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Major Changes in Northeast Ohio Health Insurance Marketplace & Open Enrollment

The Affordable Care Act -- aka Obamacare -- has become an important program for many retirees who need health insurance to bridge the gap from when employer coverage exhausts until eligible for Medicare at age 65. For those utilizing these plans and especially those that use Medical Mutual of Ohio for their insurance, it's time to review your options during the open enrollment season.

As reported earlier this year, in partnership with New York City-based Oscar Health, Cleveland Clinic announced it is making its first entrance into the health insurance market with a product bearing its name. The co-branded health insurance plan will be available in Cuyahoga, Summit, Lorain, Medina and Lake with coverage beginning Jan. 1, 2018.

The Clinic also will not be participating in Medical Mutual of Ohio's (MMO) -- a large insurer of northeast Ohioans and headquartered in Cleveland -- individual ACA products in 2018, as Crain's Cleveland Business first reported. MMO switched to a Health Maintenance Organization (HMO) from a Point of Service (POS) network for its 2018 offering, and the Clinic opted not to participate.

Medical Mutual has added University Hospitals and Summa as part of their new HMO network to make up for the Clinic's departure.

Also important to note for snowbirds: the First Health network predominant through the southeastern part of the U.S. and 'in network' for MMO is no longer available on exchange plans as of 2018. Thus many snowbirds need to explore new options to ensure they have in-network coverage in both Ohio and Florida.

The government has dramatically reduced the open enrollment period this year; in most states it starts November 1 and ends December 15. This is very important because you cannot enroll outside of open enrollment unless you have a “qualifying event,” such as:
  • Marriage, 
  • Becoming a U.S. citizen, 
  • Birth or adoption, 
  • Involuntary loss of other health coverage 
  • Permanent move to an area where new health plans are available. This only applies in most cases if you already had coverage prior to your move. 
Can’t you just continue with the coverage you have today? If you’re happy with your current policy, that’s one option, but prices are going up by an estimated average of 15% as many insurers are unsure whether they can count on government reimbursements. It doesn’t hurt to look and see if your current insurer is raising rates higher than the competition.

By now, you know that comparison shopping is not as difficult as it once was. A benefit of the ACA is the standardization. You can choose a bare bones bronze plan, a silver plan with lower deductibles and broader coverage, or a gold plan with more of both, and the various plans in each category, to qualify to be on an exchange, have to offer similar coverage features. However, understanding the nuances of the network is not as clear in my opinion.

If you have a significant health issue come up recently, then shopping takes on a new urgency. You might consider switching from a bronze to a silver plan, or silver to gold. Or you might realize that you’re not utilizing the medical system as much as you expected, and drop down to a baser metal.

Roughly 85% of the 11 million people who buy through one of the exchanges qualify for tax credits that significant reduce out-of-pocket costs for deductibles and co-pays, and can also reduce premiums. While you may think this doesn't apply to you, we have several clients with substantial wealth that have obtained upwards of $6K+ in tax credits with proper tax and retirement distribution planning.
You can get help enrolling and comparing plans by phone or with a local in-person guide, called a navigator. ACA marketplace call centers are available 24 hours a day, every day except holidays. At, you can search by city and state or ZIP code to see a list of local organizations that can help you.

We'd recommend a competent local agent that specializes in individual policies for those under age 65 or a specialist for Medicare if over 65. If you need a referral, just let me know.

To Your Prosperity,
Kevin Kroskey, CFP®, MBA

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