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Health Care Reform:

Health Insurance & Affordable Care Act

Ohio Health Insurance Marketplace

Benefits

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:

  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. 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.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions. This includes biofeedback and chiropractic care.
  10. Services for children,  including dental and eye care

Some services not included: infertility treatment, long-term nursing home care, and weight loss surgery.

Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.

Financial Aid and Medicaid

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

Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace.  In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.

You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.

Medicaid Expansion : Some states expanded their Medicaid program so more people can get health insurance.  Gov. John Kasich pushed through expansion of Medicaid in late October without approval of the legislature. Several Republican House members filed a lawsuit challenging the expansion. If the expansion stands up, you may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,499 for a family of four.

 

 

Medicaid Expansion: Some states expanded their Medicaid program so more people can get health insurance. Ohio has not yet decided whether to participate in the Medicaid expansion for low-income Americans.

CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid. 

Check with  Healthcare.gov to see if you are eligible for these programs. 

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