In the wake of the passage of the 2010 Patient Protection and Affordable Care Act, all states have been forced to review their existing insurance regulations with an eye toward achieving federal compliance. Major changes currently in effect include the prohibition against excluding children from health insurance coverage on the basis of a pre-existing condition and the stipulation that children may be covered by their parents policies up to age 26. (The latter benefit is not dependent on either educational or marital status.)
Adults with pre-existing conditions can currently access high-risk insurance pools in most states, a system that will be supplanted on January 1, 2014 by the new health care exchanges.
General Insurance Regulations
Ohio insurers must offer a guarantee of renewal on all policies and coverage cannot be cancelled due to health status or illness. Currently exclusions for pre-existing conditions are limited to 12 months, and the look-back period is 6 months. If, however, there is no break or gap in the applicant’s health coverage, no pre-existing condition exclusions are allowed.
The state of Ohio requires that health insurance companies have a 30 day open enrollment for all individuals who want to purchase health insurance. During open enrollment anyone can buy a policy regardless of their health status.
Health Care Exchanges
There has been no significant activity in Ohio toward the creation of the required health care exchange. The state has until January 1, 2013 to create its exchange before the U.S. Department of Health and Human Services assumes responsibility for the project.
Pre-Existing Condition Insurance Plan
The Pre-Existing Condition Insurance Plan in Ohio is run by Medical Mutual through the Ohio Department of Insurance. It provides coverage to eligible applicants for both primary and specialty care, plus hospital stays and prescription drug coverage. Monthly premiums run from $104 to $531 for non-smokers with medical deductibles of $1500 to $2500. The maximum out-of-pocket expenses are $3000 to $4950 for medical care, and $1000 to $2950 for prescription drugs.
Medicaid eligibility is figured by income according to a percentage of the Federal Poverty Level, which is the same formula used for benefits through the Children’s CHIP Medicare expansions.
In Ohio, all children from birth to age 19 are Medicaid eligible at 150% FPL and for CHIP at 200%.
Pregnant women can access Medicaid benefits at 200% FPL, parents at 90%, and non-elderly disabled Social Security recipients at 64%.
Approximately 16 percent of Ohio residents receive Medicare benefits, with more than 1,841,500 accessing prescription drug coverage.
Ohio’s Best Rx program is an additional government-funded prescription drug program that can help low-income Medicare recipients meet their out-of-pocket expenses.