Ohio hospitals are paid for health care services they provide by three categories of payers—commercial insurers, government programs and individual patients. Private insurance coverage is primarily provided through employer-sponsored programs in Ohio. Government payers include Medicare, Medicaid, Veterans Administration, Bureau of Workers Compensation and the military. Patients who have not purchased coverage or applied for coverage through government programs are billed directly for the services provided.
Ohio's private insurance companies provide health coverage for 46% of Ohioans and are the largest payer group for hospital claims in Ohio. Read more here about OHA's work with the commercial payer community.
As Ohio's population ages, Medicare's role insuring Ohioans 65 and older continues to grow. The federal program also covers certain younger people with disabilities and end-stage renal disease. Read more here on OHA's work with Medicare analysis and policy.
Ohio expanded eligibility to Medicaid in 2014. The program provides health care coverage for Ohio's poor and disabled citizens. Read more here on OHA's work with Medicaid analysis and policy.
Ohio hospitals help fund the state's share of Medicaid. Read more about how the program has reached a tipping point at the current franchise fee rate.
HCAP provides medically necessary free hospital-level care for low-income Ohioans and supplemental payments for hospitals with a disproportionate share of uncompensated care.
OHA collects payer performance data specific to each member organization to enhance OHA’s advocacy efforts by providing measurable data. OHA Members can click here to access details on data submission for the OHA Payer Scorecard.
Learn more here about COVID-19 financial relief through federal and state funding opportunities available to hospitals and health systems.