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Health and Medicine


Ohioans have a lot to consider when looking for health insurance
Lee Nathans, vice president of the Ohio Association of Health Underwriters, explains the aspects of health insurance Ohioans should look in to
by WKSU's STATEHOUSE CORRESPONDENT JO INGLES


Reporter
Jo Ingles
 
Vice president of the Ohio Association of Health Underwriters Lee Nathans says the type of pharmacy network is among the things that should be considered when choosing a health care plan.
Courtesy of Columbus Association of Health Underwriters
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Ohioans are starting to check out health care insurance options on the federal exchange. In an interview with Ohio Public Radio’s Jo Ingles, the vice-president of the Ohio Association of Health Underwriters Lee Nathans explains what Ohioans should consider when choosing an insurance policy.

LISTEN: Jo Ingles reports on the various health insurance options

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Nathans: "The Affordable Care Act provides that there will be no medical underwriting for plans that take effect after January 1, 2014 so no one should be precluded from getting health care coverage as of that date. Additionally and looking at the appropriateness of a plan, one should consider not only the networks but also drug plans that would be available on each individual plan offering. Prescription drug benefits are required as an essential health benefit as part of the affordable care act so all plans that will be offered on the exchanges and off the exchanges will be required to offer prescription drug benefits. In considering the appropriateness of a prescription drug plan, one should consider the specific name of the medication that they are taking, the dosage of the medication they are taking and the term that the prescription is written for. Some prescriptions may be written for 30 days at which time they would be filled by a neighborhood pharmacy. Others may be for a 90 day term at which point they would be required to be filled by mail order."

Q: "And that could make a difference to someone as far as which plan is right for them?"

A: "Absolutely. And someone should also consider what type of pharmacy network would be considered in the individual health plan and make certain that their pharmacy is going to be included within that network."

Q: "Now we know there are different plans ranging from the bottom with the bronze plan and the top with the platinum plan. If you go with one of the higher level plans, are you pretty much assured of getting a lot of flexibility and a lot of coverage?"

A: "Well that’s an interesting point because even though the gold and platinum plans would seem to have less out of pocket exposure for any individual, it may be appropriate for them to also consider a silver plan, depending on what their income is. Because the silver plans, depending on what the income level would be, offer co-insurance and deductible assistance for those individuals who are at 250 percent or lower of federal poverty level. They are going to be a bit more expensive than the bronze plans which are the lowest cost plans but in effect, even paying a bit more on premium for a silver plan may work to any individual’s advantage if they are getting cost sharing assistance for their deductibles and their co-payments."

Nathans also says Ohioans can consult an independent insurance broker for help in comparing plans. And he says there are plans available that are not on the federal exchange that might be better options for some Ohioans.
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