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 (eg, 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 4 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 insure 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.

Health Insurance Marketplace / Exchange Open Enrollment Update Year 4 

Ohio Exchange Plans

Seven companies will operate plans in southwest Ohio. See a list of these plans below. Note the 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.

  • HUMANA Health Plan of Ohio
  • CareSource Just4Me
  • Anthem Blue Cross Blue Shield (Pathway/Pathway X)
  • Premier Health Network
  • Medical Mutual of Ohio- Cincinnati Children's Hospital Medical Center is NOT a contracted provider
  • Anthem Blue Cross Blue Shield (Pathway HMO /Pathway X HMO) - Cincinnati Children's Hospital Medical Center is NOT a contracted provider
  • Ambetter from Buckeye Community Health Plan – Cincinnati Children's Hospital Medical Center is NOT a contracted provider
  • Molina Marketplace – Cincinnati Children's Hospital Medical Center is NOT a contracted provider 

Kentucky Exchange Plans

Two companies are approved to sell plans on the exchange. Note the 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 Just4Me
  • Anthem Blue Cross Blue Shield - Cincinnati Children's Hospital Medical Center is NOT a contracted provider  for the Pathway and Pathway X 

Indiana Exchange Plans

Four companies are approved to sell plans on the exchange. Note the 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.

  • Anthem Blue Cross Blue Shield
  • CareSource Just4Me
  • Managed Health Services – Cincinnati Children's Hospital Medical Center is NOT a contracted provider
  • MDWise - Cincinnati Children's Hospital Medical Center is NOT a contracted provider 
     

All Other States

Please contact your local state exchanges for more information.