Ohio Health Insurance Consumer Guide

To qualify for health coverage through the Marketplace in Ohio, you must:³

• Live in Ohio
• Be either a United States citizen or national, or be lawfully present
• Not be incarcerated
• Not be enrolled in Medicare
  

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.  
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁴
• File a joint tax return if you’re married⁵ (with very limited exceptions)⁶
• Not be able to be claimed as a tax dependent by someone else.⁵

In Ohio, you can sign up for an ACA-compliant individual or family health insurance between November 1 and January 15 during open enrollment. Your coverage starts on January 1 if you enroll by December 15. But if you apply between December 16 and January 15, your coverage will begin on February 1.⁷ 

Outside of the annual open enrollment window, you may be eligible to enroll if you experience a qualifying life event, such as giving birth or losing other health coverage. (There’s also an extended special enrollment period for people who lose Medicaid or CHIP between March 31, 2023 and November 20, 2024.⁸) 

Note that some people can enroll year-round even without a specific qualifying life event.

To enroll in a Marketplace plan in Ohio, you can: 

• Visit HealthCare.gov, a platform where you can shop, compare, and buy individual and family health plans. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor.
• Enroll via an approved enhanced direct enrollment entity.⁹
• You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

You can find affordable health insurance options in Ohio through HealthCare.gov – the ACA Marketplace. 

Under the Affordable Care Act, you may qualify for income-based subsidies, known as Advance Premium Tax Credits (APTC). These credits can reduce your premium and lower your overall costs. 

As of early 2024, nine out of ten Ohio Marketplace enrollees were receiving APTC. The subsidies averaged about $499/month, and the average net premium paid by enrollees was about $130/month.¹⁰

(The numbers above are based on effectuated enrollment in early 2024. The chart below is a little different; it shows some different metrics, and uses data from all applications submitted during the open enrollment period for 2024 coverage.)

If your household income isn’t more than 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR). CSRs help lower your deductibles and out-of-pocket expenses. With APTCs and CSRs, an ACA plan may be a cost-effective health insurance option.

Low-cost health insurance is also available through Medicaid. Use our guide to see if you qualify for Medicaid in Ohio.

Source: CMS.gov¹¹

Ohio’s 12 Marketplace insurers all filed rates and plans for 2025 Marketplace coverage in Ohio,¹² and are joined by one new insurer for 2025, Antidote Health Plan.¹³

Plan availability varies from one area to another, but residents in nearly all areas of Ohio can choose from at least five insurers’ plans for 2025 coverage:²

Ohio’s Marketplace insurers proposed the following average rate increases for 2025, calculated before premium subsidies are applied:¹⁴ (Proposed rates are under review by state regulators; rates will be finalized before open enrollment begins in November 2024.)

Source: Ohio Rate Review Submissions¹⁴ and Ohio SERFF¹³

The proposed rate changes apply to full-price premiums. Most Ohio exchange enrollees receive premium tax credits, so they don’t pay the full premium.¹⁰ For those who qualify for subsidies, changes in plan rates and subsidy amounts determine their net rate change.  

For perspective, here’s how average unsubsidized premiums have changed in Ohio over the years:

• 2015: Average increase of 4%¹⁵
• 2016: Average semi-weighted increase of 9.4%¹⁶
• 2017: Average semi-weighted increase of 17.3%¹⁷
• 2018: Average increase of 34%¹⁸
• 2019: Average increase of 6.3%¹⁹
• 2020: Average decrease of 7.7%²⁰
• 2021: Average decrease of 0.4%²¹
• 2022: Average increase of 4.8%²²
• 2023: Average semi-weighted increase of 6.85%²³
• 2024: Average increase of 7.8%²⁴

During the open enrollment period for 2024 coverage, 477,793 people enrolled in private health plans through Ohio’s Marketplace.²⁵

This was far higher than any other year; the previous record high had come in 2023, when 294,644 people enrolled through Ohio’s Marketplace during open enrollment.²⁶ 

The surge in enrollment in recent years is primarily due to the American Rescue Plan (ARP) making ACA’s premium subsidies more substantial. Under the ARP, subsidies are larger and more widely available. And this has been extended through the end of 2025 by the Inflation Reduction Act.²⁷

The 2024 enrollment growth was also partially due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in Ohio in the spring of 2023, after being paused for three years. By April 2024, more than 190,000 Ohio residents had transitioned from Medicaid to a Marketplace plan. ²⁸

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023,³⁸ 2024³⁹

Healthcare.gov: This is the federal website where you can enroll in a health insurance plan through the ACA Marketplace. 

Ohio Medicaid: Eligible individuals and families can enroll in Medicaid, which provides low-cost or free health coverage. You can also enroll in Medicaid through Healthcare.gov or call (800) 318-2596.

Ohio Department of Insurance (ODI): To receive assistance with insurance and Medicare, call an ODI representative at (800) 686-1526. 

Ohio Department of Job and Family Services: You can get help if you’re struggling to afford health coverage or want to know more about Medicaid eligibility or benefits.

Ohio Senior Health Insurance Information Program (OSHIP): OSHIP offers free health insurance information to people on Medicare.