An Ohio Family Physician curious about the human condition and how that applies to the practice of Family Medicine. By A. Patrick Jonas, MD
Wednesday, October 2, 2013
Affordable Care Act Preliminary Insurance Information for Ohio
This is from WebMD 9/25/13: Ohio Plans, Benefits, and Costs
Companies can offer four levels of plans: bronze, silver, gold and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here’s how it works:
Bronze Plan: You pay 40% and the plan pays 60%.
Silver Plan: You pay 30% and the plan pays 70%.
Gold Plan: You pay 20% and the plan pays 80%.
Platinum Plan: You pay 10% and the plan pays 90%.
Catastrophic plans may be available, especially for people who are under 30 and healthy. These plans cost less up front, but they don't give you as much coverage. They generally require you to pay more out-of-pocket costs.
You must have at least a bronze-level plan to meet minimum requirements under the Affordable Care Act and avoid the penalty for not having health insurance.
Costs:Here are the average monthly premiums across Ohio for all age groups released by the Department of Health and Human Services. Specific premiums will vary from these averages based on the region within the state, the specific insurance plan selected, and age.
Lowest cost bronze: $263
Lowest cost silver: $304
Tobacco Surcharge:Ohio allows insurance companies to charge tobacco users 50% more than non-tobacco users.
Who Is Selling Insurance in the Ohio Marketplace? Ohio is waiting for insurance companies to submit rates and plans. The state needs to give this information to the federal government by July 31.
What's covered:All approved plans in the state must cover the same package of benefits, called essential health benefits. In Ohio, the benefits include:
Outpatient services, such as doctor visits or tests done outside a hospital
Pregnancy and baby care
Mental health and substance abuse services, including behavioral health treatment
Prescription drugs, including generic and certain brand-name drugs
Rehab and habilitative services, those that help people recover from an accident or injury and those that help with developmental issues. In Ohio, this includes physical rehabilitation, speech and language therapy, applied behavioral analysis, and mental health services for children with a diagnosis of autism spectrum disorder.
Preventive and wellness services, along with those that help people manage chronic conditions. This includes biofeedback and chiropractic care.