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.

The exchange (marketplace) is an enrollment platform for individual and family health plans. These plans are used by a wide range of people, including early retirees who aren’t yet eligible for Medicare, the self-employed, and people employed by small businesses that don’t offer health benefits.

Read our overview of the Ohio health insurance marketplace – including news updates and exchange history.

Open enrollment in Ohio for 2021 individual-market coverage (on- and off-exchange) ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.

Outside of open enrollment, Ohio residents normally need a qualifying event in order to purchase regular major medical coverage, either through the exchange or directly from a health insurance company. But a qualifying event is not necessary during the COVID-related enrollment window. Uninsured residents can enroll in a plan through Ohio’s marketplace, and current marketplace enrollees can switch to a different plan if it better suits their needs.

This is all particularly important due to the enhanced premium subsidies provided by the American Rescue Plan. Some people who weren’t previously eligible for subsidies will find that they are now eligible (at least for 2021 and 2022), while others who already qualified for a subsidy will find that they now qualify for a larger subsidy. This will either reduce the amount they pay each month or make it possible for them to upgrade their coverage without a strain on their budget.

For 2021, ten insurers offer marketplace coverage in Ohio, and some expanded their coverage areas.

All Ohioans can select from at least two marketplace insurers in 2021, and residents in 78 of the state’s 88 counties can select from among three insurers.

The insurers offering plans in Ohio’s exchange for 2021 include:

• AultCare
• Ambetter (Buckeye Community Health Plan)
• CareSource (CareSource’s service area expanded in 2020 to include 65 counties)
• 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 (expanded service area to a total of 40 counties in 2021)
• Oscar Buckeye State Insurance Corporation (available in the Columbus metro areas)
• Oscar Insurance Corporation of Ohio (available in the Cleveland metro area)
• Paramount
• Summa

During the open enrollment for 2021 coverage, 201,069 Ohioans enrolled in individual market plans through the state’s exchange. That was about 2% higher than the year before, when 196,806 people enrolled, but still quite a bit lower than 2016, when nearly 244,000 people enrolled.

In most states that use HealthCare.gov, enrollment peaked in 2016 and declined for the next few years, due in part to rate increases, the expansion of short-term plans, and the elimination of the individual mandate penalty at the end of 2018. But in Ohio and nationwide, there was an overall increase in enrollment for 2021.

And enrollment is further increasing in 2021, due to the COVID-related enrollment window. CMS reported that from February 15 to March 31, 2021, more than 11,000 people in Ohio signed up for coverage through the marketplace, which was nearly double the number of people who enrolled the year before during that same period (during special enrollment periods triggered by qualifying events). 

According to the Ohio Department of Insurance, the overall average proposed rate change for 2021 was a decrease of 0.4 percent. These rates were finalized mostly as proposed, although our calculations indicate an overall average rate increase of 3.3 percent for 2021.

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, in large part due to the state’s expansion of Medicaid. According to U.S. Census data, Ohio’s uninsured rate stood at 6.6% in 2019, down from 11% in 2013. It had been even lower in 2017 and 2018, but there was a nationwide increase in the uninsured rate under the Trump administration.

As of 2021, more than 201,000 Ohio residents enrolled in health coverage through the marketplace. All of them have coverage for the ACA’s essential health benefits, without having to worry about things like pre-existing condition exclusions or lifetime/annual benefit caps.

More than three-quarters of the enrollees in Ohio’s marketplace receive premium subsidies that make their monthly premiums much more affordable than they would be without the ACA (this has increased in 2021 under the terms of the American Rescue Plan).

As of 2020, a third of Ohio’s marketplace enrollees were receiving cost-sharing reductions (CSR), which make out-of-pocket medical costs (deductible, coinsurance, copays) more affordable. This is also likely to increase in 2021, as more people, including people receiving unemployment compensation in 2021, become eligible for $0 premium plans with built-in CSR under the Amerian Rescue Plan.

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 12 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 has grown by nearly half a million people since 2013. That’s a 23 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 26 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 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 (now California v. Texas), in which 18 GOP-led states are seeking to overturn the ACA. A Supreme Court ruling in California v. Texas is expected by June 2021.

Ohio’s acceptance of federal funding to expand Medicaid eligibility to 138% of poverty has played a significant role in the state’s success with Obamacare.

Between 2013 and July 2018, the state saw an increase of almost 600,000 people covered by Medicaid and CHIP. By late 2019, however, the net increase in Medicaid/CHIP enrollment in Ohio had dropped to under half a million people.

But the COVID pandemic has pushed Medicaid enrollment higher nationwide. As of November 2020, Ohio’s Medicaid/CHIP enrollment was 38% higher than it had been in 2013, with an additional 800,000 people covered. This matched the national average increase in Medicaid enrollment at that point, which also stood at 38%.

Read more about Medicaid expansion in Ohio.

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 health insurance plans to have terms of up to 364 days, but renewals are prohibited.

Read more about short-term health plans in Ohio.

As of January 2021, there were 2,383,652 Ohio residents enrolled in Medicare. Most are eligible for Medicare due to age, but about 16% are under the age of 65 and eligible for Medicare due to a disability.

You can read more about Medicare in Ohio, including details about optional Medicare Advantage and Part D prescription plans, as well as the specifics about Ohio’s rules for Medigap policies.

• Ohio Department of Insurance — Regulates, oversees, and licenses health insurance companies, brokers, and agents.
• Ohio Senior Health Insurance Information Program — Counseling, education, and assistance for Medicare beneficiaries and their caregivers.
• Medicare Rights Center — a national program that can provide assistance with Medicare-related questions.
• HRS Erase — The federally-funded Navigator organization in Ohio; can provide information and assistance with marketplace enrollment, including enrollment in Ohio’s Medicaid program.
• CAP4Kids, Columbus area (Children’s Advocacy Project) — A compilation of community resources aimed at improving the health of children.