Indiana Health Insurance

 

Health insurance in Indiana

● Indiana relies on subsidized exchange at the federal level, so residents sign up through HealthCare.gov.

● The open registration for 2021 health plans is from 1 November to 15 December 2020; Residents with qualifying events can sign up outside that window.

● Short-term health plans in Indiana may have 364-day terms, but they must have a benefit limit of more than $2 million.

● Three insurers offering health plans for 2021 for 2021, including Anthem, which is returning to trading after a previous outing.

● Indiana accepted the ACA's Medicaid expansion in 2015; nearly 559,000 people are covered by expansion guidelines as of December 2020.

● As of August 2020, there were more than 1.28 million Indiana residents enrolled in Medicare.

Indiana's health insurance marketplace

Indiana relies on subsidized exchange at the federal level, so residents sign up through HealthCare.gov. The exchange is used by people who purchase their health insurance, including the self-employed, early retirees (not yet eligible for Medicare) and people who are employed in a small business that does not provide health benefits.

The use of the exchange is optional (people can sign up directly through insurance companies), but the exchange is the only place where people who buy their own health insurance can get premium subsidies that will minus their monthly premiums, as well as cost-sharing reductions that will minus their out-of-pocket medical costs.

Two insurance companies offer 2020 coverage for individuals and families in Indiana's health insurance marketplace. By 2021, this will increase to three companies, with Anthem's return to the marketplace.

Care Source, Celtic (MHS/Ambetter) and Anthem will all offer plans in the Indiana marketplace for 2021, though with different service areas. The proposed average rate increase for 2021 amounts to more than 10%.

Indiana, open enrollment period and dates

Open enrollment for 2021 health insurance in Indiana is November 1, 2020 to December 15, 2020. Outside of this window, Indiana residents need a qualifying event to enroll or make changes to their coverage, both on the stock exchange and outside of the exchange.

The open enrollment period is an opportunity for individuals and families to recently sign up for coverage or renew or make a change to an existing policy. It's also a good time to update the financial information on file with the exchange (for grant eligibility determinations), to ensure that grant eligibility determinations are accurate.

Medicaid expansion in Indiana

Medicaid expansion, as enacted by the ACA aka Obamacare, extends Medicaid eligibility for low-income adults to 138 percent of the federal poverty level. Indiana did not expand Medicaid in 2014, but their second waiver proposal was approved by CMS in January 2015, paving the way for Medicaid expansion in February 2015.

From 2013 to May 2020, Indiana's average monthly Medicaid/CHIP enrollment in Indiana increased by 40%, with an increase of more than 450,000 enrollment (significant enrollment growth occurred in 2015 and 2016; enrollment was therefore fairly stable until 2019, but increased again in 2020 due to the coronavirus pandemic and subsequent job losses). The Center on Budget and Policy Priorities (CBPP) noted, however, that Indiana's Medicaid enrollment is lower than it would be if the state had simply expanded coverage as required in the ACA, without the complexity (and premiums) that is integrated into the state's approach to Medicaid expansion.

Indiana has two levels of Medicaid coverage: HIP Basic and HIP Plus. HIP Plus includes dental and vision coverage and no copays unless enrollees use first aid for non-emergency care. HIP Basic has copays and does not include dental and vision coverage. People with an income above the poverty level enroll in HIP Plus and have to pay premiums. People with an income below the poverty level can enroll in HIP Basic without premiums, or they can pay premiums and enroll in HIP Plus.

As of August 2020, Indiana reported that 558,714 people were enrolled in expanded Medicaid. That was a sharp increase from about 431,000 in February 2020, but widespread job losses caused by the coronavirus pandemic pushed Medicaid enrollment numbers higher nationwide. The state had predicted that 427,702 people would be enrolled by January 2017, and enrollment initially took some time to reach that projection. But it surpassed it by far during the COVID pandemic, highlighting the importance of Medicaid as a safety net for situations such as the current pandemic.

Short-term health insurance in Indiana

Indiana has its own state regulations on short-term health insurance plans, but regulations changed in mid-2019. The state now allows short-term plans to follow federal rules in terms of duration (terms of up to 364 days and total duration, including renewals, up to three years), but the state imposes various other restrictions, including a benefit limit of at least $2 million.

The Affordable Care Act in Indiana

Indiana uses the federally subsidized health insurance exchange HealthCare.gov. And while former governors Mitch Daniels and Mike Pence both opposed the ACA (Obamacare), Pence sought - and obtained - federal approval to expand Medicaid using a waiver to improve the Healthy Indiana Plan. Extended coverage was in effect in Indiana by February 2015.

Former Governor Pence became vice president of the United States in January 2017. In the 2016 election, Republican Eric Holcomb won Indiana's governorship election. Holcomb is opposed to the ACA, and supported House Republicans in their quest to pass the AHCA. [The bill passed the House in May 2017, but failed in the Senate. It would freeze funding for Medicaid expansion for new enrollees at the end of 2019 and result in lower overall premium subsidies in the individual marketplace, along with significantly higher premiums for people over the age of 50.]

Does Indiana have a high-risk pool?

Before the ACA reformed the individual health insurance marketplace, applications were signed from the medical reference point in nearly every state, including Indiana. As a result, people with pre-existing conditions were often unfit to purchase private plans or were only able to obtain policies that excluded their pre-existing conditions or applied significantly higher premiums to them for full coverage.

The Indiana Comprehensive Health Insurance Association (now finished) was created in 1982 to provide an alternative to residents who were unable to gain coverage in the private marketplace because of their medical history.

Under the ACA, all new health insurance policies have become a guaranteed issue as of January 1, 2014. This aspect of health reform meant that plans in the individual marketplace could be purchased regardless of medical history, making high-risk pools largely obsolete. ICHIA stopped enrolling new members at the end of September 2013. Coverage for most members was extended until January 31, 2014, in order to give members enough time to secure new plans. Coverage was extended until April 30, 2014 for members with HIV and until the end of 2014 for the 12 members with end-stage kidney disease.

Medicare coverage and enrollment in Indiana

Medicare is a health coverage program run by the federal government to provide health benefits for people aged 65 and over, as well as people with long-term disabilities. As of August 2020, there were 1,280,707 Indiana residents enrolled in Medicare. 83% of individuals qualified on an age-only basis, while the other 20% were under the age of 65 and are entitled to it due to a disability.

Compared to the national average, Indiana Medicare beneficiaries are less likely to select a Medicare Advantage plan and more likely to select an autonomous Medicare Part D prescription drug plan.

Indiana Health Insurance Resources

● Indiana Department of Insurance - A government agency that regulates and licenses health insurance companies and brokers and agents who sell plans. It can serve as a resource for an Indiana resident with a question or complaint about health coverage.

● HealthCare.gov — The health insurance exchange where individuals and families in Indiana can purchase health insurance coverage and get financial assistance (premium subsidies and cost-sharing reductions) based on household income.

● (ASPIN) — The federally funded Navigator organization in Indiana; can answer questions and offer assistance to people who enroll in Medicaid or a private plan through exchange.

● Indiana State Health Insurance Assistance Information Program (SHIP) - A local service that provides help and information to Medicare beneficiaries and their caregivers.

● Indiana healthcare reform legislation

● Indiana enacted H.B.1631 in 2019, changing the rules for short-term health plans in the state.

● Indiana enacted S.B,184 in 2020, allowing the Indiana Farm Bureau to begin offering medically signed plans in the state. The plans, which will not be considered insurance and unregulated by the state insurance department, will be available for purchase at the end of 2020, for effective coverage in 2021.