Ohio is an important center of the U.S., containing several major cities, Great Lakes, and a host of universities, businesses, and culture. Whether you’re near Cleveland, Cincinnati, Columbus, Dayton or Toledo, there are many highlights of being an Ohioan. Residents of Ohio have three dependable private health insurance companies to choose from when using East Coast Health Insurance, including plans from Aetna, Humana, and Anthem Blue Cross Blue Shield of Ohio. To compare rates in your specific area and find the plan that works best for you, enter your zip code in the quote engine below.
The State of Ohio could use some work in regards to its health, according to statistics from the UnitedHealth Foundation. The state received an overall ranking of #36, due to an increase in the smoking population (which is now close to 2 million or 22.5% of adults), the number uninsured residents, children in poverty, and obese adults. Ohio also has unfortunately high levels of air pollution, as well as a lack of funding for public health programs. With all of these determinants in place, it will be difficult for Ohioans to see an increase in the quality of their health.
There are some solutions available, despite the deficiency in public health services and poor air quality. Ohio residents still have access to healthy foods and the ability to choose activity over passivity. If more residents chose to walk or ride bikes, it would cut down on air pollution and decrease the health problems that ensue from being overweight. You may still run into some smokers on your walk, but perhaps they will quit too if they start to become more active.
Public health funding can be helped by writing to your senator and other government officials, and if you are without insurance – you’ve come to the right place! There are plenty of affordable plans available in your area through one of the companies we work with. Having access to health care makes a world of difference in maintaining overall wellness.
Health Insurance Plans
- Preventive and Hospital Care plans provider a basic set of benefits with a range of deductibles and the option of opening a health savings account. Due to their HSA-compatible nature, these plans offer the ability to pay for certain medical services and expenses with tax-free funds from your HSA. Preventive care is covered at 100% from the day your plan starts, and various hospital services are available for coinsurance after your deductible has been met.
- PPO plans are available from Aetna in several types: Value, Individual PPO, and HIgh deductible. Value plans have a high deductible with a low monthly premium, and a simple copay for in-network doctor’s office visits, prescription drugs, and emergency room services. Seeking out-of-network care will cost a bit more, but is still partially covered by your plan. Preventive care is covered in full before your deductible is met, and once you have reached your deductible, you pay a percentage of coinsurance for services such as inpatient hospitalization, outpatient surgery, home health care and lab work. Some of these plans also have an option of dental benefits.
- PPO High Deductible plans are also qualified for use with a health savings account (HSA), and have a range of deductibles to fit your budget. These plans usually cover major medical expenses, such as specialist visits, hospitalization, surgery, and doctor’s office visits at 100% (in-network, 50% out-of-network) after the deductible has been met. There are dental benefits available for some of the high deductible PPO plans from Aetna as well. Aetna’s PPO network is extensive and great quality, so you have all the freedom to choose a great in-network provider, or not if you find another doctor or hospital where you are more comfortable.
Anthem Blue Cross Blue Shield of Ohio
- CoreShare plans from Anthem of Ohio have a a broad selection of deductibles (from $750 to $25,000 for individuals in-network) and access to the Anthem PPO network of providers. When using in-network services, you can save significant amounts of money, or find the provider that’s best for you out-of-network for a bit more. Preventive care including but not limited to immunizations, well-child care, pap tests and mammograms are covered at 100%. Prescription drugs included on their formulary are available for a $15 copay or 40% coinsurance.
- SmartSense plans are affordable PPOs with a basic level of coverage. The first three doctor’s office visits are available for a copayment for each plan member per year, and prescription drugs are covered from the day your plan becomes effective. Also, preventive care is free of charge when using an in-network provider. You can add dental or life insurance benefits to SmartSense plans, as well as various types of prescription drug coverage options.
- Lumenos HSA plans are high deductible plans with the capability of combining your plan with a health savings account (HSA). These plans have comprehensive coverage with several deductibles to choose from, and a selection of coinsurance options. You can choose to pay 50%, 20%, or 0% coinsurance after you meet your deductible for in-network services such as doctor’s office visits, emergency care, inpatient hospitalization and surgeries. Funds from your HSA can help you meet these expenses if needed.
- Monogram plans from HumanaOne are PPO plans that can come with prescription drug and/or dental coverage. In Ohio, these plans have a comprehensive level of benefits, such as inpatient and outpatient care, physician services, surgery, skilled nursing, and more for 100% coverage in-network after you have met your deductible. Preventive care services such as child wellness check-ups, GYN exams, prostate and breast cancer screenings, and immunizations are available at no cost with an in-network provider immediately.
- Autograph HSA plans are high deductible plans available in either $2,000, $3,000, $4,000 or $5,000 for individuals in-network, and are qualified for use with a health savings account. Each of these plans will cover a large number of in-network services at 100% after deductible, including doctor and specialist office visits, surgeries, allergy testing, diagnostic lab and X-ray, and emergency care to name a few. Prescription discounts are also available with the Autograph plan, and you can choose in or out-of-network care, as it is a PPO.
Public Health Options
Though as stated above, the public health system needs a bit of a boost in funding, there are programs and services available for Ohio residents with low-income and other needs. The most well-known program is Medicaid, which is open to pregnant women, families, children, elderly, disabled and other individuals who cannot afford health insurance. More specialized programs are available for specific illnesses and groups of people. For a full list of the public health programs offered in the State of Ohio, visit the Ohio Department of Health site.
- Medicaid: medical coverage for low-income individuals, families, children, and those who are disabled, blind or elderly. For more on eligibility for Medicaid in Ohio, read our Medicaid Eligibility article.
- Women Infants and Children Program (WIC): the Special Supplemental Nutrition Program for Women, Infants, and Children, which provides nutritional assistance to low-income pregnant, breastfeeding women, and mothers with children up to age 5
- Bureau for Children with Medical Handicaps (BCMH): state-funded program that gives families who have children with specific medical needs access to health care and payment for medical services
- Ohio HIV Drug Assistance Program (OHDAP): provides assistance to individuals with HIV/AIDS in order for them to afford necessary medications for treatment
- Women’s Health Services Program: assistance for low-income women to receive proper reproductive health testing, screening for cervical cancer, STD testing, and pregnancy health education
Health Insurance Laws
Regulation on health insurance in Ohio are similar to other states in the U.S., as health reform has changed a great deal of the laws pertaining to health insurance policy. One very important area involves how individuals with pre-existing conditions are treated in regards to health plans. Health insurance companies are currently allowed by law to turn down any person they decide has a pre-existing condition. Ohio insurers determine a pre-existing condition based on the prudent person standard, which is a broad definition meaning an individual has received or could have received care in the past for certain symptoms.
Once an insurance company in Ohio has decided you have a pre-existing condition, they have the ability to reject you for coverage, or accept you for a plan and increase your premiums. If you are sold a plan, insurers are allowed to issue an exclusion period of up to 12 months, or give you a permanent exclusion period by attaching an elimination rider to your plan. The state of Ohio does not have a high risk pool program for those with pre-existing condition or other individuals who are denied insurance due to being a high-risk individual. High-risk is determined by your health status, medical history, tobacco use, lifestyle, and your blood pressure.
Luckily for those with pre-existing conditions, the Affordable Care Act will make a requirement for all health insurance companies to accept adults with qualifying health problems and histories. This law already has been passed for children with pre-existing conditions since 2010, and as of January 1, 2014, adults will be able to apply for health insurance without being overcharged or rejected. Elimination riders and exclusion periods will also be made illegal to implement.
For those who have insurance or get accepted for a policy, there is a law called guaranteed renewability that protects your right to have insurance. Once you are insured, this regulation ensures you stay covered by your plan despite coming down with an illness during that term. At the end of the year when your plan expires, the health insurance company you are with is required to offer to renew the same plan. As long as you have paid your premiums and met your claims, and not violated your plan in any way, you are eligible for guaranteed renewability.