Billing

Healthcare Exchanges

Healthcare Exchanges

On October 1, 2013, health insurance options were made available to the American public as part of the Affordable Care Act (ACA). These insurance plans provide another option for obtaining health insurance coverage. Currently, most individuals obtain insurance coverage by purchasing it themselves, via their employer, or are eligible for coverage provided by the government (e.g., Medicare and/or Medicaid). The information provided here only addresses those health insurance options being made available via ACA (aka “marketplace”, “exchanges” or “exchange plans”). Additional information regarding the exchange plans is available through, www.healthcare.gov.

This online marketplace allows individuals to:

• Shop for health insurance options in their state
• Compare health plans
• Purchase and enroll in a health plan

The plans on the Health Insurance Marketplace are separated into four health plan categories — Bronze, Silver, Gold, or Platinum. Each metallic level varies by the percentage of costs you have to pay on average toward the heath care you receive in the form of deductible, coinsurance, and/or co-payments. Review plan details of coverage carefully before choosing.

State-by-State Health Plans

Each state approved specific companies to sell plans on the exchanges. Many hospitals, including Cincinnati Children's, do not contract with all of the plans in their state's exchange. It is important that individuals confirm that their child’s preferred providers are in network prior to selecting a new plan on the exchange. A good number of the insurance plans have limited or no out-of-network benefits, and individuals will be financially responsible for all unpaid charges. To ensure you and your family do not incur any unexpected out-of-pocket expenses for your child’s care at Cincinnati Children’s if you choose insurance through the new health care exchanges, Cincinnati Children’s recommends that you enroll in one of the plans listed in bold below with which Cincinnati Children’s is contracted as an in-network provider.

2025 Health Insurance Marketplace / Exchange

When searching participation status for Cincinnati Children’s Hospital Medical Center on marketplace websites including Healthcare.gov, search using “Children’s Hospital Medical Center”.

Ohio Exchange Plans

Nine companies will operate plans in southwest Ohio. See a list of these plans below. Note the two plans at the top of the list, in bold, are the plans that are considered in-network for Cincinnati Children's and its employed physicians.

• CareSource Marketplace
• Medical Mutual of Ohio
• Aetna CVS Health – Cincinnati Children’s Hospital Medical Center is NOT a contracted provider.
• Ambetter from Buckeye Health – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Anthem Blue Cross Blue Shield – Pathway X HMO plans – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Molina Healthcare Marketplace – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Antidote Health Plan of Ohio, Inc. – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Oscar Health Insurance – Cincinnati Children’s Hospital Medical Center is NOT a contracted provider.
• UnitedHealthcare – Cincinnati Children’s Hospital Medical Center is NOT a contracted provider.

Kentucky Marketplace Plans

Four companies are approved to sell plans on the exchange. See a list of these plans below. Note the plan at the top of the list, in bold, is the only plan that is considered in-network for Cincinnati Children's and its employed physicians.

• CareSource Marketplace
• Ambetter by WellCare of Kentucky – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Anthem Blue Cross Blue Shield – Pathway X HMO plans – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Passport Health Plan by MolinaHealthcare – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.

Indiana Marketplace Plans

Three companies are approved to sell plans on the exchange in southeastern Indiana. Cincinnati Children's and its employed physicians are not currently contracted with these companies.

• Ambetter from MHS – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• Anthem Blue Cross Blue Shield – Pathway X HMO plans – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.
• CareSource Marketplace – Cincinnati Children's Hospital Medical Center is NOT a contracted provider.