Ohio Health Insurance: Marketplace, Private Plans & 2027 Changes

Shopping for health insurance in Ohio? The individual market is changing significantly for 2027. CareSource is leaving Ohio's individual market, Molina will no longer offer Marketplace plans, and a new Marketplace carrier is entering parts of the state.

Even if your current insurance company is staying, premiums, provider networks, prescription coverage, deductibles, and Marketplace financial assistance can change from one year to the next.

We help self-employed workers, individuals, families, early retirees, and small business owners compare HealthCare.gov plans with other available coverage based on their doctors, prescriptions, budget, and needs.

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Ohio Health Insurance at a Glance

Topic What Ohio Residents Should Know
Marketplace Ohio uses the federal Marketplace at HealthCare.gov.
2027 Open Enrollment November 1, 2026 through January 15, 2027.
January 1 Coverage Select a Marketplace plan by December 15, 2026.
CareSource Leaving Ohio's individual health insurance market after December 31, 2026.
Molina Will not offer Marketplace plans in Ohio for 2027. Limited off-exchange coverage may remain.
New for 2027 AmeriHealth Caritas Next is entering selected Ohio counties.
Premium Changes Proposed 2027 rate changes vary widely by carrier, with many requesting double-digit increases.
Ohio Medicaid Ohio expanded Medicaid for qualifying adults ages 19 through 64.
Medicaid Change for 2027 Work and community-engagement requirements begin January 1, 2027 for certain expansion adults.

CareSource Is Leaving Ohio's Individual Health Insurance Market

CareSource has announced that it will not offer Ohio Marketplace plans for the 2027 plan year.

CareSource's individual coverage remains in effect through December 31, 2026 for members who continue paying their premiums, but current individual members will need replacement coverage for 2027.

This does not mean CareSource is leaving every line of business in Ohio. CareSource continues to participate in Ohio Medicaid. The 2027 exit discussed here concerns individual health insurance, including Marketplace coverage.

Molina Is Also Leaving Ohio's Marketplace

Molina Healthcare is also changing its individual-market participation for 2027.

Current filings indicate that Molina will no longer offer Qualified Health Plans through HealthCare.gov in Ohio for 2027.

Molina may retain limited individual coverage sold outside the Marketplace, but Marketplace Premium Tax Credits cannot be used with off-exchange coverage.

Have Molina Medicaid? Molina continues to participate in Ohio Medicaid managed care. The Marketplace change does not mean all Molina coverage in Ohio is ending.

Have CareSource or Molina Marketplace Coverage? Here's What to Check

1. Check Your Doctors

Write down your primary care doctor, specialists, preferred hospital, and any other providers you use.

A provider who accepts CareSource or Molina may not participate with the replacement plan you're considering.

2. Check Your Medications

Compare each medication using its exact name and dosage.

Review the formulary tier, pharmacy network, prior authorization requirements, and prescription deductible.

3. Compare Total Costs

Don't compare only monthly premiums.

Look at deductibles, specialist visits, prescriptions, hospital costs, coinsurance, and the annual out-of-pocket maximum.

4. Enroll by December 15

Choose replacement Marketplace coverage by December 15, 2026 if you want the new plan to begin January 1, 2027.

Don't assume an automatically assigned replacement plan is your best fit. HealthCare.gov can automatically match certain enrollees to coverage when a plan ends, but you should still compare the assigned plan with the other choices available.

Ohio Uses HealthCare.gov

Ohio does not operate a separate state health insurance Marketplace.

Individuals and families who want Marketplace coverage use the federal Marketplace at HealthCare.gov.

Qualified Health Plans sold through HealthCare.gov are ACA-compliant major medical insurance. They cover pre-existing conditions and include the consumer protections required for ACA-compliant individual plans.

HealthCare.gov is also where eligible Ohio households receive Premium Tax Credits. Those federal tax credits generally cannot be applied to coverage purchased outside the Marketplace.

Ohio Marketplace Insurance Companies for 2027

Ohio continues to have a relatively competitive individual health insurance market, although the carrier mix is changing.

Current 2027 filings indicate Marketplace participation from several consumer-facing insurance brands, including:

  • Ambetter from Buckeye Health Plan
  • Anthem Blue Cross and Blue Shield
  • Medical Mutual
  • Oscar Health
  • SummaCare
  • UnitedHealthcare
  • Antidote Health
  • AmeriHealth Caritas Next
Carrier counts can look different depending on how they're counted. Some insurance brands use more than one legal insurance company in Ohio. Current filings show at least nine issuer entities, but fewer recognizable consumer brands.

AmeriHealth Caritas Next is new to Ohio's individual Marketplace for 2027 and is building a network in selected counties rather than throughout the entire state.

AmeriHealth Caritas Next Is Entering Parts of Ohio

AmeriHealth Caritas already operates an Ohio Medicaid plan, but for 2027 the company is also expanding its AmeriHealth Caritas Next Marketplace network into selected Ohio counties.

Its current provider recruitment materials identify Marketplace network expansion in:

  • Butler County
  • Clermont County
  • Cuyahoga County
  • Delaware County
  • Franklin County
  • Hamilton County
  • Lucas County
  • Mahoning County
  • Miami County
  • Montgomery County
  • Warren County
A new carrier can create another option, but check the network carefully. A plan's value depends on whether the doctors, hospitals, prescriptions, and services you use are included.

Proposed Ohio Health Insurance Rates for 2027

Ohio insurers have submitted preliminary individual-market rate filings for 2027.

The proposed changes vary substantially by insurance company, which is more useful than relying on one statewide average.

Insurance Company Proposed Average 2027 Change
Ambetter / Buckeye About +9.5%
Anthem Blue Cross and Blue Shield About +16.2%
Medical Mutual About +21.6%
Oscar Buckeye State About +18.0%
Oscar Insurance Corporation of Ohio About -1.5%
SummaCare About +10.4%
UnitedHealthcare About +24.1%
Antidote Health About +15.8%
AmeriHealth Caritas Next New for 2027
These are proposed carrier averages, not your personal premium change. Final rates may differ. Your own premium also depends on your age, ZIP code, specific plan, tobacco status where applicable, and Marketplace financial assistance.

If you receive a Premium Tax Credit, compare your net premium after assistance rather than looking only at the carrier's full-price premium.

Ohio Open Enrollment for 2027

Ohio follows the HealthCare.gov Open Enrollment schedule.

Open Enrollment for 2027 Marketplace coverage runs from November 1, 2026 through January 15, 2027.

  • November 1, 2026: Open Enrollment begins.
  • December 15, 2026: Select a plan by this date for coverage beginning January 1, 2027.
  • January 15, 2027: Open Enrollment ends. Plans selected after December 15 generally begin February 1.
CareSource and Molina Marketplace members should review their options early. Because your current Marketplace coverage is changing, waiting until January could leave you without replacement coverage beginning January 1.

Marketplace Financial Help in Ohio for 2027

Eligible Ohio households may qualify for federal Premium Tax Credits when purchasing coverage through HealthCare.gov.

The temporary enhanced federal subsidies that applied through 2025 have expired.

Under the general federal rules now in effect, Premium Tax Credit eligibility generally applies to households between 100% and 400% of the federal poverty level, subject to the other eligibility rules.

Income isn't the only factor. Household size, employer coverage, Medicaid eligibility, Medicare eligibility, age, ZIP code, benchmark-plan pricing, and tax filing status can all affect Marketplace assistance.

Self-Employed Health Insurance in Ohio

We work with Ohio contractors, tradespeople, owner-operators, truck drivers, real estate professionals, farmers, consultants, freelancers, small business owners, and other people who buy health insurance without traditional employer benefits.

Self-employed applicants often have another challenge: estimating annual household income for Marketplace assistance.

Estimate Net Income

Marketplace applications generally use expected net self-employment income after eligible business expenses, rather than simply gross business revenue.

Update Changes During the Year

Commission income, seasonal work, contracting, farming, and business ownership can make income difficult to predict.

Report meaningful changes rather than waiting until the next Open Enrollment period.

Understand MAGI

Marketplace Premium Tax Credits use Modified Adjusted Gross Income, or MAGI.

MAGI generally begins with Adjusted Gross Income and then applies specific federal adjustments.

Tax Deductions Can Matter

Certain allowable retirement, HSA, and other tax deductions may affect Adjusted Gross Income and therefore the income used for Marketplace purposes.

Ask your tax professional which deductions actually apply to your situation.

Advance Premium Tax Credits are reconciled on your federal tax return. If your final income differs from the estimate used during enrollment, your final tax-credit amount may differ too.

Learn more about self-employed health insurance →

Marketplace Plans vs. Other Private Health Coverage in Ohio

Ohio residents may also encounter health insurance and health-benefit products offered outside HealthCare.gov. They do not necessarily work the same way as Marketplace plans.

HealthCare.gov Marketplace Plans

  • ACA-compliant major medical insurance
  • Coverage for pre-existing conditions
  • ACA-required essential health benefits
  • Defined annual out-of-pocket limits
  • No medical underwriting for eligibility
  • Premium Tax Credits for eligible households

Other Private Coverage

  • May be sold outside HealthCare.gov
  • Some products may use medical underwriting
  • Pre-existing-condition rules may differ
  • Benefits and exclusions can differ
  • Provider networks may work differently
  • Marketplace Premium Tax Credits generally cannot be used
Don't choose based only on monthly premium. Compare provider networks, prescriptions, deductibles, hospital costs, annual out-of-pocket exposure, exclusions, underwriting, and pre-existing-condition provisions.

Your Ohio County and Provider Network Matter

Ohio has multiple geographic rating areas and many major regional hospital systems.

A Marketplace plan available in Cleveland may be very different from one available in Cincinnati, Columbus, Toledo, Dayton, or a rural Ohio county.

Before selecting coverage, check:

  • Your primary care physician
  • Your specialists
  • Your preferred hospital or health system
  • Nearby urgent care facilities
  • Your prescriptions
  • Your preferred pharmacy
  • Out-of-area coverage if you travel regularly
Insurance-company name alone isn't enough. Different products from the same carrier can use different provider networks.

Ohio Medicaid Expansion

Ohio expanded Medicaid in 2014.

The expansion population is often referred to as Group VIII or MAGI Adult.

Eligible adults ages 19 through 64 may qualify based largely on household income and other Medicaid requirements. The effective income threshold is generally around 138% of the federal poverty level after the applicable MAGI income rules are considered.

Ohio Medicaid accepts applications throughout the year. Medicaid enrollment is not limited to the annual HealthCare.gov Open Enrollment period.

Ohio Medicaid Work Requirements Begin January 1, 2027

Beginning January 1, 2027, Medicaid eligibility rules change for certain adults enrolled in Ohio's Group VIII expansion coverage.

The new work and community-engagement requirement generally applies to certain adults who:

  • Are ages 19 through 64
  • Are not pregnant
  • Receive Medicaid based on income
  • Are enrolled in the affected Group VIII category
  • Do not qualify for an exemption

Non-exempt members generally need to spend at least 80 hours per month participating in qualifying activities.

Qualifying activities may include:

  • Paid employment
  • Volunteer or community service
  • School or qualifying education
  • Approved job-training or work programs
  • A combination of qualifying activities
Not everyone with Ohio Medicaid has to meet the requirement. Many Group VIII members qualify for exemptions, including certain caregivers and people with qualifying health conditions. Ohio Medicaid is sending notices to potentially affected members.

What If You Lose Ohio Medicaid?

Losing Medicaid can create a Special Enrollment Period for Marketplace coverage through HealthCare.gov.

This could happen because your household income increases, you no longer meet an eligibility category, or another Medicaid eligibility rule changes.

Depending on your circumstances, alternatives may include:

  • A HealthCare.gov Marketplace plan
  • An employer-sponsored plan
  • A spouse's employer coverage
  • Other available individual coverage
Don't wait until you've been uninsured for several months. Special Enrollment Periods have deadlines, so review replacement coverage soon after receiving notice that Medicaid is ending.

Leaving a Job or Losing Employer Health Insurance?

Losing qualifying employer health insurance can create a Special Enrollment Period through HealthCare.gov.

Depending on your circumstances, you may compare:

  • COBRA continuation coverage
  • A spouse's employer-sponsored plan
  • A Marketplace plan through HealthCare.gov
  • Ohio Medicaid if eligible
  • Other available individual coverage

COBRA can allow you to keep the same employer plan temporarily, but the monthly premium may increase substantially once the employer stops contributing toward the cost.

Learn more about COBRA alternatives →

Ohio Health Insurance for Early Retirees

Retiring before age 65 can leave several years between employer health insurance and Medicare eligibility.

Depending on your circumstances, options may include:

  • HealthCare.gov Marketplace coverage
  • COBRA
  • A spouse's employer plan
  • Other available individual coverage

Marketplace financial assistance can make income planning especially important because taxable retirement withdrawals, pensions, investment income, and other income can affect household MAGI.

Retirement itself doesn't determine whether you qualify for Marketplace assistance. Eligibility depends on household income and the other applicable Marketplace rules.

Small Business Health Insurance in Ohio

Ohio small business owners are also facing changing health insurance costs for 2027.

One analysis of the preliminary federal rate filings estimates that proposed Ohio small-group increases average roughly 16%, although actual renewals vary substantially by insurer, group, location, employee demographics, and plan.

That makes it worth comparing more than simply renewing the same group plan.

Traditional Group Insurance

Employer-sponsored medical coverage where eligible employees participate in a group health plan.

Level-Funded Coverage

Certain employers may qualify for level-funded arrangements that combine employer funding with stop-loss protection.

Underwriting, eligibility, plan design, and refund provisions vary by carrier and arrangement.

ICHRA

An Individual Coverage HRA can allow an employer to reimburse eligible employees for individual health insurance under applicable federal rules.

This can give employers more control over contributions while allowing employees to select qualifying individual coverage.

QSEHRA

Certain qualifying small employers that do not offer a group health plan can reimburse eligible employees for qualifying individual insurance and medical expenses under QSEHRA rules.

A higher renewal doesn't automatically mean you should move away from group coverage. Compare the actual employer cost, employee cost, provider networks, benefits, tax treatment, and administrative responsibilities of each strategy.

Learn more about small business health insurance →

How We Help Ohio Residents

Self-Employed & 1099 Workers

Contractors, tradespeople, truckers, owner-operators, manufacturing contractors, real estate professionals, farmers, consultants, freelancers, and other independent workers.

Self-employed health insurance →

CareSource & Molina Members

If your current Marketplace plan is ending, we can help compare replacement options and recheck your doctors, hospitals, medications, costs, and networks.

Individuals & Families

We compare premiums, deductibles, doctors, prescriptions, Marketplace assistance, and other available coverage.

Individual & family health insurance →

People Paying Full Price

If you don't qualify for Marketplace Premium Tax Credits, we can compare full-price Marketplace coverage with other available options.

Early Retirees

We help people who need coverage before Medicare compare Marketplace insurance, COBRA, spouse coverage, and other available options.

Small Business Owners

We can discuss traditional group plans, level-funded coverage, ICHRAs, QSEHRAs, and additional employee benefits.

Small business health insurance →

Serving All 88 Ohio Counties

We work with Ohio residents by phone and video, so you don't need to live near a local insurance office.

Central Ohio
Columbus, Dublin, Westerville, Delaware, Grove City, Newark and surrounding communities
Northeast Ohio
Cleveland, Akron, Canton, Parma, Lorain, Youngstown and surrounding communities
Southwest Ohio
Cincinnati, Dayton, Hamilton, Mason, Kettering, Middletown and surrounding communities
Northwest Ohio
Toledo, Findlay, Bowling Green, Sandusky and surrounding communities
Southeast Ohio
Athens, Marietta, Zanesville and surrounding communities
Rural Ohio
We help clients throughout Ohio's smaller cities, towns, and rural counties by phone and video
Your ZIP code matters. Insurance-company availability, premiums, provider networks, and plan choices can vary across Ohio. We'll focus on what is actually available where you live.

Official Ohio Health Insurance Resources

HealthCare.gov
Marketplace enrollment, Premium Tax Credits, plan comparison, and Special Enrollment Periods.
Visit HealthCare.gov →

Ohio Department of Insurance
Consumer insurance information, complaints, insurance-company information, and regulatory resources.
Visit Ohio Department of Insurance →

Ohio Medicaid
Medicaid eligibility, managed care, renewals, and 2027 work and community-engagement changes.
Visit Ohio Medicaid →

Common Questions About Ohio Health Insurance

Does Ohio use HealthCare.gov?

Yes. Ohio uses the federal Health Insurance Marketplace at HealthCare.gov for Marketplace individual and family coverage.

Is CareSource leaving Ohio?

CareSource is leaving Ohio's individual health insurance market after the 2026 plan year.

Current Marketplace members need replacement individual coverage for 2027.

Is CareSource leaving Ohio Medicaid?

No. CareSource remains one of Ohio's Medicaid managed care plans. The announced exit applies to the individual health insurance market, including Marketplace plans.

Is Molina leaving the Ohio Marketplace?

Yes. Current 2027 filings indicate Molina will no longer offer Marketplace plans through HealthCare.gov in Ohio.

Molina continues to participate in Ohio Medicaid, and limited off-exchange individual coverage may remain.

What happens if I have CareSource or Molina Marketplace coverage?

Review replacement coverage during Open Enrollment.

Select a new Marketplace plan by December 15 if you want replacement coverage beginning January 1, 2027.

Is a new insurance company entering Ohio for 2027?

AmeriHealth Caritas Next is entering selected Ohio counties for the 2027 Marketplace plan year.

Its availability is not statewide, so check the plans actually offered for your ZIP code.

How much are Ohio health insurance premiums increasing in 2027?

There is no single increase that applies to every Ohio resident.

Preliminary carrier filings vary widely, from a proposed decrease for one Oscar entity to increases above 20% for some other insurers.

Your actual change depends on the carrier, plan, age, location, and any Marketplace financial assistance.

When is Ohio Open Enrollment for 2027?

Open Enrollment runs from November 1, 2026 through January 15, 2027.

Select a plan by December 15, 2026 for coverage beginning January 1, 2027.

Did Ohio expand Medicaid?

Yes. Ohio expanded Medicaid to qualifying adults, generally ages 19 through 64, subject to income and other eligibility requirements.

Does Ohio Medicaid have work requirements in 2027?

Beginning January 1, 2027, certain non-exempt adults enrolled through Ohio's Group VIII Medicaid expansion category will need to meet a work and community-engagement requirement.

The general requirement is at least 80 hours per month of qualifying work, education, volunteering, job training, or a combination of approved activities.

Does everyone on Ohio Medicaid have to work 80 hours?

No. The requirement applies only to certain adults in the affected Medicaid expansion category, and numerous exemptions are available.

Ohio Medicaid is notifying members who may be affected.

Can self-employed people get Marketplace insurance in Ohio?

Yes. Self-employed Ohio residents can purchase individual coverage through HealthCare.gov and may qualify for Premium Tax Credits if they meet the applicable requirements.

Can I get Ohio health insurance outside Open Enrollment?

Possibly. Marketplace enrollment outside Open Enrollment generally requires a Special Enrollment Period after a qualifying event such as losing other coverage, getting married, having a baby, or certain moves.

Ohio Medicaid accepts applications throughout the year for eligible residents. Other types of coverage may have different enrollment rules.

Is private health insurance cheaper than HealthCare.gov?

It depends on the applicant and the type of coverage.

Some non-Marketplace products may have lower premiums for certain eligible applicants, but benefits, medical underwriting, exclusions, provider networks, and pre-existing-condition rules can differ.

Compare what the policy actually covers rather than using monthly premium as the only factor.

Can you check whether my doctors are in network?

Yes. Give us the names of your doctors, specialists, preferred hospitals, prescriptions, and pharmacy when we compare your options.

Can you help me if your office is in Arizona?

Yes. We are licensed in Ohio and work with Ohio clients remotely by phone and video.

Compare Your Ohio Health Insurance Options for 2027

With CareSource leaving the individual market, Molina leaving the Marketplace, a new insurer entering, premium changes, and new Ohio Medicaid rules, 2027 is an important year to review your coverage. We'll help you compare the available options, check your doctors and prescriptions, and understand the costs before you choose.

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