Ohio Health Insurance

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Facts and Figures

Place in State
Health Report Card 36^th
Insured 9,929,484
Uninsured 1,475,900
Insurance
Carriers 15
Number of
Primary Care Physicians 25260
Number of
Hospitals 183
Average Cost of
Health Insurance* $885

Breakdown of Insureds

Employer-sponsored health insurance 63%
Private plans 5%
Medicaid 15%
Medicare 16%
Others 1%

Insurance Carriers

State Health Report Card

Obesity among adults went up from 21.5 percent to 29.7 percent over the last ten years. There are now more than 2.6 million obese adults in Ohio. Diabetes among adults went up from 7.7 percent to 10.1 percent over the last five years. There are 889,000 adults with diabetes living in the state. The uninsured population went up from 11.0 percent to 13.7 percent in the last five years. Children living in poverty went up from 18.7 percent to 22.9 percent among those under 18 in the past year. Smoking went up from 20.3 percent to 22.5 percent of the adult population. There are nearly two million adult smokers in Ohio.

Ohio Health Insurance Laws and Regulations

Ohio health insurance plans are required to be sold with a guaranteed renewability clause. With this, policyholders can renew their coverage as many times they see necessary provided they kept up with their premium payments and do not violate their contracts. In addition, insurers cannot terminate a health policy due to a member’s health condition. Ohio health insurance plans can exclude coverage for a pre-existing condition for up to 12 months after the plan goes into effect. However, you can switch to a different plan without going through another exclusion period as long as you maintain coverage. Newborns and newly adopted children are automatically covered for up to 31 days under their parents’ health policy provided that the policy in question covers dependents. Health insurers in Ohio can deny an applicants request for coverage under several circumstances. They are also required to hold a thirty-day open-enrollment period every year; all valid applications received during this time must be accepted. Small businesses, with two to fifty employees, are eligible to purchase group health plans as long as they meet certain conditions. They may be required to have a minimum number of participants or employer contribution. Ohio health insurance quotes for group coverage can vary according to the risk factors of its members. However, coverage cannot be cancelled when a member gets injured or sick. Self-employed individuals in Ohio who cannot meet the requirements for group health plans are eligible to purchase individual coverage. Fortunately, a portion of the premiums for individual health plans may be tax-deductible.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Ohio health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Ohio, 81,922 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 148,238 Medicare policyholders in Ohio to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 185,014 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plan when they hit the donut hole. An average of $512 per person or a total of $94,798,047 was saved in Ohio.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 2,137 individuals in Ohio have benefited from this new law.

When looking at Ohio health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. All private policyholders in Ohio will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Ohio health insurance with no deductibles or co-pays. In 2011, more than 1,203,274 Medicare subscribers and 2,138,000 individuals with private policies received such services in Ohio.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 4,154,000 residents in Ohio have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Ohio received a total of $5.1 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Ohio, 179 community health centers received a total of $53.9 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Ohio has already received a total of $17 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

Medicaid jfs.ohio.gov (Search: Medicaid)

800-324-8680

Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits for this program include physician services, inpatient hospital, outpatient services, home health services, dental & vision, laboratory & x-ray, ambulatory surgery centers, non-emergency transportation, nursing, family planning, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program services, Medicare Premium Assistance, Eligibility: 1. Must be U.S. citizens or legal residents living in Ohio. 2. Must not exceed income limits. Children aged 0-18 years: 150% of the federal poverty level (FPL). Pregnant women: 200% of the FPL. Aged, blind, and disabled: 64% of the FPL with assets not exceeding $1,500 for singles and 83% of the FPL with assets not exceeding $2,250 for couples. Workers with disabilities: 250% of the FPL, with assets not exceeding $10,580. Must be 16-64 years old, disabled, and employed.

Healthy Start

800-324-8680 TDD: 800-292-3572

Healthy Start offers health coverage for children 18 years or younger and pregnant women who meet income requirements. The program offers comprehensive coverage which includes doctors visits, immunizations, hospital care, prescriptions, vision and dental care, substance abuse, mental health, and more. Eligibility: Qualified applicants must be U.S. citizens or qualified residents living in Ohio, and; 1. Pregnant women with income not exceeding 200% of the federal poverty level (FPL). 2. Children under 19 with incomes not exceeding 200% of the FPL. Uninsured children with incomes between 150% and 200% of the FPL are eligible for the program. 3. Certain children 21 years old and younger who are about to leave foster care.

Ohio Medicare

800-633-4227

Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

Breast and Cervical Cancer Prevention Project

614-728-2177

Ohio’s Breast and Cervical Cancer Project offers screening, diagnostics, and other related care to qualified low-income women. Benefits for this program include clinical breast exams, mammograms, breast and cervical cancer screenings, Pap tests, pelvic exams, and many more. Coverage for breast and cervical cancer treatment is possible through Medicaid. Eligibility: 1. Must be U.S. citizens or qualified residents living in Ohio. 2. Must not exceed 200% FPL. 3. Must be uninsured or have an insurance plan that doesn’t cover breast or cervical cancer screenings. 4. Must be between 40 and 64 years old. Women 65 years old and above can qualify for the program provided they are not enrolled in Medicare.

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