Health Insurance Marketplace in Indiana
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Indiana has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Indiana’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Affiliated Service Providers of Indiana, Inc., based in Terra Haute, Indiana, is collaborating with community mental health centers and Ivy Tech Community College to develop a navigator workforce consisting of veterans, certified recovery specialists, and Ivy Tech Community College students to reach out to and educate individuals, families and small businesses on the Health Marketplaces and help them select and enroll in qualified health plans.
Plus One Enterprises, LTD, LLC is a woman-owned, black-owned, small business based in Anderson, IN and Madison County (east central Indiana). Plus One Enterprises will help individuals and employers in Delaware and Madison Counties, focusing on people who are under and uninsured, facilitating enrollments in qualified health plans and the Small Business Health Options Program (SHOP), and reaching out to small employers.
toll free – 855-758-7166
contact: Deborah Hester.
Health and Hospital Corporation of Marion County (HHC), part of the Indiana state government, operates the Marion County Public Health Department and Wishard Health Services—a patient-centered healthcare system for the uninsured and underinsured residents. HHC will hire and train staff to assist clients and implement an extensive education and media campaign to promote the Federally Facilitated Exchange.
United Way Worldwide, working with local United Ways and 2-1-1—the free, three-digit dialing code for health and human services—information, referral, and assistance service centers will work to provide access to health insurance to individuals, households, workers, and outreach to employers in Indiana.
Who you can contact for more help
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in Indiana
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- TransforMED IN – Health Care Innovation Award
- National Council Of Young Men’s Christian Associations Of The United States Of America (YMCA Of The USA) IN – Health Care Innovation Award
- Trustees Of Indiana University IN – Health Care Innovation Award
- University Of North Texas Health Science Center IN – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- American Health Network of Ohio Care Organization, LLC Indianapolis, IN – Advance Payment ACO Model
- Saint Joseph Regional Medical Center-Mishawaka Campus Mishawaka, IN – BPCI Initiative: Model 2
- Amedisys Home Health of Jeffersonville Jeffersonville, IN – BCPI Initiative: Model 3
- LifeSpan Resources, Inc. New Albany, IN – Community-based Care Transition Program
- Aging & In-Home Services of Northeast Indiana Fort Wayne, IN – Community-based Care Transition Program
- Cass County Community Health Center Logansport, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Community Health Center of Jackson County Seymour, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- HealthLinc, Inc. Valparaiso, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Heart CIty Health Center Elkhart, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Indiana Health Centers at Kokomo Kokomo, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Vermillion-Parke Community Health Center Clinton, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Indiana Health Centers, Inc. at South Bend South Bend, IN – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Franciscan Alliance Indianapolis, IN – Pioneer ACO
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Indiana
In November 2012, Governor-elect Mike Pence (R) announced that he would not move forward with setting up a state-based health insurance exchange when he takes office in 2013.1
During his term, Governor Mitch Daniels (R) had signed Executive Order #11-01 in 2011 to conditionally establish and operate the Indiana Insurance Market, Inc., a nonprofit corporation to serve as the Indiana health insurance exchange.2 The Executive Order defined Indiana’s exchange as a nonprofit incorporated by the Secretary of the Indiana Family and Social Services Administration, working with the Indiana Department of Insurance. An interagency group including, the Department of Insurance, the Family and Social Services Administration, and the Office of Medicaid Policy and Planning, worked on exchange planning in the state. However, since issuing the Executive Order, Indiana began to move away from a state-based exchange.3 While the state had assembled two pieces of draft exchange legislation, the Department of Insurance did not propose either during the 2012 legislative session, which ended in March 2012.4
On May 5, 2011, Governor Daniels signed HB 1210, which prohibits qualified health plans purchased through an exchange in Indiana from covering abortions, except in the case of rape, incest, or to avert impairment or death of the pregnant woman.5
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Indiana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Anthem Blue Cross Blue Shield of Alaska- Blue Access PPO.
In May 2011, Indiana was among the first three states to be awarded a federal Level One Establishment grant.6 The Indiana Department of Insurance and Family and Social Services Administration received of $6.9 million to update their information technology systems, develop a financial management plan, and acquire legal, actuarial, and financial expertise.7 The Indiana Family and Social Services Administration also received a federal Exchange Planning grant of $1 million in September 2010.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Indiana has proposed to the federal government that they will cover low-income residents with the Healthy Indiana Plan.
The federal government will assume full responsibility for running a health insurance exchange in Indiana beginning in 2014.
Additional resources related to Indiana’s exchange planning can be found at:http://www.nationalhealthcare.in.gov
1. Gov-Elect Pence: Indiana Should Not Establish State-based health insurance exchange. November 15, 2012. http://www.mikepence.com/exchange
2. Indiana Executive Order #11-01. January 2, 2011.http://www.in.gov/gov/files/Executive%20orders/EO_11-01.pdf
3. State of Indiana Letter to CMS. Comment on State Exchange Plan Application. January 10, 2012. http://www.in.gov/aca/files/Indiana_Exchange_Certification_Application_Comments.pdf
4. Level One Establishment Grant Quarter 1 Report. 10/30/2011.http://www.in.gov/aca/files/HIX_Level_One_Quarterly_Report.pdf
5. HB 1210 (Chapter 33). Indiana’s 2011 act related to Health Care Exchanges and Abortion.http://www.in.gov/legislative/bills/2011/HE/HE1210.1.html
6. Indiana Health Insurance Exchange Level One Funding Solicitation.http://www.statecoverage.org/files/IN_InsuranceMarketGrantITGAPSummary_2011.pdf
7. HealthCare.gov. “Creating a New Competitive Marketplace: Affordable Insurance Exchange Establishment Grant Awards List.” August 12, 2011.http://www.healthcare.gov/news/factsheets/exchanges05232011a.html
Also of interest
Provided by the Henry J. Kaiser Family Foundation