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Ohio Health Insurance
Health insurance is a vital aspect from financial planning point of view. Buying appropriate health insurance coverage for your family can be costly and requires a good consideration of all potential risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. The rising healthcare costs often create financial havoc in these families’ lives, in the event of physically crippling hazards. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
Ohio stands at 32nd place in the 2008 Healthiest States List issued through the United Health Foundation’s Health Rankings. The state’s health care system has been declining since past few years; it was on 29th and 25th position in 2007 and 2006 respectively. The major challenges faced by Ohio’s health system include low public health funding, high percentage of children under poverty, high prevalence of smoking and high level of air pollution. The state, having the population of more than eleven million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Ohio who meet specific eligibility requirements.
The Ohio Department of Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 10.9% of the residents are uninsured as the Ohio government strives to tackle the healthcare issues in the state. Approximately, 33.8% uninsured Ohio citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.
Health insurance is one thing that you cannot afford to survive without. When shopping for health coverage, make sure to get in contact with a licensed health insurance agent/broker to avail the benefits of health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Ohio. These regulations apply to all insurance companies offering individual or family health insurance in Ohio:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 6 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, direct access to OB/GYNs, infertility coverage |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Ohio. These regulations apply to all insurance companies offering small group health insurance in Ohio:
| Small Group Size | 2-50 |
Employee Qualifications | Owner can count as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 35% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Ohio. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period – Disabled | 6 months |
Maximum Premium Increase | 100% |
State Legislation Reference | |
Additional Notes | To qualify for COBRA, a person must have been on the group plan for at least 3 months and must have not voluntarily have terminated their employment. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Ohio to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Ohio does not have a high risk pool for residents who are unable to obtain private health insurance due to pre-existing health conditions.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Ohio provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Healthy Start |
Website | |
Phone Number | 800-324-8680 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | NA |
Length of Coverage | Based on Eligibility |
Residency Requirements | Ohio resident, U.S. citizen |
Other Eligibility Requirements |
|
Pre-Existing Condition Exclusions | None |
Cost | $0 or minimal share of cost. Some families may have to pay co-payment of $1 to $3 for covered services. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Ohio:
| Governing Agency | Department of Job and Family Services |
Website | |
Phone Number | 800-324-8680 |
Residency Requirements | Ohio resident, U.S. citizen, legal immigrant |
Federal Poverty Line Income Limits | Families with Children under the age of 19 Income at or below 90% FPL |
Additional Resources
Ohio Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Ohio’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Ohio: At-A-Glance
Provides exclusive health data of the Ohio state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
