Open Enrollment Period in Ohio

• Open Enrollment for 2025: November 1, 2024 – January 15, 2025

• Enroll by December 15 for coverage starting January 1

• Enroll between December 16 and January 15 for coverage starting February 1

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

You generally have 60 days from the event to enroll. There are also extended SEPs for those losing Medicaid or CHIP coverage.

Types of Health Insurance Plans Available

Plans are offered in four “metal” tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs; best for those who rarely use care.

• Silver: Moderate premiums/costs; required for cost-sharing reductions.

• Gold: Higher premiums, lower out-of-pocket costs; good for frequent care.

• Platinum: Highest premiums, lowest costs; best for those needing frequent care.

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums, high deductibles, and cover essential benefits after the deductible is met.

Plan Types:

• HMO: Lower premiums, limited network, referrals required for specialists.

• PPO: Higher premiums, larger network, out-of-network coverage, no referrals.

• EPO: More flexibility than HMO, no out-of-network coverage except emergencies, no referrals needed.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes between 100% and 400% of the federal poverty level (FPL), with expanded eligibility through 2025.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing out-of-pocket costs.

• Medicaid/CHIP: Ohio expanded Medicaid to adults earning up to 138% FPL. CHIP covers children in families with incomes up to 206% FPL, depending on age.

How to Compare and Choose a Plan in Ohio

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Make sure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the Ohio Exchange

For 2025, 13 insurers offer Marketplace coverage in Ohio, including:

• Ambetter (top-rated for affordability and claims)

• Anthem Blue Cross and Blue Shield

• CareSource

• Medical Mutual of Ohio

• Molina Healthcare

• Paramount Insurance Company

• Oscar

• UnitedHealthcare

• AultCare

• Summa Insurance

• Buckeye Health Plan

• The Health Plan

• Devoted Health

Plan availability varies by region, and some providers offer HMO, PPO, and EPO options.

Navigating Ohio’s Online Enrollment Portal

How to Apply:

Go to the federal enrollment website and create an account.

Enter household and income information to check eligibility for subsidies or programs.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from Navigators, certified application counselors, and local agencies. Assistance is available by phone, online, or in person.

Alternatives to the Marketplace

• Short-term health plans: Temporary coverage for gaps; not ACA-compliant and may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Forgetting to update income, which can affect subsidy eligibility and lead to tax repayment.

• Missing enrollment deadlines, resulting in loss of coverage or waiting until the next Open Enrollment.

• Choosing the wrong metal tier for your needs.

• Not checking if your providers are in-network.

State-Specific Health Programs or Initiatives

• Medicaid Expansion: Ohio expanded Medicaid to cover adults up to 138% FPL.

• CHIP: Covers children in families with incomes up to 206% FPL.

• Premium Subsidies: Enhanced by federal law, making coverage more affordable for most enrollees.

• Local Assistance Programs: The Ohio Department of Insurance and Job and Family Services offer additional resources for coverage and eligibility questions.

Ohio’s Marketplace offers a wide range of plans, strong consumer protections, and robust assistance for residents seeking affordable health coverage.