Health insurance in Ohio
- Ohio has a federally facilitated marketplace so residents enroll through HealthCare.gov.
- Open enrollment for 2020 health plans has ended, although Ohio residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Short-term health plans can be sold in Ohio with initial plan terms up to 364 days.
- Ten insurers are offering plans in the exchange for 2020 — the same as 2019, but up from eight in 2018.
- An estimated 500,000+ Ohioans have gained coverage under ACA’s Medicaid expansion.
- Nearly 207,000 people enrolled in Ohio’s exchange for 2019, which was about 10% lower than 2018’s enrollment.
- The uninsured rate in Ohio has dropped by more than 40 percent since 2013 (although it was higher in 2018 than it had been in 2017).
- Ohio’s lawmakers split on support for the ACA.
Ohio’s health marketplace
Ohio has a federally facilitated exchange, which means residents in Ohio use HealthCare.gov to enroll in exchange plans. But Ohio is one of seven states that participates in plan management and the qualified health plan (QHP) certification process.
Open enrollment for 2020 individual market coverage (on- and off-exchange) has ended. Outside of the open enrollment window, Ohio residents must have a qualifying event in order to purchase regular major medical coverage. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
During the open enrollment for 2019 coverage, 206,871 Ohioans enrolled in individual-market plans through the state’s exchange. That was about 10 percent lower than enrollment in the previous year, and down about 15 percent from peak enrollment in 2016. In most states that use HealthCare.gov, enrollment peaked in 2016 and has declined since then. This is due to a variety of factors, including increasing premiums for people who don’t qualify for premium subsidies, confusion about the legal status of the ACA (due to GOP efforts to repeal the law via legislation and court cases), the expansion of short-term plans, and the elimination of the individual mandate penalty at the end of 2018.
For 2020, ten insurers are offering plans in Ohio’s exchange, and nearly all of the state’s residents will be able to select from among at least two insurers in the exchange. In 2018, residents in 42 of Ohio’s 88 counties had only one available insurer. That dropped to 16 counties in 2019, and thanks to coverage area expansions, Logan County will be the only area of the state where just a single insurer offers exchange plans for 2020.
According to the Ohio Department of Insurance, average premiums in Ohio’s individual market are decreasing by 7.7 percent for 2020, although that might include the introduction of new, lower-cost plans, as the rate changes for existing plans seem to indicate an average increase in premiums, rather than a decrease.
The insurers offering plans in Ohio’s exchange for 2020 include:
- Ambetter (Buckeye Community Health Plan)
- CareSource (plans are available in 60 counties in 2019. CareSource’s 2020 filing indicates a coverage area expansion but does not clarify the details)
- Community Insurance Company (Anthem BCBS) (rejoined the exchange as of 29, after exiting at the end of 2017)
- Medical Health Insuring Corp. of Ohio (Medical Mutual)
- Molina (expanding coverage area to a total of 39 counties in 2020)
- Oscar Buckeye State Insurance Corporation (available in the Columbus and Cleveland metro areas)
- Oscar Insurance Corporation of Ohio
Read more about the Ohio health insurance marketplace.
Ohio Medicaid/CHIP enrollment
Ohio’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in the state’s success with Obamacare.
In early 2014, the Kaiser Family Foundation estimated that about half of Ohio’s population would be eligible for expanded Medicaid or CHIP, in large part because of the more generous eligibility guidelines under the ACA. Between 2013 and July 2018, the state saw an increase of almost 600,000 people covered by Medicaid and CHIP. By mid-2019, however, the net increase in Medicaid/CHIP enrollment in Ohio had dropped to about 517,000 people (in most states, Medicaid enrollment grew sharply for about two years after expansion was implemented, and then plateaued; in some cases, it has declined since then due to changes in the way a state verifies eligibility, improving economic conditions in the state, etc.).
Read more about Medicaid expansion in Ohio.
Ohio does not allow renewal of short-term health insurance plans
The Trump administration relaxed the federal rules for short-term plans in 2018, allowing them to have much longer durations, including extensive renewals. But the new rules are clear in noting that states can impose stricter guidelines. Ohio allows short-term plans to have terms of up to 364 days, but renewals are prohibited.
Read more about short-term health plans in Ohio.
How has Obamacare helped the Buckeye State?
Under the ACA, Ohio’s federally facilitated exchange and expanded Medicaid program both helped residents gain health coverage. During the first open enrollment period, equal numbers of people enrolled in private plans and Medicaid.
The state’s uninsured rate has dropped significantly as a result of the ACA. The Ohio Department of Medicaid reported in early 2017 that the uninsured rate in the state had reached an all-time low of 8.7 percent by mid-2016. That was down from 17.3 percent in 2012.
U.S. Census data put the uninsured rate even lower as of 2017, at 6 percent, although it increased to 6.5 percent in 2018. But census data also pegged the uninsured rate in 2013 at just 11 percent, which was well below the national average at that point. Using official U.S. Census data, the uninsured rate in Ohio was almost 41 percent lower in 2018 than it had been in 2013, despite the increase from 2017 to 2018.
The bulk of the decrease is due to the expansion of Medicaid, which has been the primary factor in driving the uninsured rate among low-income Ohio residents to 14.1 percent by 2016 — the lowest it had ever been.
Ohio and the Affordable Care Act
Ohio’s U.S. Senators are split on healthcare reform. Sherrod Brown, a Democrat, supports the ACA, while Rob Portman, a Republican, is a vocal opponent of the ACA.
In the House, Ohio’s delegates now include 11 Republicans and just four Democrats. Only one of those Republicans — David Joyce, who won re-election in 2018 — voted against the GOP’s American Health Care Act, which was an effort to repeal the ACA.
Ohio’s state legislature has a strong Republican majority, and former Governor John Kasich, also a Republican, was not a fan of the ACA in general. (He didn’t see it as being effective in reducing healthcare costs and claimed it was “messing up the economy.”) So it’s no surprise that Ohio opted for a federally facilitated exchange rather than running its own exchange.
But Kasich broke ranks with most of his fellow Republican governors – and with his state’s legislature – in opting to expand Medicaid in Ohio. His reasoning was that it would have been immoral to not do so, and he’s vehemently challenged Republicans on this issue. Ohio’s average monthly Medicaid enrollment grew by 517,462 between 2013 and June 2019. That’s a 24 percent increase, which far exceeds Medicaid growth in most states with Republican governors (the national average across all states, including those with Democratic leadership, has been 29 percent).
Kasich was also vocal in his opposition to Congressional Republicans’ proposals to fully repeal the ACA, including Medicaid expansion. Kasich met with President Trump and then-HHS Secretary Tom Price in 2017 to address his concerns and discuss possible reforms to the current system.
Kasich wanted to keep Medicaid expansion in place, but he proposed a lower eligibility cut off at 100 percent of the poverty level (as opposed to the current 138 percent). People with income above the poverty level would instead be covered under private plans in the exchange, presumably with subsidies that are similar to what the ACA currently provides for low-income enrollees. Similar proposals have been put forth by several Republican governors over the last few years, but have been rejected not only by the Obama administration but also by the Trump administration.
Kasich was term-limited and could not seek re-election in 2018. Republican Mike DeWine won the governor’s race, and took office in January 2019. DeWine has long opposed the ACA, but his position on Medicaid expansion appeared to soften as of 2018, when he said that the state would keep Medicaid expansion in place if he became governor. DeWine has served as the state’s attorney general since 2011. And while he joined in a lawsuit that year that challenged the constitutionality of the ACA, he did not join in the Texas v. Azar case, in which 20 states are seeking to overturn the ACA.
Medicare enrollment in the state of Ohio
Medicare Advantage plans offer an alternative for beneficiaries who want additional benefits beyond what traditional Medicare offers, although they also come with additional network restrictions and out-of-pocket costs (Medicare Advantage has a cap on out-of-pocket, unlike Original Medicare; but Original Medicare can be paired with a Medigap supplement that pays all or most of the out-of-pocket exposure).
Most Medicare Advantage plans come with integrated Part D prescription drug coverage. But Original Medicare doesn’t cover most prescription drug costs. Enrollees who don’t have access to retiree prescription drug coverage can purchase stand-alone Medicare Part D plans. As of mid-2019, nearly 45 percent of all Medicare beneficiaries in Ohio had stand-alone Part D coverage.
In the state of Ohio, about 83 percent of Medicare recipients qualify based on age, while 17 percent qualify due to disability. Medicare spends about $9,463 per Ohio enrollee each year – higher than the national average of $8,970. In 2009, the most recent data available, the state ranked 6th in overall spending with $19.3 billion per year.
State-based health reform legislation
Scroll to the bottom of this page for a summary of recent Ohio bills related to health reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.