Indiana Health Insurance: Find Affordable Plans

Indiana residents have a lot of options when it comes to obtaining affordable health insurance. You can enroll in an employer plan, sign up for Medicaid or Medicare,  purchase insurance from an individual insurer.  or you could use the Health Insurance Marketplace for Affordable Care Act options.

• Marketplace plans: Indiana allows you to purchase individual health insurance if you’re self-employed, your employer doesn’t offer group coverage, your coverage through your employer isn’t adequate, or if the plan doesn’t cover your spouse or dependents.
• Open enrollment: In Indiana, you’re able to enroll for coverage during an open enrollment period. For coverage beginning in 2023, that runs from October 15 to December 7, 2022.  If you miss Open Enrollment, you can’t buy a marketplace plan until the next year unless you qualify for a Special Enrollment Period.
• Special enrollment: Life events such as getting married, moving, or having children may qualify you for a special enrollment period if you need to change your coverage or apply for insurance. You have 60 days from the time of the event to sign up for a new plan or make changes to your current plan.
• Premium tax credit: Indiana uses the federal Health Insurance Marketplace. If you want the Advanced Premium Tax Credit to help you pay your health care premiums, you need to purchase a plan through the exchange.
• Coverage types: About 53.3% of Indiana residents obtain their health coverage through an employer, while 4.4% have individual plans. An additional 17.7% are enrolled in Medicaid, and 14.8% of residents are covered by Medicare. Another 8.8% of Indiana residents are uninsured.

Indiana uses the federal Health Insurance Marketplace. You can create an account at HealthCare.gov to enroll in a health insurance plan. The process is relatively easy – provide your contact information, choose several security questions, and select a password.

You should gather all of the information you need ahead of time. This includes the full names, birth dates, and Social Security numbers for everyone you intend to include on your plan. After you’ve set up your account and provided all the information, HealthCare.gov automatically determines whether you’re eligible for the Advanced Premium Tax Credit, Medicaid, or other financial assistance.

The application includes several questions regarding your income and household status, such as:

• How many people did you claim as dependents on your last tax return?
• What is your total household income?
• Would you like to apply for financial aid?
• What is your marital status?

Once you’ve provided all of the required information, you can compare health insurance plans to determine which one best suits your needs. HealthCare.gov provides a tool that helps you compare up to three plans side by side so you can see what each plan provides, as well as the premium, deductible, and coinsurance requirements. When you decide on a plan, you can complete the enrollment right on the website.

The following companies offer health insurance coverage in Indiana through the Health Insurance Marketplace:

• Ambetter from MHS
• Anthem Blue Cross Blue Shield
• CareSource
• Cigna
• US Health and Life Insurance Company

The enrollment process for health insurance coverage is identical for individuals and families, but before you purchase a plan, you need to evaluate your needs. Factors to consider include:

• How many individuals need coverage
• How much you can afford to pay in premiums and out-of-pocket costs (such as annual deductibles)
• Your family members’ medical needs
• What type of plan you’d prefer

Insurance for individuals in Indiana 

You have a lot of flexibility when you’re shopping for individual coverage. If you’re healthy and don’t need to see a doctor on a routine basis, you can save some money by shopping for a plan with a lower monthly premium and a higher deductible. Keep in mind that coverage won’t begin until you meet your annual deductible, so you want to make sure you can afford out-of-pocket expenses if you find yourself in need of care.

There are three types of plans you can choose from and each has benefits and drawbacks.

• Health Maintenance Organization (HMO) plans are the most affordable but only cover services received from providers within the plan’s network. You’re also required to obtain a referral anytime you need to see a specialist.
• Preferred Provider Organization (PPO) plans allow you to see whomever you wish, but you’ll pay less for services received within the plan’s provider network.
• Point-of-Service (POS) plans have the benefits of an HMO without harsh penalties for seeing out-of-network providers. If you wish to see a specialist outside of the network, for example, you can do so at the cost of a higher copayment.

Insurance for families in Indiana 

You don’t have the luxury of thinking only of your own needs when you’re shopping for a family health insurance plan. While you may not require ongoing treatment, your child or spouse may need to see a specialist for a chronic medical condition. When you’re reviewing policies, remember that you’re looking for a plan that reduces your total out-of-pocket expenses. The plan that offers the lowest premiums may not be the least expensive option overall.

Consider factors such as your family deductible, your copayment for each medical service, and how well you’re able to afford the monthly premium. The best plan for your needs will balance the cost of your medical services with the amount of money you’re paying every month. Some HMOs may have networks that include the types of specialists you anticipate needing to see, which could make a particular HMO a cost-saving option if its in-network providers can offer the care your family needs.

The Health Insurance Marketplace offers four tiers of insurance coverage in Indiana: Bronze, Silver, Gold, and Platinum. The tiers reflect how comprehensive a plan is based on its monthly premium, annual deductible, coinsurance requirements, and more.

• Bronze plans are the least expensive insurance plans available but not ideal for people who require ongoing treatment for chronic health conditions or who anticipate needing care in the future. In addition to high deductibles, these plans have coinsurance requirements of 40% of the cost of your medical expenses. If you’re healthy and just want protection in the event of an unexpected injury, one of these plans could work for you. The cheapest Bronze plan in Indiana costs $327 per month in 2023.
• Silver plans cost a little more than Bronze plans but have lower deductibles and copayment requirements. With a Silver plan, you’re only required to pay 30% of the cost of medical services after meeting your deductible. There are cost-sharing initiatives available that allow some low-income families to qualify for Silver plans for lower premiums than a Bronze plan. The least expensive Silver plan in Indiana in 2023 costs $395 per month.
• Gold and Platinum plans provide the most comprehensive coverage and are meant for families who need ongoing care for one or more members of their household. A Gold plan has a coinsurance requirement of 20%, while a Platinum plan reduces your coinsurance to only 10%. These plans are considerably more expensive than Bronze and Silver plans, but their coverage may make them worth the added premium under the right circumstances. The cheapest Gold plan in Indiana costs $521 in 2023.

There are two options available for families in Indiana who can’t afford health coverage for themselves or their children: Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid is a program run jointly by the Indiana and federal governments, while CHIP is meant to ensure that low-income children have access to health care while they’re growing up.

Medicaid in Indiana 

The Indiana Medicaid program provides health care coverage for state residents who have low or very low incomes. To qualify, you must meet at least one of the following criteria:

• At least 65 years old
• Pregnant
• Responsible for a minor child
• Have a disability
• Have a household member with a disability

The income limit for an individual to qualify for Indiana Medicaid is $16,971 per year. This limit increases if you have other eligible members in your household. The limit for a household of two is $22,930, for example, while for a household of three, it’s $28,888. Your entire household income must fall under the appropriate threshold to qualify for coverage.

Medicaid provides coverage for routine preventive care, emergency room treatment, outpatient procedures, diagnostic testing, and other approved services that are considered medically necessary. Adults over the age of 18 who require a nursing home level of care may receive benefits in a long-term care facility or in their own home.

To apply for Medicaid, you can visit Indiana’s Medicaid website to learn more about the program and fill out an application.

Indiana CHIP Program 

Families who don’t qualify for Medicaid with an income above the threshold may still be able to apply for the Indiana CHIP program. CHIP covers the cost of preventive care, immunizations, medications, mental health care, speech therapy, dental visits, and vision care for children. It also covers prenatal care for pregnant women.

To qualify, a beneficiary must be under the age of 19 or an expectant mother. To learn more about the CHIP program, you can visit the Hoosier HealthWise website.

Indiana offers multiple options for elderly residents and people with disabilities to obtain health coverage. You can enroll in Original Medicare, choose a Medicare Advantage plan, and purchase a Medicare Supplement plan to reduce your out-of-pocket expenses. You’re also able to enroll in Medicare Part D if you’re in need of prescription drug coverage.

• Medicare Part A and B make up Original Medicare. Part A covers inpatient care in hospitals and nursing facilities, as well as hospice and home health care services. Part B covers outpatient procedures, preventive care, diagnostic testing, medical equipment, and medical transportation. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage plans are sold by individual insurers and provide coverage for everything offered by Part A and B. Many MA plans also offer extra benefits, such as dental, vision, and prescription drug coverage. As of 2023, there are 146 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

Medicare Supplement Insurance plans are designed to help fill the coverage gaps in Original Medicare and are also known as Medigap plans. These plans help cover your out-of-pocket expenses, such deductibles, coinsurance, and copays.

Eligibility 

To qualify for Medicare, you must first meet certain criteria. Medicare is available to U.S. citizens or permanent residents who are aged 65 or old or receiving Social Security Disability benefits for at least 24 months. If you have end-stage renal disease or ALS, you may also qualify for Medicare at a younger age.

Enrollment 

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources 

Indiana’s State Health Insurance Assistance Program (SHIP) can provide you with free assistance understanding your Medicare options, can help you find a Medicare Advantage plan that suits your needs, or give you information about available financial assistance programs. You can visit the SHIP website or call 800-452-4800 for assistance.

You can purchase short-term health coverage for up to one year, with a maximum lifetime coverage limit of $2 million over the duration of the plan. These plans are meant to be temporary with a maximum of 36 consecutive months.

Temporary health insurance plans aren’t governed by the same set of rules insurers must follow under the ACA. Your rates can be increased due to a health condition or genetic predisposition to certain illnesses, and you can be denied coverage for preexisting conditions. If you’re pregnant, you may be denied coverage for prenatal care throughout your pregnancy.

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