Ohio's marketplace offers nothing but HMO medical coverage, yet I can still help you obtain a nationwide PPO. Here's how LLC owners, S-corp owners and small-business operators in Ohio can evaluate insurance for themselves and their households.
Hi, I'm Sam Jaber, and I'm licensed as a health insurance broker in 36 states, Ohio included. I work with Ohio entrepreneurs by phone, from solo LLC operators to S-corp owners employing a spouse and shop owners with several workers.
A lot of Ohio business owners want the same PPO coverage they previously had while employed by a larger company. Unfortunately, HealthCare.gov doesn't offer that option in Ohio because its plans are all HMOs. But there are other protections to consider, including Medicaid during low-income startup periods and Ohio's coverage continuation law when leaving employment. I'll explain how these options fit together.
Ohio's individual marketplace lists 189 medical plans offered by 11 insurance companies this year. Every one of those 189 plans is an HMO.
Nationwide PPO coverage remains available to Ohio residents through private insurance outside the marketplace. I can help arrange it. The carrier evaluates medical answers from each family member to determine the premium, and its provider network extends across the country. For a healthy household, I'd compare this option early.
If your company employs only its owners and their relatives, you'll use individual coverage through HealthCare.gov in Ohio. Once you hire a worker who isn't an owner or family member, you may qualify for a group plan through SHOP, the small-business marketplace.
Premium tax credits are calculated using projected household income for the year of coverage. Sole proprietors and single-member LLC owners begin with net business profit, while S-corp owners include wages and pass-through earnings. Ohio's Medicaid expansion covers eligible adults earning up to 138% of the federal poverty level. Qualifying for Medicaid generally prevents someone from receiving marketplace premium credits, so those benefits ordinarily don't apply together.
Here's an Ohio tax detail to discuss with your preparer: state income tax calculations begin with federal adjusted gross income, meaning federal deductions taken above the line also affect that starting figure.
When you qualify for a credit, marketplace coverage will generally be your family's most affordable route because the credit cannot be used elsewhere. Since every Ohio option is an HMO, check the network for each person's doctors before focusing on premiums. Recalculate your income estimate whenever business profit changes.
Next step: Bring your most recent tax return and your expected earnings for this year. We'll compare HMOs using your family's doctors and projected income.
If household income exceeds the credit range, you're paying the entire premium for each person. Ohio marketplace HMOs generally exclude nonemergency out-of-network care, so many business owners start considering private coverage at that point.
With a privately underwritten nationwide PPO, the carrier considers everyone's medical information and may approve coverage, deny it or approve it while excluding a named condition. Healthy households frequently qualify for less than the marketplace's unsubsidized premiums, while keeping access to in-network providers during travel or college attendance outside Ohio. Because policy benefits vary, I'll go through them with you before you choose.
Next step: Give me a call, and I'll compare a nationwide PPO premium for your household with the Ohio marketplace HMOs offered in your county.
Business owners sometimes earn very little during a company's early stages. Ohio's expanded Medicaid program can help during those periods, covering eligible adults up to 138% of the poverty level. As profits increase beyond that threshold, marketplace credits may become available instead. Report the higher income and adjust your coverage accordingly.
Next step: Before signing up during your startup year, call me. We'll compare Medicaid eligibility with marketplace coverage for everyone in your household.
When you're leaving an employer, Ohio law may allow continuation of an insured group health plan for as long as 12 months. You must have maintained coverage for three consecutive months and satisfy the law's remaining requirements. Federal COBRA could also apply, and losing employer coverage creates an opportunity to enroll through the marketplace.
Before deciding, compare the cost of keeping your old coverage with a credit-supported marketplace HMO and a nationwide PPO.
Next step: Call me several weeks ahead of your final workday. We'll compare continued employer coverage, marketplace plans and private PPO insurance.
Straight answers, no sales pitch.
No. Ohio's marketplace has 189 individual medical plans, and all are HMOs. I can arrange private nationwide PPO coverage for healthy business owners.
Without employees, owners purchase individual insurance through HealthCare.gov or privately. SHOP group coverage requires hiring someone who isn't an owner or a relative.
Ohio's Medicaid expansion may provide coverage when your household income doesn't exceed 138% of the federal poverty level.
Often, yes. The federal health insurance deduction for self-employed people may apply, up to net profit. Because Ohio starts its income tax calculation with federal adjusted gross income, ask your tax preparer how the deduction affects your situation.
Tell me how your company is organized, its approximate net earnings, your county and which relatives need insurance. I'll explain the cost and which coverage I'd select if I were in your position.
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