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Ohio health insurance

Ten insurers offer 2019 coverage through exchange; short-term plans are now available with terms up to 364 days.

Health insurance in Ohio

Ohio’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Ohio is among the states that have done the least to preserve the Affordable Care Act’s gains.

Ohio has a federally facilitated exchange, which means residents in Ohio use 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 2019 individual market coverage (on- and off-exchange) ended on December 15, but enrollment is still possible for Ohio residents who have qualifying events.

During the open enrollment for 2018 coverage, more than 230,000 Ohioans enrolled in individual-market plans through the state’s exchange. That was about 3.6 percent lower than enrollment in the previous year. Effectuated enrollment is always lower than the number of people who initially enroll. 204,589 people had effectuated coverage through Ohio’s exchange as of early 2018.

In 2018, ten insurers filed rates and plans for 2019 coverage in Ohio, up from eight in 2018. For 2019, only 16 counties have just one insurer offering coverage, and 33 counties have two insurers. The other 39 counties have three or more insurers offering plans in the exchange.

According to the Ohio Department of Insurance, average premiums in Ohio’s exchange are increasing by 6.3 percent for 2019.

The insurers offering plans in Ohio’s exchange for 2019 include:

  • AultCare
  • Ambetter (Buckeye Community Health Plan)
  • CareSource (expanded into one additional county; plans available in 60 counties in 2019)
  • Community Insurance Company (Anthem BCBS) (rejoined the exchange for 2019 in 25 counties, after exiting at the end of 2017)
  • Medical Health Insuring Corp. of Ohio (Medical Mutual) (expanded coverage area to a total of 51 counties in 2019),
  • Molina (expanded coverage area to a total of 33 counties in 2019)
  • Oscar Buckeye State Insurance Corporation (new for 2019, available in the Columbus metro area, in Delaware, Fairfield, Franklin, and Licking counties)
  • Oscar Insurance Corporation of Ohio 
  • Paramount
  • Summa

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.

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. But census data also pegged the uninsured rate in 2013 at just 11 percent, which was well below the national average at that point).

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 outgoing Governor John Kasich, also a Republican, is not a fan of the ACA in general. (He doesn’t see it as being effective in reducing healthcare costs and claimed it’s “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 587,039 between 2013 and August 2019. That’s a 28 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 27 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 HHS Secretary Tom Price in 2017 to address his concerns and discuss possible reforms to the current system.

Kasich wants to keep Medicaid expansion in place, but he’s 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 while the Obama Administration gave states some leeway in terms of the details, they did not allow any states to use federal ACA funding to expand Medicaid only to people with income under the poverty level. The Trump Administration has not yet allowed that, but it’s possible that they might in the future.

Kasich was term-limited and could not seek re-election in 2018. Republican Mike DeWine won the governor’s race, and will take 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 2018, in which 20 states are seeking to overturn the ACA.

Medicare enrollment in the state of Ohio

Ohio Medicare enrollment totaled nearly 2.3 million as of September 2018. Nearly 42 percent of those enrollees were covered under private Medicare Advantage plans instead of Original Medicare.

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 September 2018, more than 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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.