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Posted by on Sep 23, 2013 in Ohio | 0 comments

Ohio’s Federally Facilitated Exchange

Ohio’s Health Insurance Marketplace

Will the new online health insurance exchange in Ohio be run by the State of Ohio?

On November 16, 2012, Governor John Kasich notified the U.S. Department of Health and Human Services that Ohio would not operate a state based exchange and instead default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry and decision-making on Medicaid and Children’s Health Insurance Plan eligibility. Consumers may use the federal exchange website, HealthCare.gov, to apply for coverage, compare plans, and enroll in health insurance beginning October 1.

In Governor Kasich’s letter to HHS, he stated:

“My administration is committed to improving health care for all Ohioans through forward-thinking, solutions-oriented strategies aligned with our state’s ongoing efforts to create a jobs-friendly climate. Accordingly, we are modernizing Ohio’s Medicaid program, streamlining outdated health and human service delivery systems, implementing insurance market reforms and changing how we pay for care to reward value and coordinated care rather than volume.”

Will coverage and premiums be the same statewide?

Companies  may choose to participate in only some regions of the state; they are not required to offer coverage statewide. Different regions of the state may have different health insurance options than other regions.

Ohio is divided into 17 geographic rating areas, which are used to help determine insurance premiums. Insurance companies may charge different premiums in each of the regions in which they participate. This means the same person may have a different premium from the same carrier in Area One than they would have in Area Eight. Here is a breakdown of how the regions are divided:

AREA COUNTIES
1 Williams, Fulton, Lucas, Defiance, Henry, Wood
2 Paulding, Putnam, Hancock, Van Wert, Allen, Hardin, Mercer, Auglaize
3 Darke, Shelby, Miami, Champaign, Clark, Preble, Montgomery, Greene
4 Butler, Warren, Hamilton
5 Clinton, Highland, Clermont, Brown, Adams
6 Ottawa, Sandusky, Erie, Seneca, Huron, Wyandot
7 Crawford, Richland
8 Marion, Morrow
9 Logan, Union, Delaware, Know, Licking, Franklin, Madison, Fairfield, Pickaway, Fayette
10 Ross, Vinton, Pike, Jackson, Scioto, Lawrence, Galia
11 Lorain, Cuyahoga, Lake, Geauga, Ashtabula
12 Ashland, Medina, Summit, Portage
13 Trumbull, Mahoning, Columbiana
14 Wayne, Holmes
15 Stark, Carroll
16 Coshocton, Tuscarawas, Harrison, Jefferson, Muskingum, Guernsey, Belmont, Perry, Morgan, Noble, Monroe
17 Hocking, Athens, Washington, Meigs

 

Which companies will be offering plans through Ohio’s federally-facilitated exchange?

According to a June 6, 2013 press release from the Ohio Department of Insurance, 14 companies filed 214 different plans. On August 1, 2013, the ODI announced in a press release that only 12 companies offering 200 individual plans and 6 companies offering 184 small group plans were approved by the Department of Insurance for the exchange. Upon the ODI’s completion of the rate review process, the submissions were sent to the federal government for review and certification.

Anthem BlueCross BlueShield, dba Community Insurance Company will offer individual and small group plans statewide. Anthem DirectAccess individual PPO products will be offered at the gold, silver, bronze, and catastrophic metal levels using the Pathway X network. Small group PPO, Anthem DirectAccess products will be available at the gold, silver, and bronze levels.

HealthSpan, Inc., owned by Catholic Health Partners will be offering individual and small group HMO products. HealthSpanOne individual products will be available at the gold, silver, and bronze metal levels. HealthSpan small group products will also be offered at the gold, silver, and bronze metal levels.

Summa Insurance Company: SummaCare Inc, part of Summa Health System, will offer individual and small group PPO products. SummaCare individual products will be available at the gold, silver, bronze, and catastrophic metal levels using the Select and Mercy Choice networks. SummaCare small group products will be offered at the platinum, gold, silver, and bronze metal levels using the Premier, Select, and Mercy Choice networks.

AultCare Insurance Company individual products will be offered at the platinum, gold, silver, bronze, and catastrophic metal levels. AultCare small group products will be available at the platinum, gold, silver, and bronze metal levels.

Buckeye Community Health Plan, Inc., a wholly owned subsidiary of Centene Corporation, filed individual products to be offered on the exchange.

CareSource will offer individual and small group products statewide. Individual plans will be available at the platinum, gold, silver, bronze, and catastrophic metal levels. Small group plans will be available at the platinum, gold, silver, and bronze metal levels.

Humana Health Plan of Ohio individual HumanaConnect HMO products, offered both on and off the exchange, will be available at the platinum, gold, silver, bronze, and basic (catastrophic) metal levels.

Kaiser Foundation Health Plan of Ohio will offer individual and small group HMO products at the gold, silver, and bronze metal levels.

Medical Health Insuring Corporation of Ohio, MHICO, a wholly owned subsidiary of Medical Mutual of Ohio, will offer individual Market products at the gold, silver, and bronze metal levels and small group products at the gold and silver levels.

Molina Healthcare of Ohio will offer individual Molina Marketplace plans.

Paramount Insurance Company currently offers group commercial and managed Medicare and Medicaid products. The company will be a new entrant to the individual market, ensuring its Medicaid members have access to a Paramount product if they lose Medicaid eligibility. Paramount HMO individual exchange only products were filed at the gold, silver, bronze, and catastrophic metal levels.  

Coventry Health and Life Insurance Company, CHL Ohio individual exchange PPO products will be available at the gold, silver, bronze, and catastrophic metal levels in areas 10, 13, 16, and 17.

Aetna, the new parent company of Coventry, withdrew from the exchange market, stating:

“The decision in Ohio was made after we took a long view at both Aetna state-by-state and Coventry state-by-state,” Aetna spokesman Susan Millerick said. “Ohio is one of the markets where we chose to pull Aetna and leave Coventry. There was no need to have two separate plans in the exchange. We found the Coventry plan to be the most competitive, so we withdrew the Aetna offering.”

Read more about Aetna’s decision HERE.

Coordinated Health Mutual Inc., dba InHealth Mutual, would have been Ohio’s new CO-OP, but the company failed to meet all of the requirements needed to obtain a state license to sell health insurance by the July 31 federal deadline.

 

New information is being released every day. Follow this blog to receive updates as new information is released in Ohio.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

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Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

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