Providing Value for Consumers and Ohio

Ohio’s health plans cover more than 9 million Ohioans through a variety of insurance products that provide consumers with both peace of mind and value.

Commercial Insurance Plans  – Getting health insurance through employers or the individual market is where most Ohioans receive their coverage

  • More than 7 million covered lives
  • The cost of employer-based insurance in Ohio is 4 percent less than the national average for family coverage
  • Premiums in Ohio for individual coverage are about 5 percent less than the national average
  • $12 billion: Ohio’s health plans pay each year for medical care
  • Ohio’s health plans rank above the national average according to JD Power and Associates
  • Annually, Ohio’s health plans identify almost 3% of claims being filed as duplicates bills for the same service
  • 97% of the more than 38 million claims filed in one year were processed within 30 days
  • Almost 75 percent of Ohioans with insurance have access to providers outside the preferred network of providers
  • Access to 24-hour nurse hotlines to help consumers at any hour

Medicare Advantage- Seniors and others who qualify for Medicare can receive their Medicare through Medicare Advantage Plans

  • Medicare Advantage plans enhance benefits for recipients including extra services like dental, vision, health and wellness and smoking cessation
  • 14 OAHP member companies offer Medicare Advantage Plans
  • 487,578 enrollees in Ohio
  • 90% of plans have no co-payment for preventive services and screenings
  • The average value of extra benefits for Medicare Advantage recipients was worth $87 a month in 2009
  • 88% member satisfaction reported
  • Ohio’s health plans offer Special Needs Plans (SNPs) for those eligible for both Medicare and Medicaid and have specific chronic or disabling conditions like diabetes, congestive heart failure, mental illness or HIV/AIDS
  • Medicare Advantage has high standards for prompt payment of claims – 95% of clean claims must be paid within 30 days of receipt

Medicaid Care Coordination – Ohio’s safety net to provide health insurance benefits to those in need

  • 1.5 million Ohioans enrolled
  • 7 OAHP member companies serve enrollees throughout Ohio
  • Adding value for consumers and the state by serving as the health care home for members, coordinating the medical, behavioral and social service needs to keep people’s lives and health on track.
  • $1 Billion; fiscal benefit to the state
  • Consumer satisfaction is high with less than 1% of enrollees expressing concern
  • Advice from toll-free, 24-hour nurse hotline
  • Expanded provider networks
  • Transportation services to appointments
  • No co-pays
  • Incentives for members to maintain good health
  • 98% of clean claims paid within 30 days and 99.9% of clean claims paid within 90 days