Residents of The Buckeye State know they have a diverse landscape, but what about diverse health care choices? Ohio is ranked as the 36th best state when it comes to health care. The study takes health care access, quality, and good public health into consideration for the rankings.
Health insurance options in Ohio
According to the Ohio Department of Insurance, residents can get health insurance through several different routes:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Ohioans get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 52% | ||
| Individual or family | 5% | ||
| Medicaid | 21% | ||
| Medicare | 15% | ||
| Military | 1% | ||
| Uninsured | 6% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Only six percent of Ohio residents are uninsured, putting the state ahead of the national average. That's good news for policyholders, because the more uninsured people there are, the higher costs can be for insured people.
Ohio health insurance companies
Ohio residents have plenty of options when it comes to finding the right health insurance provider. Here are some of the top insurers in the state:
- AultCare
- Ambetter
- CareSource
- Community Insurance Corporation (Anthem BCBS)
- Medical Mutual
- Molina Healthcare
- Oscar Buckeye State Insurance Corporation
- Oscar Insurance Corporation of Ohio
- Paramount
- SummaCare
These providers offer both family and individual plans. Check insurer sites to see how coverage varies based on where in the state you live.
Ohio health insurance costs and rate factors
Ohio residents spend $8,712 on health care expenditures per year, more than the national average. So what factors determine how much you'll be paying in Ohio? Health care costs vary quite a bit based on the individual, but these are the main factors companies will consider when pricing your policy:
Plan type
If you want more coverage, you're going to have to fork over more funds. Marketplace plans are divided into four different metal categories: bronze, silver, gold, and platinum.
So, how much should you expect to pay for health care in Ohio? Here are the average monthly prices in 2020 for a middle-aged Ohio resident:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $278 | $368 | $445 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a gold plan cost about 54 percent more than a bronze plan. This price jump is because gold plans cover 80 percent of health care costs, whereas bronze plans only cover 60 percent.
The lowest level of coverage is the catastrophic plan, which people under 30 or with a hardship or affordability exception are eligible for. This type of plan comes with a $8,150 yearly deductible. With such a high deductible, it may be worth it to purchase a bronze or silver plan that saves you money when you need to use your insurance.
Body mass index
According to the CDC, obesity makes you more likely to suffer from numerous health conditions. That's why many insurers will ask for your BMI to price your policy. A higher BMI could mean a higher risk, causing policy prices to jump.
In 2018, Ohio had a 34 percent obesity rate, the 17th highest rate in the country. Out of the many Ohio residents who used QuoteWizard to compare health insurance plans, 36 percent have a BMI in the obese range.
Tobacco use
There are substantial risks that come from smoking. Tobacco users also pay more for health insurance. According to America's Health Rankings, 21.1 percent of Ohio residents are smokers, the eighth highest rate in the country.
Age
Health insurance can increase as your age does. According to HealthCare.gov, older people pay up to three times more for health care than younger people. On average, OH residents who used QuoteWizard to shop for health insurance plans are 40 years old.
Location
Due to the different laws, regulations, and insurance providers surrounding the health care marketplace, your location is a big factor in how much you'll pay in premiums.
Health insurance rates are also usually community rated. Costs are dependent on claims that everyone in your area files. This means that if a neighbor files a high number of claims, your policy prices could spike.
Living in a healthier state could keep your costs low. Ohio is ranked as the 39th healthiest state in America.
Ohio health insurance laws
The Affordable Care Act makes it so that insurance companies can't use certain factors when pricing your policy.
- Pre-existing conditions: People with pre-existing conditions used to pay more for health insurance. But according to the Department of Health & Human Services, insurance companies can no longer charge people with pre-existing conditions more.
- Gender: According to a study by Health Services Research, women historically pay more for health care. However, insurance companies cannot charge men and women different premiums for the same plan.
- Insurance and medical history: Thanks to the ACA, insurance companies can no longer analyze your medical history and past insurance coverage.
The health insurance marketplace has out-of-pocket limits. For 2018, the out-of-pocket limits are $8,150 for an individual plan and $16,300 for a family plan.
Ohio law requires that insurance companies provide at least some coverage for these services:
- Infertility treatment
- Coverage for emergency services
- Maternity benefits
- Hospitalization coverage for mental illness
- Mammography
- Cancer clinical trial
- Outpatient coverage for mental and emotional disorders
There are more services that insurers need to provide. Check out the full list here.
Medicare and Medicaid in Ohio
Medicare and Medicaid are government-funded health care programs offered to different groups. Medicare helps those over 65 and Medicaid offers coverage to low income families and children.
Medicare
Those over 65 are eligible for Medicare. There are a number of options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program. In Ohio, there are four kinds of Medicare Savings Programs, including:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
The rate of uninsured Americans has improved considerably since the Affordable Care Act (ACA) became law in 2010. Medicaid expansion was influential in reducing Ohio’s overall uninsured rate.
In 2013, 11.0% of Ohio’s residents did not have health insurance. After Ohio expanded its Medicaid program in 2014, and by 2019 the state’s uninsured rate dropped by 19.9%. A major factor of this was a 5.7% increase — or 122,000 Ohio residents — in Medicaid enrollment from 2013 to 2019.
These are the state's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Ohio Department of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Jillian Froment
- Insurance Hotline:
- (800) 686– 1526
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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