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DISCOUNT PLANS ARE NOT HEALTH INSURANCE: Discount plans give you a false sense of security. Discount Plans are not controlled by the Ohio Department of Insurance and may not be there for you when you need them. Discount plans have no annual maximum out of pocket and you are responsible for the entire negotiated price of all procedures. Most discount plans have very small or limited networks. Your premium savings mean nothing if you have to pay for a major claim with no Maximum Out of Pocket.
MAJOR MEDICAL PLANS: These are the plans you are looking for. Most of the plans listed below are Major Medical Health Plans. Major Medical Plans come in many forms from HMO’s to PPO’s and the more expensive freedom of choice plans. Major Medical Plans cover the majority of your claims after you have met your deductible
SHORT TERM COVERAGE: Do not purchase short term coverage unless you know you will be covered by a Group Plan within the next 6 months. All Short Term plans have certain things in common. Short Term plans do not pay for any pre existing conditions. Short Term Plans are written for no more than 6 months in Ohio and are only renewable 1 time. Any condition you might develop while on a short term plan will be considered pre existing (not covered) if you have to apply for another short term plan. Pre existing conditions developed while you are covered by a short term plan could result in a premium rate up or exclusion rider when your short term plan expires. Your condition could keep you from purchasing regular coverage when your short term coverage expires. “Regular” health plans can be cancelled by you at anytime and are not long term contracts that require you to continue your coverage for any set period of time. Short Term plans are an excellent choice of coverage only if you know you will be covered by a group plan within the next 6 months.
COLLEGE OR STUDENT PLANS: These plans do not make sense. The term “college” or “student” usually means that the plan is watered down to save premium and appeal to a young adult that needs to save money. I recommend a regular individual Major Medical Plan for college students and most of the time, you can purchase a regular plan for the same or less premium than a college or student plan.
VALUE PLANS, SMART SENSE PLANS, SAVE RIGHT PLANS, RIGHT START AND SAVOR PLANS: These are all plans offered by well known major medical companies. The plans are designed to save premium and each of these plans provide less coverage than you might want or need. The plans limit or eliminate doctor copays. They have cut back on or eliminated prescription coverage. The plans have a much higher annual maximum out of pocket. I do not recommend applying for any of these plans without talking to a reputable broker first. You must understand the limitations of the plan you choose.
DEFINED BENEFIT PLANS: These are NOT Major Medical Plans. Defined Benefit Plans cover only the items and procedures listed on the Outline of Coverage and in the policy.. Defined benefit plans are for the most part HIPPA qualified plans and most Guaranteed Issue plans are defined benefit plans. HIPPA qualified plans meet the government requirements required to count as qualified coverage for pre existing conditions.
COBRA PLANS: COBRA is a government program that requires companies to allow you to continue your Group coverage after you have resigned or have been terminated. If you work for a company that employees 25 or more employees and provides Group health coverage, you probably qualify for COBRA. You have a maximum of 63 days to enroll in COBRA and COBRA is expensive. COBRA is your plan of choice if you do not qualify, due to health issues, for Individual Coverage.
HIPPA COVERAGE: HIPPA coverage is also guarantee issue coverage that you qualify for only when you have exhausted your COBRA benefits and do not qualify for Major Medical Coverage. HIPPA coverage is very expensive and the plans offered are not the plans most people would choose if eligible for Major Medical Coverage.
GUARANTEED ISSUE INDIVIDUAL PLANS: There are a couple of companies that offer Guarantee Issue plans in Ohio. These plans are Defined Benefit Plans and are more affordable than HIPPA or Open Enrollment. Defined Benefit Guaranteed Issue plans are a much better option than Discount plans.