathway X HMO 6500 0 for HSA
Anthem Bronze Pathway X HMO 5500 0 for HSA
Anthem Silver Pathway X HMO 10 for HSA
As always, our website makes it easy for you to compare and apply for the most affordable health insurance plans in Ohio. We will help you with your federal tax subsidy (if you are eligible) and assist you in understanding your benefits and how to get the lowest rates.