With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Florida, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Ohio
Ohio ranked 40th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths included a high rate of high school graduation, a low percentage of uninsured population, and ready availability of primary care physicians. Challenges for Ohio included high levels of air pollution, high rates of preventable hospitalizations, and a high prevalence of diabetes.
Ohio individual and family health insurance
When the Obamacare health insurance exchanges opened for 2014 enrollment, Ohio defaulted to the federal health insurance marketplace, healthcare.gov. Individuals and families living in Ohio may purchase health insurance coverage through the state’s federally facilitated exchange and in the private marketplace.
Those who buy health insurance through healthcare.gov may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
The U.S. Department of Health and Human Services reported that 154,668 individuals in Ohio selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Ohio enrolled in a marketplace plan increased to 234,341 during the open enrollment period.3
|Ohio’s health insurance exchange:||healthcare.gov|
|Ohio Department of Insurance:||insurance.ohio.gov|
Ohio small group health insurance plans
In Ohio, small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program, SHOP Marketplace, at healthcare.gov/marketplace/shop and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from healthcare.gov.
Ohio COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may qualify for health insurance continuation through mini-COBRA programs. State mini-COBRA programs allow those who work for a small business and lose health insurance coverage due to a qualifying event to continue coverage, too. These programs generally work like the federal COBRA continuation coverage, but their terms may vary. Ohio’s small group COBRA continuation variations are as follows:4
|Eligible group sizes||2 to 19|
|Maximum continuation period – standard||12 months|
|Maximum premium||Up to 100 percent of the full group rate|
|State legislation reference||3923.38 Continuing policy upon termination of employment|
|More Information||800-686-1578 |insurance.ohio.gov/consumer/pages/cobra.aspx|
|Additional notes||The employ must have been continuously insured under a group policy or under the group policy and any prior similar group coverage replaced by the policy for the entire three-month period preceding termination of employment. Those who voluntarily terminate their employment or are terminated due to gross misconduct are not eligible.Continuation must be elected in writing and accompanied by the first premium payment—both given to the employer. This must be done the earliest of the following: 31 days after the termination of coverage, 10 days after the date of coverage termination, if the employer provides notification of the right to continue coverage prior to the termination date, 10 days of the employer provides notification of the right to continue coverage if he or she does so after the date of termination.|
Ohio high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPS and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Ohio elected to expand its Medicaid program in 2014.
The information below is specific to Ohio’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Ohio Department of Medicaid|
|Where to apply||healthcare.gov | benefits.ohio.gov|
|Eligibility7||Ohio resident, U.S. citizen or qualified non-citizen | Eligible individuals may include: Children up to 19 years old and their parents and caretakers, Some 19 and 20 year olds, Adults up to age 64 living at or below 138 percent of the federal poverty level, Pregnant women, Some women with breast and/or cervical cancer, Adults age 65 and older, People with certain disabilities, including blindness, Some immigrants.|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines. The information below is specific to Ohio’s CHIP program.
|Where to apply||healthcare.gov | hbenefits.ohio.gov|
|Age Limit||Up to 19|
|Residency Requirements||Ohio resident, U.S. citizen or qualified non-citizen|
|Eligibility8||Must meet certain financial requirements, which vary by program|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 LA Writer Ohio Laws and Rules. “3923.38 Continuing Policy Upon Termination of Employment.” Codes.Ohio.gov. Retrieved from http://codes.ohio.gov/orc/3923.38.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 NC Department of Health and Human Services. NC Division of Medical Assistance. “Who is Eligible for North Carolina Health Choice for Children?” ncdhhs.gov. Last updated June 6, 2014. Retrieved fromhttp://www.ncdhhs.gov/dma/healthchoice/who.htm.