The Indiana Health Insurance Marketplace
Indiana defaulted to a federally-run health insurance exchange, which increases opportunities for uninsured residents to get covered. Prior to the federal health law, about 500,000 Indianans remained uninsured due to exorbitant coverage costs, rigid underwriting, and health problems. Now every resident who couldn’t previously obtain coverage through their employer, Medicaid, a high-risk pool, or other health plan can enroll in a benefit-rich, cost-effective policy through the marketplace. Subsidized individual health plans under the Affordable Care Act allow more people to get covered in Indiana through a small selection of private insurers throughout the state. The ACA requires plans to pay for certain benefits and provide sufficient coverage simultaneously. This law also requires most Indiana residents to enroll in a health plan, whether Hoosier Healthwise or the marketplace, and the exchange helps bridge the gap for many individuals and families in need of medical insurance by offering financial assistance.
Indiana exchange plans use government-issued subsidies to lower premiums and cost sharing for qualifying policyholders. Many individuals applying for the marketplace coverage are eligible for reduced rates and medical expenses, including residents who earn between 100-400 percent FPL. Another perk of the marketplace is mandatory coverage for ten categories of essential health benefits. These groups help pay for important health services related to maternity and newborn care, prescriptions, doctor’s office visits and inpatient care. Policies are available from four carriers in Indiana.
The exchange provides beneficial coverage options for individuals, families and small businesses at discounted rates. Contact a licensed agent for assistance and further details on the marketplace at 888 803 5917.
Each plan sold through the marketplace for individuals falls under one of four “metallic” tiers indicating how much your future plan will pay for covered care. Comprehensive plans range from bronze to platinum, indicating the amount of coverage you’ll receive from low to high. Bronze and silver plans also have more reasonable premium rates, while gold and platinum plans are more costly as they provide better coverage.
Catastrophic plans are another option made specifically for Hoosiers under age 30 with little need to see the doctor. These affordable policies only cover a few services but protect your health and help you evade the penalty for going without coverage. Four office visits and preventive care are covered in full, and emergency room visits are covered at deductible with catastrophic plans. While they are reasonable, catastrophic plans aren’t eligible for use with tax credits. Use the cost comparison tool below to view estimates of your rates in all the coverage tiers.
Premium Tax Credit
The health insurance exchange offers financial assistance to residents with family income between 100 and 400 percent of poverty. Lower income enrollees will receive the greatest amount of assistance, including help paying for monthly premiums and covered medical expenses. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Marketplace applicants in Indiana earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of FPL, the government will provide you with a premium tax credit.
Tax credits are estimated by income and family size, and the cost of the second-least expensive silver plan in your area as a percentage of income. According to income, you can determine about how much your premium share will be in the table below. The remainder is paid for by the tax credit. For a clearer picture of your potential premium discount, use the tool at the bottom of the page.
Only four Indiana insurers sell coverage inside the marketplace, providing uninsured residents and small businesses with affordable coverage. Depending on your area, approximately 1-2 of those four companies will be offered. Also, you may find that the insurers’ provider networks have fewer doctors and facilities in-network, which is commonplace for exchange plans. A smaller network size allows insurers to afford to offer benefit-rich plans at a low cost. Verify with your doctors that they are included in your plan’s network prior to applying. If not, you may want to research off-exchange plans that can connect you with your preferred providers. The following carriers sell plans on the marketplace in Indiana.
For an easier marketplace shopping experience, each insurer is required to cover ten types of benefits, which lets you know instantly what to expect from your plan. Copays, coinsurance and deductibles vary between plans and companies, as do specific services covered under these categories. Certain services, such as preventive immunizations or exams, are covered in full, and others, like office visits, might be covered for a $40 copayment or a percentage of coinsurance. Always read the your plan’s schedule of benefits to be sure a service is covered before going to the doctor.
Essential Health Benefits include:
- Preventive, wellness, and chronic disease management services
- Emergency care
- Office visits
- Hospital care
- Pediatric care, including dental and vision
- Rehabilitative and habilitative services and devices
- Maternity and newborn care
- Laboratory tests
- Mental health and substance abuse services, including behavioral health care
Small Business Health Options Program
In addition to individual and family plans, the marketplace provides policies to small businesses and their workers through the Small Business Health Options Program (SHOP). Businesses with up to 50 full-time employees can cover their team through SHOP, and those with up to 25 workers can receive subsidies. Eligibility guidelines for the Small Business Health Care Tax Credit include less than 25 full-time workers who earn $50,000 per year each. If you’re a business owner with up to 10 full-time equivalent workers who make no more than $25,000 per year each, you may be eligible for a subsidy to cover half of your premium contribution.
How to Apply
You can only apply for marketplace plans each year during open enrollment. Don’t worry if you miss the deadline, as you can purchase a short-term plan until the next open enrollment period begins. During open enrollment, you can apply by contacting a licensed agent at 888.803.5917. If you prefer enrolling on your own, visit HealthCare.gov to apply online. Those who aren’t seasoned web users can locate a facility where navigators can help you sort out the online application process, such as public health centers.
For assistance on all levels of exchange enrollment, use the resource of knowledgeable insurance professionals at East Coast Health Insurance. Our agents are licensed to sell non-marketplace individual health plans throughout Indiana, and are also certified in subsidized marketplace coverage. In a one-on-one chat with an agent, we’ll research your choices for discounted health plans and connect you with the optimal policy for your needs.
Compare Indiana Marketplace Plans
Use the cost comparison tool below for an estimate of your plan options and pricing on the marketplace. While not entirely accurate, this calculator can help you better visualize what discounts you may qualify for. To receive an accurate rate quote and subsidy calculation, or to purchase a plan in your area, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.