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Ohio Health Insurance

Ohio Medical Insurance Overview

In Ohio, there is a lot of room for the improvement of healthcare overall and it is hoped that the state’s residents will benefit from the latest reform in healthcare laws.  The state does exhibit some strengths and weaknesses as a whole, but there are a lot of people residing in this state who do not have health insurance coverage.  When the Patient Protection and Affordable Care Act went into effect, it was designed to bring more options to the table for residents in Ohio as well as the rest of the country as a whole.  By 2020, it is expected to offer insurance benefits to as many as 30 million more residents in the country.  Many hope that this new legislation will have a positive effect on the health status of all Ohioans.Ohio’s Health Care Issues
Ohio ranks in 39th place with regard to the health of its residents.  This is a drop from 2011 when the state was in the 35th place.  This ranking was provided by the United Health Foundation and it takes all of the factors into account as far as the health status of each individual state.  Below is a brief listing of the state’s strengths and weaknesses:

Ready availability of primary care physicians
Low incidence of Salmonella
Low percentage of uninsured population
High prevalence of obesity
Low per capita public health funding
High prevalence of diabetes

Understanding Ohio’s Uninsured Population
In Ohio, seven percent of the population is uninsured, according to data provided by the Henry J. Kaiser Family Foundation.  The website reveals that 23% of the state’s non-elderly population has no insurance coverage, which equates to 1,667,500 residents who are uninsured as of 2014.

Listed below are statistics related to the uninsured population of the state of Ohio:

  • 4% of children under the age of 18 have no insurance
  • 11% of adults between 19 to 64 are not covered by insurance
  • 28% of people earn under 199% of the Federal Poverty Level (FPL)
  • 9% earn between 200-399% of the FPL
  • 4% of people earn over 400% of the FPL, but opt not to get coverage

Group Health Plans
In the state of Ohio, your best bet for obtaining health insurance is through the workplace.  As such, these plans usually offer many different levels of coverage and costs associated with premiums.  Because of the ability for insurance companies to spread the risk over a large group of people, these plans tend to be less expensive options overall.  In addition, insurance companies offering group coverage cannot deny coverage to people based on the presence of a pre-existing medical condition.  In Ohio, 50% of the population has coverage under this plan type.

The Department of Insurance regulates private insurance companies in the state of Ohio.

Signing Up
In order to enroll into the company’s benefits plan, you should wait for a designated enrollment period.  This period of time is usually set by the human resources department and can vary from company to company.  If you wish to sign up for coverage, consult with a representative from HR to get the necessary information.  Before you take on the monetary responsibility of going through your company’s insurance plan, you should consider all of the options available to you.

Keep the following factors in mind when taking your insurance options under consideration:

  • Is it a more affordable option to go through your spouse’s insurance plan?
  • Do you need special coverage because of a health condition?  Will the group plan cover your medical needs?
  • Is the plan affordable to you under your current budget?  If not, you can consider many of the state-funded programs that are available in Ohio.

Pre-Existing Condition Exclusion Periods
If you have a pre-existing condition, you may be required to wait up to a year before your insurance policy takes effect.  However, HIPAA regulations prevent insurers from imposing an exclusion period on a plan’s dependent that is under 19 years old.  If you are covering a young dependent under your policy, you do not have to worry that your dependent will have to wait through an exclusion period.  In addition, the state of Ohio allows insurance companies to look into your medical records for a period of six months to determine if you have such a condition.  Furthermore, genetic predispositions to conditions or illnesses cannot be used as a pre-existing condition without an official diagnosis.

Affiliation or Waiting Periods
Waiting periods of two to three months apply to everyone obtaining insurance coverage under an employer’s group plan, without regard to a pre-existing condition.  The waiting period is two months for people enrolling on time and three months for people enrolling late.

Individual Health Plans
If you can’t get coverage through a group plan because you need more coverage or your employer does not offer such coverage, you may be able to obtain insurance through an individual policy.  In the state of Ohio, 4% of residents have this type of plan coverage.  It can prove to be difficult to obtain this sort of coverage because insurance companies can impose elimination riders on the plan or limiting coverage through medical underwriting.

It is estimated that a healthy young person in Ohio can obtain this sort of coverage for as little as $66 per month.  For individual policies, insurance providers can look back into your medical records for six months to see if you have a pre-existing condition.  In addition, the maximum time frame of which you can be excluded from coverage is 12 months.

Continuation Coverage
If you have lost your job or dependent status due to a divorce from a covered employee, you may be able to get temporary coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).  This coverage can give you benefits extending up to 18 months following the termination of your original group policy.  Eligibility for COBRA is strictly dependent on the amount of employees that the company who issued the policy had.

A conversion plan is also available for those individuals who want to convert their group coverage to an individual policy.  This allows you to keep the same levels of coverage along with the same insurance provider.

Ohio Health Benefit Exchange
It was decided in 2012 that the state of Ohio would not pursue the creation and implementation of its own health benefits marketplace.  As such, the marketplace is located at and is able to be used as a resource for residents to find and compare options, gather information and purchase a suitable insurance plan.  In 2011, the Governor signed a bill prohibiting any exchange from covering abortions for residents with the exception of rape or health risks imposed on the woman.  Despite receiving approval for plan management in Ohio, the state opted out of having the marketplace operated on the state-level.

Ohio State Insurance Programs
Thirty percent of people living in Ohio are covered under a state-funded program.  There are plenty of options to pick from based on your age, gender, health status and income level.  Each program is listed in detail below.

Ohio High Risk Pool
This program is available to those who have had trouble getting insurance benefits because of a pre-existing condition.  The Ohio Risk Pool covers primary and specialty care services, prescription medications, hospital stays and eligibility is based on if you have a pre-existing condition.  In order to qualify, you must have gone without health insurance for a period of six months prior to the application.

Medicaid is available to people with low-incomes and it provides a great deal of services for those who are eligible.  You are granted coverage if you meet the income requirements and you may be required to pay associated costs for medical services.

Healthy Families
Those living in a low income situation can get benefits through the Healthy Families program.  Included in the coverage are services like family planning, home health, dental and vision, nursing care and more.  If you are earning 90% of the Federal Poverty Level or under, you can obtain coverage for you and your dependents under the age of 19.

Healthy Start
This program offers uninsured kids with a wide variety of medical benefits.  Eligibility is given to pregnant women and children who fall into specific income brackets.  People under the age of 21 who have left the foster care system in the state of Ohio can get benefits through the Healthy Start program.

Women-Infants-Children (WIC)
WIC is managed by the USDA Food and Nutrition Service and works towards the improvement of the lives of women, infants and children who are in low income situations.  Nutritional assistance is provided to those who qualify along with immunization benefits.

Breast & Cervical Cancer Project (BCCP)
This program provides cancer screening to women and includes pap tests, biopsies, colposcopies and more.  If you are a woman living in Ohio and are earning 200% or less than the Federal Poverty Level, you can apply for coverage.

Ohio Genetics Program
Though this program, you can go to a genetics center in the state of Ohio and learn about any birth defects or genetic disorders that you may have.  In addition, the program endeavors to provide informational guidance on the treatment options available.  Depending on your insurance coverage, there may be costs associated with participation.

Medicare and the Medicare Prescription Drug Program
The Medicare program and its corresponding prescription drug program are available to disabled people, individuals with end-stage renal disease and seniors who have worked in a Medicare covered job for at least 10 years.

Health Coverage Tax Credit
This tax credit subsidizes the cost of private health insurance for people who are receiving trade assistance.  The credit equals 72.5 percent of the premium amount that is paid by covered individuals, with the remainder being their responsibility.

VA Medical Benefits Package
The VA Medical Benefits Package is setup for qualifying veterans to receive a range of care services and benefits.  In order to be eligible for this package, you must have served 24 consecutive months of service in any branch of the armed forces and have received an honorable discharge.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance connects consumers with 475 programs that offer financial assistance when it comes to the costs of prescription medications.

Ohio Help Me Grow Program
This program is for expectant parents and young children who live in the state of Ohio.  It offers a great deal of services that include outreach and education.

National Association of Mental Illness (NAMI) Helpline
The National Association of Mental Illness Helpline is a nationwide program that works to improve the lives of those suffering from mental illnesses.  The helpline consists of only volunteers who have the knowledge and backgrounds to offer guidance and information to people who call in.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA gives strict guidelines for private insurance companies to follow when issuing health insurance to consumers in the United States.  The Act was passed in 1996 and provides regulations on how insurance companies can deny coverage and how waiting periods are handled.  For more information on the Health Insurance Portability and Accountability Act, read this website.