Obamacare in Ohio

Health Insurance Marketplace in Ohio

If you live in Ohio, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Ohio will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Ohio 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

Ohio Association of Foodbanks

Since 1991 the Ohio Association of Foodbanks has benefited thousands of people in need in the State of Ohio. The Ohio Association of Foodbanks will provide outreach support through a variety of phone, online, and promotional tools.

Children’s Hospital Medical Center

Children’s Hospital Medical Center serves the medical needs of infants, children and adolescents with family-centered care, innovative research and outstanding teaching programs. They plan on reaching out and enrolling the uninsured through the main hospital location in urban inner city geographic area as well as two satellite locations.

Clermont Recovery Center, Inc.

Clermont Recovery Center, Inc., a not-for-profit drug and alcohol outpatient treatment and prevention agency located in the county seat of Batavia, Ohio. The organization will educate and help enroll the uninsured in coverage in several counties in Ohio, including Clermont, Brown and Adams.

Helping Hands Community Outreach Center

Helping Hands Community Outreach Center is a nonprofit organization serving the Dayton Ohio region and provides resources to families and individuals who are hospitalized. The organization will attend local events and will work with businesses and public agencies to promote education and awareness of the Marketplaces.

Neighborhood Health Association

The Neighborhood Health Association (NHA), a Federally Qualified Health Center (FQHC) system located in Northwest, Ohio will through its Affordable Care Act Insurance Enrollment Project, raise community awareness regarding the insurance Exchange and facilitate enrollment in for the uninsured.

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.

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Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP’s in Ohio:

Coordinated Health Plans of Ohio, Inc.

Accountable Care Organizations in Ohio

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

• The Research Institute At Nationwide Children’s Hospital OH – Health Care Innovation Award
• University Hospitals of Cleveland OH – Health Care Innovation Award
• Welvie, LLC OH- Health Care Innovation Award
• Innovative Oncology Business Solutions, Inc. OH- Health Care Innovation Award

Health care facilities where Innovation Models are being tested

• NOMS ACO, LLC Sandusky, OH – Advance Payment ACO Model
• Cleveland Clinic Health System Cleveland, OH – BPCI Initiative: Model 2
• Mercy St. Vincent Medical Center Toledo, OH – BPCI Initiative: Model 2
• Aultman Hospital Canton, OH – BPCI Initiative: Model 2
• Berger Hospital Circleville, OH – BPCI Initiative: Model 2
• Kindred Transitional Care and Rehabilitation – The Greens Lyndhurst, OH – BCPI Initiative: Model 3
• Kindred Hospital Cleveland Subacute Unit Cleveland, OH – BCPI Initiative: Model 3
• Kindred Hospital Cleveland Cleveland, OH – BCPI Initiative: Model 3
• Mercy Medical Center Canton, OH – BPCI Initiative: Model 4
• Summa Akron City and St. Thomas Hospitals Akron, OH – BPCI Initiative: Model 4
• Summa Barberton Hospital Barberton, OH – BPCI Initiative: Model 4
• North East Ohio Coalition on Readmissions Niles, OH – Community-based Care Transition Program
• Ohio AAA Region 8 OH – Community-based Care Transition Program – Community-based Care Transition Program
• The Southwest Ohio Community Care Transitions Collaborative OH – Community-based Care Transition Program
• PSA 3 Area on Aging Lima, OH – Community-based Care Transition Program
• Akron/Canton, Ohio Area Agency on Aging (A/C AAA) OH – Community-based Care Transition Program
• Area Office on Aging of Northwestern Ohio, Inc. Toledo, OH – Community-based Care Transition Program
• Community Care Connection Dayton, OH – Community-based Care Transition Program
• East Central Ohio Community Care Transitions Coalition Byesville, OH – Community-based Care Transition Program
• Doctors Making Housecalls, LLC Durham, NC – Independence at Home Demonstration
• Springfield Center for Family Medicine Springfield, OH – Comprehensive Primary Care Initiative
• Springfield Health Care Center Inc Springfield, OH – Comprehensive Primary Care Initiative
• Suburban Family Practice-Bennett-Providence Medical Group Huber Heights, OH – Comprehensive Primary Care Initiative
• Suburban Family Practice-Koren-Providence Medical Group Huber Heights, OH – Comprehensive Primary Care Initiative
• Summit Family Physicians Inc. Middletown, OH – Comprehensive Primary Care Initiative
• TCHMA Compton Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Forest Hills Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Hyde Park Internists Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Madeira Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Mason Mason, OH – Comprehensive Primary Care Initiative
• TCHMA MOB 440 Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Rookwood IM Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Westside IM Cincinnati, OH – Comprehensive Primary Care Initiative
• The Christ Hospital Medical Associates MOB 334 Cincinnati, OH – Comprehensive Primary Care Initiative
• The Christ Hospital Medical Associates, LLC Cincinnati, OH – Comprehensive Primary Care Initiative
• The Christ Hospital Medical Associates, LLC Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Health First Physicians – Loveland Loveland, OH – Comprehensive Primary Care Initiative
• TriHealth: Health First Physicians – Mariemont Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Health First Physicians – Mason Mason, OH – Comprehensive Primary Care Initiative
• TriHealth: Queen City Physicians – Hyde Park Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Queen City Physicians – Madeira Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Queen City Physicians – Western Ridge Internal Medicine Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Queen City Physicians-Western Hills Internal Medicine Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Bethesda Group Practice Milford, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Bethesda Group Practice, Arrow Springs Lebanon, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Deerfield Family Practice Lebanon, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Moreira & Robles Internal Medicine Associates Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – West Chester Medical Group West Chester, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Western Family Physicians Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – White Oak Family Practice Cincinnati, OH – Comprehensive Primary Care Initiative
• Waynesville Healthcare-Providence Medical Group Waynesville, OH – Comprehensive Primary Care Initiative
• TCHMA Red Bank IM Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Norwood Internal Medicine Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Norwood Family Medicine Cincinnati, OH – Comprehensive Primary Care Initiative
• Upper Valley Family Care -Troy Troy, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Woodbury Dayton, OH – Comprehensive Primary Care Initiative
• Maineville Family Physicians Maineville, OH – Comprehensive Primary Care Initiative
• TriHealth: Group Health – Kenwood Cincinnati, OH – Comprehensive Primary Care Initiative
• TriHealth: Group Health – Finneytown Cincinnati, OH – Comprehensive Primary Care Initiative
• TCHMA Delamerced Cincinnati, OH – Comprehensive Primary Care Initiative
• Beavercreek Commons Family Practice-Providence Medical Group Beavercreek, OH – Comprehensive Primary Care Initiative
• Family Practice Associates of Southwest Ohio, Inc. Middletown, OH – Comprehensive Primary Care Initiative
• TriHealth: TPP – Physician Associates of Good Samaritan Hospital Forest Park, OH – Comprehensive Primary Care Initiative
• Sugarcreek Family Practice-Providence Medical Group Bellbrook, OH – Comprehensive Primary Care Initiative
• TriHealth: Group Health- Springdale Cincinnati, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Springboro Springboro, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Patterson Woods Dayton, OH – Comprehensive Primary Care Initiative
• The Christ Hospital Medical Associates, LLC Cincinnati, OH – Comprehensive Primary Care Initiative
• Farmersville Medical Center-Providence Medical Group Farmersville, OH – Comprehensive Primary Care Initiative
• Group Health Clifton Cincinnati, OH – Comprehensive Primary Care Initiative
• Generations Family Medicine of SW Ohio Middletown, OH – Comprehensive Primary Care Initiative
• Germantown Medical Associates-Providence Medical Group Germantown, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Lincoln Park Kettering, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Beavercreek Beavercreek, OH – Comprehensive Primary Care Initiative
• Kettering Physician Network – Integrated Medical Group Beavercreek, OH – Comprehensive Primary Care Initiative
• Kettering Physician Network – South Dayton Internists Kettering, OH – Comprehensive Primary Care Initiative
• Lawrence P Wang MD LLC Terrace Park, OH – Comprehensive Primary Care Initiative
• Lugo Family Practice-Providence Medical Group Centerville, OH – Comprehensive Primary Care Initiative
• Medway Medical Clinic-Providence Medical Group Medway, OH – Comprehensive Primary Care Initiative
• PriMed Physicians Vandalia Vandalia, OH – Comprehensive Primary Care Initiative
• Butler County Community Health Consortium, Inc. dba Primary Health Solutions Hamilton, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Chesapeake Family Medical Center Chesapeake, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Family Healthcare, Inc. Logan, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Cordelia Martin Health Center Toledo, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Family Healthcare, Inc. New Lexington, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Family Healthcare, Inc. – Chillicothe Chillicothe, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Family Healthcare, Inc. – McArthur Mc Arthur, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• HealthSource Goshen Loveland, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• HealthSource New Richmond Family Practice New Richmond, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• HealthSource Ripley Ripley, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Ironton Family Medical Center Ironton, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Lower Lights Christian Health Center Columbus, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Neighborhood Health Care, Inc. dba Neighborhood Family Practice Cleveland, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• NEON Southeast Health Center Cleveland, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Piketon Family Health Center Piketon, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Richard D Watkins Canton Community Clinic, Inc. Canton, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• The HealthCare Connection – Lincoln Heights Cincinnati, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• The HealthCare Connection – Mt. Healthy Family Practice Cincinnati, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• West Portsmouth Family Health Center West Portsmouth, OH – Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration
• Cleveland Clinic Home Care Services: Medical Care at Home Program Independence, OH – Independence at Home Demonstration
• Larry Lawhorne MD Dayton, OH – Innovation Advisors Program
• Margaret Namie RN, BSN, MPH, CPHQ Cincinnati, OH – Innovation Advisors Program
• Srikant Iyer MD, MPH Cincinnati, OH – Innovation Advisors Program

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Ohio

On November 16, 2012, Governor John Kasich (R) notified federal officials that Ohio would default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry.¹ The Governor also indicated Ohio would maintain control over Medicaid eligibility determinations.

Prior to the announcement, the Department of Insurance in collaboration with other stakeholder agencies solicited subcontractors’ assistance for the first year of exchange planning and implementation. Contractors evaluated financing options and sustainability, provided actuarial services and economic modeling, and an information technology (IT) gap analysis.^2,3,4

On December 21, 2011, the Governor signed HB 79, which prohibits qualified health plans purchased through an exchange from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.⁵

Contracting with Plans: On February 14, 2013, Lieutenant Governor Mary Taylor sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) reiterating the state’s intention to perform plan management activities. The Ohio Department of Insurance (ODI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). ODI will use the System for Electronic Rate and Form Filing (SERFF) to collect, review, and approve plan rate and benefit information. ODI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.⁶

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO.

Exchange Funding

In September 2010, the Ohio Department of Insurance received a $1 million federal Exchange Planning grant.

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Ohio is expected to participate Medicaid expansion pending General Assembly approval.

Next Steps

On March 8, 2013, Ohio received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.⁷

For more information on Ohio’s exchange planning, visit: www.ohioexchange.ohio.gov

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1. John Kasich. “Ohio Says No to an Obamacare Health Exchange.” November 16, 2012.http://governor.ohio.gov/exchange.aspx
2. Assist with the first year of planning for design and implementation of a federally mandated American Health Benefit Exchange. August 31, 211. Milliman. http://www.ohioexchange.ohio.gov/Documents/MillimanReport.pdf
3. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Roadmap and Budget Report. September 14, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
4. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Blueprints Report. September 13, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
5. HB 79. 129th General Assembly. Signed December 21, 2011. Enrolled version.http://www.legislature.state.oh.us/bills.cfm?ID=129_HB_7911.
6. Letter from Lieutenant Governor Taylor to Gary Cohen. February 14, 2013.
7. Letter from Gary Cohen to Lieutenant Governor Taylor. March 8, 2013.

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