You can still get a nationwide PPO in Ohio, even though every marketplace medical plan is an HMO. Here is how owners of Ohio LLCs, S-corps and small shops are covering themselves and their families.
Hi, I'm Sam Jaber, a Tampa-based health insurance broker licensed in 36 states. I help Ohio business owners by phone, whether you run a one-person LLC, an S-corp with your spouse on payroll, or a small shop with a few employees.
Owners in Ohio often expect to rebuild the PPO they had at a larger company. On HealthCare.gov they can't: Ohio's marketplace sells only HMOs. The good news is that Ohio has a Medicaid backstop for a lean startup year and a continuation law for owners leaving a job. Here's how it all works for you.
Ohioans can choose among 189 individual medical plans from 11 insurers this year, and all 189 are HMOs.
You can still get a nationwide PPO in Ohio. It comes from outside the marketplace as a privately underwritten plan I can arrange: each family member answers health questions, the premium reflects those answers, and the network reaches providers nationwide. If your household is healthy, it's the first thing to price.
With no employees beyond owners and family, you shop the individual marketplace, which in Ohio is HealthCare.gov. Hire someone who isn't an owner or a relative and the small-business marketplace, SHOP, may become available for a group plan.
Your premium tax credit depends on household income for the coverage year. Sole proprietors and single-member LLCs start from net profit; S-corp owners count their salary plus pass-through profit. At the low end, Ohio's Medicaid expansion covers adults up to 138% of the federal poverty level, and Medicaid eligibility generally rules out the credit, so the two don't overlap.
One Ohio-specific note for your tax preparer: Ohio's income tax starts from federal adjusted gross income, so federal above-the-line deductions shape your Ohio starting point as well.
Then the marketplace is usually where your family pays least, since the credit is only usable there. Every option is an HMO, so run each family member's doctors against the network before comparing premiums. If profit shifts during the year, update the estimate.
Next step: Bring last year's return and your read on this year, and we'll pick an HMO that fits the estimate and your family's doctors.
Above the credit range, you pay full price per person for HMO coverage that generally pays outside its network only in emergencies. Many Ohio owners decide that's the point to look privately.
With an underwritten nationwide PPO, the insurer reviews everyone's health answers and accepts the application, rejects it, or accepts it with one named condition excluded. Healthy families often come in under the marketplace's full price and keep in-network care on trips and at college campuses out of state. Policies differ, so we'll review benefits before you decide.
Next step: Call me, and I'll quote a nationwide PPO for your family beside the Ohio HMOs in your county.
A new company may pay its owner almost nothing at first. Ohio handles that better than many states: the Medicaid expansion covers adults up to 138% of the poverty level. When profit picks up and pushes you past that line, the marketplace credit takes over, so report the change and move.
Next step: Call me before you enroll in a startup year, and we'll work out whether Medicaid or a marketplace plan fits the household.
If your employer's group plan is insured, Ohio law may let you continue it for up to 12 months when you've been covered three months in a row and meet the statute's other conditions. Federal COBRA may apply too. Losing job coverage also opens a window to buy on the marketplace.
Price continuation against a marketplace HMO with a credit and a nationwide PPO before you commit.
Next step: Ring me a few weeks before your last day, and we'll compare continuation, the marketplace and a private PPO.
Straight answers, no sales pitch.
No medical PPO is sold there. All 189 individual medical plans are HMOs. A healthy owner can buy a nationwide PPO privately through me.
Owners with no staff use HealthCare.gov or buy privately. Group coverage through SHOP opens up only once you've hired someone outside the ownership and your family.
If household income is up to 138% of the poverty level, Ohio's expanded Medicaid may cover you.
Often, through the federal self-employed health insurance deduction, limited to net profit. Ohio's income tax starts from federal adjusted gross income; confirm the details with your tax preparer.
Share the company's structure, what it roughly netted, your county, and who in the family needs coverage. I'll tell you which option I'd choose in your seat and what it runs.
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