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Health Care Reform:

Health Insurance & Affordable Care Act

Ohio Health Insurance Marketplace

Who Is the Marketplace for?

The Ohio Health Insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. In Ohio, the Marketplace is run by the federal government. The Marketplace, also called an Exchange, is mainly for people who:

  • Don’t have insurance
  • Aren’t insured by their employer
  • Don’t have Medicare
  • Aren’t included in their spouse’s employer insurance
  • Have pre-existing conditions and may have had trouble getting insurance before
  • Have private insurance but want to look at other options
  • Own a small business

The Affordable Care Act required most Americans to sign up for health insurance in 2014. Generally, you don't need to buy insurance through the Marketplace if you are covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll:  The next open enrollment period is Nov. 15, 2014, to Feb. 15, 2015. Enroll online at HealthCare.gov or call 800-318-2596. You can also download an enrollment application at HealthCare.gov, or insurance brokers can help you enroll.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event.

Plans and Costs

Benefits

What’s Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. They include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Lab tests
  8. Rehabilitative services, such as those that help people recover from an accident or injury, and habilitative services, which help people with developmental issues.
  9. Preventive and wellness services, along with those that help people manage chronic conditions; these are covered at no additional cost.
  10. Services for children, including dental and eye care

 

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance, such as Medicaid or CHIP. Here’s what’s available:

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $11,670 and $46,680 a year, or if you have a family of four and make between $23,850 and $95,400 a year. Subsidies are based on your estimated household income for 2015. You can use your 2014 tax return to estimate your 2015 income. When you file taxes for 2015, the IRS will adjust your subsidy based on your actual income.

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