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Tips for Navigating the Health Insurance Marketplace in Ohio

Navigating the Health Insurance Marketplace can be daunting. There are dozens of plans that provide a variety of services for individuals, entire families and those with pre-existing conditions. The best way to start exploring health care options is to determine which coverage levels and plans apply to your specific medical needs.

Coverage Levels

To decide which coverage level is best for you, you must first decide the amount of care you require. Listed below are the coverage levels currently available in Ohio:

  • Bronze – Bronze level coverage is characterized by the lowest premiums and the highest deductibles. If you seldom need care and are only looking for a plan to help cover medical emergencies, this plan may be best for you. However, be aware that most of your routine care will need to be paid out of pocket.
  • Silver – If you qualify for “extra savings,” this plan is recommended for you. You will pay a moderate premium with a moderate deductible to have more of your routine care covered than with Bronze coverage.
  • Gold – With Gold level coverage, most of your medical expenses will be covered. You will have to pay a high monthly premium but will get a low deductible in exchange.
  • Platinum –Platinum level coverage has the highest premiums but also the lowest deductibles. If you require regular care from multiple physicians, this plan may be best for you, as it will cover almost all of your medical expenses.
  • Catastrophic – This level of coverage is not available for everyone. To qualify for Catastrophic level coverage, you must be younger than 30 years of age and meet the hardship exemption requirements. This plan has very low premiums but comes with very high deductibles and minimal coverage.
Plan Types

After picking a coverage level, you will need to pick a plan under that category. If you have specialists you see regularly, or a primary care physician you would like to continue seeing, you will need to select a plan that accommodates those needs. Here are the plans currently available at most coverage levels:

  • Health Maintenance Organization (HMO) Plan – HMOs can limit your coverage by providing care from only doctors that work directly for them, and these generally do not cover out-of-network care unless it is an emergency. HMOs may also require you to live or work in one of their service areas.
  • Exclusive Provider Organization (EPO) Plan – EPOs are managed care plans that will only cover services from doctors, specialists and hospitals in their network. Medical emergencies are the only exception.
  • Point of Service (POS) Plan – For POS plans, you will need a referral to see doctors or specialists outside of your plan’s network and will have to pay extra. However, you will pay less for using doctors and hospitals within the POS’s network.
  • Preferred Provider Organization (PPO) Plan – With PPOs, you pay less to see providers within the network, but you can use doctors, hospitals and specialists outside of the network without a referral. Only some additional costs may apply for care received outside the PPO’s network.