Alyssa Lane
If you're looking to cut down on insurance costs, you may be wondering if there are any subsidies available to you. In Ohio, Medicaid provides free or low-cost medical benefits to eligible low-income individuals, including pregnant women, infants, children, older adults, and those with disabilities. Additionally, the Children's Health Insurance Program (CHIP) covers uninsured children and teens up to the age of 19, and in some cases, those with income above the poverty level may be charged premiums. To find out more about eligibility and enrollment, you can check online resources or get in touch with the relevant departments.
| Characteristics | Values |
|---|---|
| Organization | STRS Ohio |
| Who is eligible | Eligible service retirement and disability benefit recipients |
| Requirements | 20 or more years of total service credit for benefit recipients who retired on or after Aug. 1, 2023; 15 or more years of total service credit for benefit recipients who retired before Aug. 1, 2023 |
| Application Process | Submit a completed application, a copy of the previous year's federal tax return, and a copy of your Medicare card if applicable |
| Application Deadline | 15th of the month |
| Additional Benefits | $0 monthly premium for the benefit recipient, lower out-of-pocket costs for all enrollees, access to a large provider network, reward programs, free rides to healthcare appointments |
| Other Options | Medicaid, Children's Health Insurance Program (CHIP) |
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What You'll Learn
Medicaid eligibility and enrollment
Ohio residents can enrol in Medicaid year-round, without having to wait for an open enrolment period. To enrol, you can use the Ohio Benefits website, which will enable you to check your eligibility and enrol if you qualify. Alternatively, you can enrol by phone at 1-800-318-2596 or 800-324-8680.
Eligibility for Medicaid in Ohio is based on income and assets. Low-income individuals of all ages can enrol in Medicaid, with varying income limits depending on their situation. Adults are eligible with incomes up to 138% of the poverty level, while children are eligible with incomes up to 206% of the poverty level, and pregnant women are eligible with incomes up to 200% of the poverty level. Additionally, certain low-income individuals who are blind, disabled, or aged 65+ can enrol, but they must also have low asset/resource levels.
Ohio has expanded Medicaid under the Affordable Care Act (ACA), so low-income adults without dependent children have been eligible for coverage since 2014. The ACA's Medicaid expansion took effect in Ohio in January 2014, but the state also used a Section 1115 waiver to expand Medicaid in 2013 to cover 30,000 non-elderly adults in Cuyahoga County. The eligibility threshold was 138% of the poverty level, the same as the ACA guidelines.
Ohio Medicaid offers managed care plans that provide personalized care to meet the healthcare needs of its members. These plans include access to a large provider network, reward programs, and free rides to healthcare appointments and pharmacies. Additionally, there is no copay for any medical or behavioural health service.
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STRS Ohio premium subsidy
In Ohio, eligible service retirement and disability benefit recipients can benefit from the STRS Ohio premium subsidy, which subsidises a portion of the monthly costs of medical plan premiums, making them more affordable. To be eligible for the subsidy, benefit recipients who retired before 1 August 2023 must have 15 or more years of total service credit. Those who retired on or after 1 August 2023 must have 20 or more years of total service credit.
The Health Care Assistance Program (HCAP) is designed to provide financial assistance to qualified benefit recipients to help pay for their STRS Ohio medical plan. The program currently includes a $0 monthly premium for the benefit recipient and often lower out-of-pocket costs for all enrollees in the plan. However, covered family members who may receive the same plan coverage as the qualifying benefit recipient are not eligible for the $0 premium and must pay the full cost of their coverage.
To apply for the STRS Ohio premium subsidy, you must submit a completed application, a copy of the previous year's federal tax return, and a copy of your Medicare card (if applicable). Applications must be received by the 15th of the month to be considered for approval for the next month.
Ohio also has other options for subsidising insurance premiums. For example, Ohio Medicaid provides managed care plans for eligible Ohioans with low incomes, pregnant women, infants, children, older adults, and individuals with disabilities. Additionally, many Medicare beneficiaries in Ohio receive Medicaid's help with paying for Medicare premiums, prescription drug costs, and covering expenses not reimbursed by Medicare, such as long-term care.
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Healthcare.gov
If you are based in Ohio, you may be able to get subsidised coverage through Medicaid and the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
In states that have expanded Medicaid coverage, your household income must be below 138% of the federal poverty level (FPL) to qualify. In all states, your household income must be between 100% and 400% FPL to qualify for a premium tax credit that can lower your insurance costs. If your income is at or below 150% FPL, you may qualify to enrol in or change Marketplace coverage through a Special Enrollment Period. If your income is above 400% FPL, you may still qualify for savings on a Marketplace health insurance plan.
You can check if you might save on Marketplace premiums, or qualify for Medicaid or CHIP, based on your income. You can also find out who to include in your household and how to estimate your income before you apply. You'll get exact plan prices and savings by filling out a Marketplace application.
Some Medicaid programs pay for your care directly, while others use private insurance companies to provide coverage. Even if you don't qualify for Medicaid based on income, you should still apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability.
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CareSource Medicaid
In Ohio, eligible individuals with low incomes, pregnant women, infants and children, older adults, and individuals with disabilities can apply for Medicaid health care coverage. CareSource Medicaid is a popular choice for Ohioans, as it offers a range of benefits and services that go beyond just quality health care.
One of the advantages of choosing CareSource is its large provider network, which gives members access to a wide range of doctors and health care providers. Additionally, CareSource offers reward programs like Kids First and Babies First®, as well as free rides to health care appointments, pharmacies, and more. Another unique feature of CareSource is that they never charge a copay for any medical or behavioral health service, which can help reduce out-of-pocket expenses for members.
To apply for CareSource Medicaid in Ohio, individuals can use the self-service Ohio Benefits Portal, call the Ohio Medicaid Consumer Hotline at 1-800-324-8680, or visit their local Department of Job and Family Services (JFS) office. It is worth noting that if an individual is assigned a health plan other than CareSource, they have the option to switch within 90 days by contacting the Ohio Medicaid Consumer Hotline.
While CareSource Medicaid is a popular choice in Ohio, it is also available in other states, including Georgia, Indiana, and Michigan. Each state may have slightly different eligibility requirements and application processes, so it is important for individuals to review the specific guidelines for their state.
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Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP) provides health coverage to eligible children through both Medicaid and separate CHIP programs. Children from families with incomes too high to qualify for Medicaid but too low to afford private coverage are eligible for CHIP. CHIP is managed by states according to federal requirements and is funded by both states and the federal government.
In Ohio, CHIP was implemented in 1998, initially covering children up to age 19 with household incomes up to 150% of the poverty line. This threshold was later increased to 200% of the poverty line. The federal government pays 67% of the cost of Ohio's traditional Medicaid program, with the state covering the remaining cost.
CHIP coverage is available to children in families that earn too much money to qualify for Medicaid but still need assistance with health coverage. The costs of CHIP coverage differ in each state, but families will not pay more than 5% of their annual income. Routine "well child" doctor and dental visits are free under CHIP, and there may be a fixed amount for covered health care services after paying the deductible.
To apply for CHIP in Ohio, you can use the self-service Ohio Benefits Portal, call the Ohio Medicaid Consumer Hotline at 1-800-324-8680, or visit your local Department of Job and Family Services (JFS) office. There is no limited enrollment period for CHIP, and if you qualify, your coverage can start immediately.
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Frequently asked questions
Ohio Medicaid provides free or low-cost medical benefits to eligible individuals with low incomes, including pregnant women, infants, children, older adults, and individuals with disabilities.
You can apply for Ohio Medicaid online using the self-service Ohio Benefits Portal, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680, or by visiting your local Department of Job and Family Services (JFS) office.
Yes, STRS Ohio offers premium subsidies for eligible service retirement and disability benefit recipients by subsidizing a portion of the monthly costs. To qualify for a premium subsidy, benefit recipients who retired before August 1, 2023, must have 15 or more years of total service credit.
