When can I enroll in an individual plan?
Based on the Affordable Care Act regulations, individual insurance plans hold an open enrollment period in the fall. Open Enrollment is from November 1, 2017 to December 15, 2017 for an effective date of January 1, 2018. Alternatively, if you have a qualifying event you may enroll within 60 days of the date of the event.
What carriers are available in my county of residence for 2018?
CLICK HERE TO VIEW LIST OF ISSUERS FOR YOUR COUNTY
The Ohio Dental Association is licensed to sell individual policies issued by Medical Health Insuring Corp. of Ohio (Medical Mutual of Ohio, MMO). We are happy to assist in areas where Medical Mutual of Ohio is offering a 2018 individual product.
If you need assistance purchasing plans from other companies, the American Dental Association offers assistance through the following link: https://www.ahix.com/individual-and-family-health-insurance-plans.
Consumers may also contact the federal exchange in Ohio directly by visiting www.healthcare.gov or by calling 1-800-318-2596.
Do I qualify for a healthcare subsidy?
Individuals may be eligible for government subsidies to help pay for
premiums. Subsidies are available only for coverage purchased through
the exchange. Subsidies are calculated based on the modified adjusted
gross income for the year and the household size. Subsides may be
available to individuals with incomes between 100% of the Federal
Poverty Level (FPL) and 400% of the FPL. More information on qualifying
for premium assistance can be found at healthcare.gov.
Individuals may also qualify for savings on out-of-pocket costs when
they obtain medical care. These savings are called "cost-sharing
reductions." Cost-sharing reductions reduce the amount an individual
pays for out-of-pocket costs such as deductibles, coinsurance and
How are premium rates determined?
Premium rates both on and off of the marketplace are determined by the age of each individual who will be covered by a plan. Other factors that affect the premium for coverage include where a person lives and the level of plan (metal tier) that they select and whether they are a smoker or non-smoker.
Can I still buy individual insurance if I have a very serious pre-existing medical condition?
Under the ACA, insurers providing individual insurance will no longer be able to, in most cases, exclude, limit or deny coverage for any American including children under age 19 solely on the basis of a pre-existing condition.
How do I request a change or terminate my individual coverage?
Please contact the Customer Service phone number on your id card for further assistance.
What benefits will an individual health policy cover?
All individual health insurance plans will offer coverage that includes essential health benefits. The essential health benefits include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services
- Prescription drugs
- Laboratory services
- Preventive and wellness services
- Pediatric services
- Rehabilitative and habilitative services and devices.
Each plan or insurance company may add items or services to these minimum essential benefits and may vary the hospitals and doctors that are part of the network. It is important to compare plans and check to make sure the hospitals and providers you want are part of the plan’s network. Individual plans can be purchased through the exchange (healthcare.gov) or outside of the exchange (off-market plans) which are offered through an insurance agent.
What is a qualifying event?
A qualifying event
is a life-change that makes you eligible within 60 days of the event to
change your health insurance coverage outside the annual enrollment
period. Life changes might include a marriage, birth, adoption, death,
divorce, loss of coverage due to reduction in work hours, loss of job,
relocation, or loss of student insurance or Medicaid. It is not a voluntary loss of coverage or due to non-payment. Proof of qualifying event is required to be submitted at the time of application. Please click here for a list of acceptable events and the required documentation.