Obamacare in Ohio

Health Insurance Marketplace in Ohio

If you live in Ohio, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Ohio will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Ohio 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

Ohio Association of Foodbanks

Since 1991 the Ohio Association of Foodbanks has benefited thousands of people in need in the State of Ohio. The Ohio Association of Foodbanks will provide outreach support through a variety of phone, online, and promotional tools.

Children’s Hospital Medical Center

Children’s Hospital Medical Center serves the medical needs of infants, children and adolescents with family-centered care, innovative research and outstanding teaching programs. They plan on reaching out and enrolling the uninsured through the main hospital location in urban inner city geographic area as well as two satellite locations.

Clermont Recovery Center, Inc.

Clermont Recovery Center, Inc., a not-for-profit drug and alcohol outpatient treatment and prevention agency located in the county seat of Batavia, Ohio. The organization will educate and help enroll the uninsured in coverage in several counties in Ohio, including Clermont, Brown and Adams.

Helping Hands Community Outreach Center

Helping Hands Community Outreach Center is a nonprofit organization serving the Dayton Ohio region and provides resources to families and individuals who are hospitalized. The organization will attend local events and will work with businesses and public agencies to promote education and awareness of the Marketplaces.

Neighborhood Health Association

The Neighborhood Health Association (NHA), a Federally Qualified Health Center (FQHC) system located in Northwest, Ohio will through its Affordable Care Act Insurance Enrollment Project, raise community awareness regarding the insurance Exchange and facilitate enrollment in for the uninsured.

Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP’s in Ohio:

Coordinated Health Plans of Ohio, Inc.

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.

Subscribe to the Obamacare-enrollment newsletter

Accountable Care Organizations in Ohio

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Ohio

On November 16, 2012, Governor John Kasich (R) notified federal officials that Ohio would default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry.1 The Governor also indicated Ohio would maintain control over Medicaid eligibility determinations.

Prior to the announcement, the Department of Insurance in collaboration with other stakeholder agencies solicited subcontractors’ assistance for the first year of exchange planning and implementation. Contractors evaluated financing options and sustainability, provided actuarial services and economic modeling, and an information technology (IT) gap analysis.2,3,4

On December 21, 2011, the Governor signed HB 79, which prohibits qualified health plans purchased through an exchange from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.5

Contracting with Plans: On February 14, 2013, Lieutenant Governor Mary Taylor sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) reiterating the state’s intention to perform plan management activities. The Ohio Department of Insurance (ODI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). ODI will use the System for Electronic Rate and Form Filing (SERFF) to collect, review, and approve plan rate and benefit information. ODI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.6

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO.

Exchange Funding

In September 2010, the Ohio Department of Insurance received a $1 million federal Exchange Planning grant.

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Ohio is expected to participate Medicaid expansion pending General Assembly approval.

Next Steps

On March 8, 2013, Ohio received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.7

For more information on Ohio’s exchange planning, visit: www.ohioexchange.ohio.gov


1. John Kasich. “Ohio Says No to an Obamacare Health Exchange.” November 16, 2012.http://governor.ohio.gov/exchange.aspx
2. Assist with the first year of planning for design and implementation of a federally mandated American Health Benefit Exchange. August 31, 211. Milliman. http://www.ohioexchange.ohio.gov/Documents/MillimanReport.pdf
3. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Roadmap and Budget Report. September 14, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
4. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Blueprints Report. September 13, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
5. HB 79. 129th General Assembly. Signed December 21, 2011. Enrolled version.http://www.legislature.state.oh.us/bills.cfm?ID=129_HB_7911.
6. Letter from Lieutenant Governor Taylor to Gary Cohen. February 14, 2013.
7. Letter from Gary Cohen to Lieutenant Governor Taylor. March 8, 2013.

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