Key Takeaways
- Ohio Medicaid provides health coverage for low-income individuals and families
- Ohio expanded Medicaid under the ACA, covering adults up to 138% of the federal poverty level
- The Ohio Health Insurance Marketplace uses the federal HealthCare.gov platform
- Ohio has a High-Risk Pool (OIHA) for individuals who cannot obtain coverage elsewhere
- The Ohio Life and Health Insurance Guaranty Association protects policyholders when insurers become insolvent
Ohio State Health Programs
Ohio provides several programs to ensure residents have access to health insurance coverage.
Ohio Medicaid
Ohio's Medicaid program covers low-income individuals and families:
Eligibility Categories
| Category | Income Limit |
|---|---|
| Children | Up to 206% FPL |
| Pregnant Women | Up to 200% FPL |
| Parents/Caretakers | Up to 138% FPL |
| Adults (Expansion) | Up to 138% FPL |
| Aged/Disabled | Various limits |
Medicaid Expansion
Ohio expanded Medicaid under the ACA:
- Covers adults ages 19-64
- Income up to 138% of Federal Poverty Level
- No asset test for expansion population
- Comprehensive benefits package
Exam Tip: Ohio is a Medicaid expansion state. Know that expansion covers adults up to 138% FPL.
Ohio Health Insurance Marketplace
Ohio uses the federally facilitated marketplace (HealthCare.gov):
Marketplace Features
| Feature | Description |
|---|---|
| Platform | HealthCare.gov |
| Open Enrollment | November 1 - January 15 |
| Tax Credits | Premium assistance available |
| Plan Tiers | Bronze, Silver, Gold, Platinum |
Special Enrollment Periods
Qualify for special enrollment with:
- Loss of other coverage
- Marriage or divorce
- Birth or adoption
- Move to new coverage area
Ohio Insurance Highrisk Association (OIHA)
The OIHA provides coverage for individuals who cannot obtain standard coverage:
OIHA Eligibility
| Requirement | Description |
|---|---|
| Ohio Resident | Must live in Ohio |
| Rejection | Denied coverage by insurers |
| Medical Condition | Conditions making insurance unavailable |
| Not Eligible Elsewhere | Cannot get Medicaid or Medicare |
OIHA Coverage
| Coverage Element | Description |
|---|---|
| Benefits | Comprehensive health coverage |
| Premiums | Higher than standard market |
| Pre-existing | May have waiting period |
Note: ACA provisions have reduced the need for high-risk pools, but OIHA remains available.
Children's Health Insurance Program (CHIP)
Ohio's CHIP program covers children in families above Medicaid limits:
CHIP Eligibility
| Factor | Requirement |
|---|---|
| Age | Under 19 |
| Income | Above Medicaid, up to 206% FPL |
| Residency | Ohio resident |
| Not Insured | No access to employer coverage |
Ohio Life and Health Insurance Guaranty Association
Protects policyholders when insurers become insolvent:
Coverage Limits
| Coverage Type | Maximum Limit |
|---|---|
| Life Insurance Death Benefit | $300,000 |
| Cash Surrender Value | $100,000 |
| Health Insurance | $500,000 |
| Annuity Present Value | $250,000 |
| Disability Income | $300,000 |
Important Rules
- Producers cannot use guaranty association as selling point
- Coverage only for Ohio residents
- Applies to licensed Ohio insurers
- Does not cover HMOs or self-funded plans
What income level qualifies Ohio adults for Medicaid expansion coverage?
What platform does Ohio use for its health insurance marketplace?
What is the maximum death benefit coverage provided by Ohio's Life and Health Insurance Guaranty Association?
Who qualifies for coverage through the Ohio Insurance Highrisk Association (OIHA)?
Can Ohio insurance producers use the Guaranty Association as a selling point?
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