Ohio Health Care Services

Residents can access a variety of Ohio health care programs through the Ohio Department of Health or the Governor's Office of Health Transformation. It is important to note that each of the potential programs available to you under the Ohio health care services umbrella will have unique eligibility criteria, and separate application and enrollment processes. The sections to follow will introduce you to the general populations each of the primary health care programs are designed to serve, and give you an idea of what eligibility requirements you need to meet to qualify for different types of coverage.

Types of Healthcare Services in Ohio

The three main sources of free or low cost insurance in Ohio are:

  • Medicaid insurance.
  • Medicare insurance.
  • Affordable Care Act health plans.

Other Ohio health care services options include the Alien Emergency Medical Assistance program and the Refugee Medical Assistance program. The Alien Emergency Medical Assistance program provides emergency medical care for individuals who are not American citizens and are therefore ineligible for assistance under Medicaid insurance or Medicare insurance. The Refugee Medical Assistance program is a gap insurance plan open to individuals or families who have resided in the United States for eight or fewer months who are not eligible for Medicaid healthcare and have incomes below the Federal Poverty Level. Qualifying applicants will be required to provide documentation related to income, citizenship, any other health insurance they may hold and certain pre-existing conditions. Benefits for enrollees parallel those available to Medicaid recipients.

Medicaid Insurance in Ohio

As a Medicaid expansion state, Ohio administers a robust Medicaid insurance program open to any individuals or families who meet the base income qualifications. The state’s Department of Medicaid complies with the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate through the Children’s Health Insurance Program (CHIP) and Healthchek, a comprehensive bundle of products and services for Medicaid-enrolled children and youths.

If you qualify for Medicaid coverage in Ohio, you will be encouraged to select an approved managed care plan through which to access your benefits. Managed care plans facilitate efficient and consistent care, which improves patient outcomes. Ohio also offers Transitional Medical Assistance to bridge potential gaps in care for individuals and families who cease to meet Medicaid income limits and are required to secure alternative health care insurance through Ohio health care programs that are available statewide.

Medicare Insurance in Ohio

Ohio residents typically become eligible for Medicare insurance when they turn 65. Residents with disabilities and certain medical conditions such as end-stage renal disease may qualify for coverage at an earlier age. Any changes in disability or medical condition status can affect an enrollee’s eligibility, for this type of Ohio healthcare program and may result in disqualification of, changes to, or discontinuation from benefits.

All applicants for Medicare coverage must meet minimum legal residency requirements and be able to document that they and/or their current/former spouses paid Medicare taxes for a certain number of years. Unlike Medicaid insurance, Medicare does not use income as a qualifying factor. However, some premiums will be higher for applicants above a pre-determined income level. Other restrictions also apply. For example, individuals who are incarcerated or living in the United States illegally are not eligible for Medicare insurance.

When you apply for Medicare benefits is extremely important. Applicants may pay higher premiums or penalties for not enrolling when they first become eligible, or in accordance with other guidelines. Learn more about applying for Medicare coverage by downloading our free guide.

Affordable Care Act Insurance Plans in Ohio

Residents seeking low cost insurance in Ohio are encouraged to explore Affordable Care Act plans. ACA plans are managed through the state’s Health Insurance Marketplace, which is administered by the federal government. To apply for a low-cost insurance plan through the Marketplace, you must wait for an Open Enrollment Period or qualify for a Special Enrollment Period as the result of life changes, such as marriage or the adoption or birth of a baby. You will need a variety of information, including income and tax documentation and Social Security Numbers for yourself and the other members of your household, in order to complete an ACA low-cost insurance plan application. Assistance is available for individuals who need help navigating the application process.

There are four types of low-cost insurance plans available through the Marketplace. The plans are named after metals – Bronze, Silver, Gold and Platinum – and are differentiated by the percentages of health care costs paid by the Ohio health insurance company and plan-holder, respectively. The lower a plan’s monthly premium, the more costs of day-to-day care policyholders will be responsible for paying. The Marketplace offers patients guidance on how to select the cost ratios that best fit their needs.

Affordable insurance plans in Ohio purchased through the Marketplace are income-sensitive. Individuals and families with lower incomes qualify for tax credits that reduce the amount they are required to pay monthly toward their Ohio health care insurance. Some applicants will qualify for Cost Sharing Reductions as part of Ohio health care services, a special form of credit that further reduces the costs of insurance deductibles and copays if they opt for designated plans. Changes to family size or structure, or to individual or family income, can adjust eligibility for tax credits throughout the year; these inconsistences will be balanced when the individual or family files taxes at the start of the following year. To read more about health services in Ohio, download our free, comprehensive guide.