Health insurance plan options in Indiana are now much more affordable for many Hoosier residents. Thanks to a federal subsidy that can pay up to 100% of your Exchange healthcare premium, rates have reduced and benefits are greatly enhanced. And of course, because of the “guarantee-issue” provision, no applicant can be denied for medical reasons, and no waiting period or pre-existing exclusion will be placed on these policies during Open Enrollment.
Comparing, choosing and enrolling for Marketplace coverage can be time-consuming and frustrating. However, we handle most of the hard work for you, including the calculation of your financial assistance and applying for Indiana coverage. We show you the plans that are best-suited to cover any conditions you may have. For persons that have no medical issues, many budget-oriented options will keep your premium low.
Applying for a policy takes less than 20 minutes instead of a few hours, which was common in previous years. The number of questions has reduced and the online application is significantly smaller. Federal subsidy amounts have also slightly increased for 2016. And, more policies are available since the number of participating carriers has increased. For example, Indiana healthcare plans from Ambetter (see details below) offer numerous choices at excellent rates.
Most Popular Plans
We have listed below many of the most popular available plans (in most areas). Before applying for coverage, we review your circumstances and research and find the policies that are the best choices. Of course, much more specific and comprehensive details are provided before you apply for coverage. And before an application is submitted, you can compare all available plans, regardless of cost.
Some policies are not offered in all areas. HSA-eligible policies may have different contribution limits and maximum out-of-pocket expense totals. Also, when a “copay” is mentioned, this particular benefit (office visit, prescription etc…) is typically not subject to a deductible and your cost is much less. NOTE: Not all options are listed. We focused on the most affordable and cost-effective policies.
Anthem Blue Cross Blue Shield:
Pathway X 6850 – $6,850 deductible with $40 pcp office visit copay. Only available for persons under age 30. However, several Bronze-tier options provide more comprehensive benefits with only a slightly higher premium.
Pathway X 4950 50 – Cheapest Bronze-tier plan with a $4,950 deductible and 50% coinsurance. Most expenses must be paid out-of-pocket until the deductible is met.
Pathway X 5000 40 – $5,000 deductible but $50 pcp office visit copay helps.
Pathway X 20 For HSA – Health Savings Account option with $4,500 deductible.
Pathway X 4250 30 – Least expensive Anthem Silver-tier policy. Low office visit copays of $25 and $50 with $15 generic drug copay. $4,250 deductible is less than most Bronze-tier options.
Pathway X 10 For HSA – $3,000 deductible HSA option with 10% coinsurance.
Pathway X 1500 25 – Very comprehensive coverage with low out-of-pocket expenses. Office visit copays of $20 and $50 with a major medical deductible of $1,500.
Additional information on BCBS plans in the Hoosier state can be found here. We regularly update prices and changes in benefits.
Physician’s Health Plan (PHP):
Marquee 6850 – One of the cheapest available options. $6,850 deductible with no coinsurance.
Marquee Bronze 5000 – $5,000 deductible with a $50 copay on pcp office visits. Maximum out-of-pocket cost is $6,850. Available as an HMO or POS (Point Of Service).
Marquee Bronze HSA 3750 – HSA-eligible plan with $3,750 deductible, 40% coinsurance, and maximum out-of-pocket expenses of $6,550.
Marquee Silver 2000 -Lowest-cost Silver option. $2,000 deductible with 20% coinsurance. $30 pcp copay and $15 copay for generic drugs.
Marquee Silver 2500 -$2,500 deductible with 30% coinsurance. Slightly more expensive than previous plan and same maximum out-of-pocket maximum. Generic drug copay is $10 instead of $15.
Marquee Gold 1250 -$1,250 deductible with 10% coinsurance and $35 pcp office visit copay. Costs about 20% more than most expensive Silver-tier policy.
Essential Care 1 – $6,800 deductible with 0% coinsurance.
Essential Care 5 – Similar to previous plan, but three pcp office visits (per person) are included with no copay or deductible to meet.
Balanced Care 2 – Very popular option. Copays of $30 and $60 on office visits with $15 generic drug copay. Deductible is $6,500.
Balanced Care 1– Similar to previous plan, although slightly more expensive because of lower deductible ($5,500) and lower generic drug copay ($10).
Secure Care 1 – Only Gold-tier plan available. Low $1,000 deductible, although maximum out-of-pocket expenses are $6,350.
Marketplace Bronze Basic – $20 pcp office visit copay and $6,200 deductible.
Marketplace Bronze Plus – $10 pcp office visit copay with $4,800 deductible.
Marketplace Silver Basic – $5,000 deductible with 100% coverage for pcp office visits (no deductible or copay to meet).
Marketplace Silver Plus – $2,500 deductible with 100% coverage for pcp office visits (no deductible or copay to meet).
Marketplace – $700 deductible. $20 and $50 copays on office visits. One of the most affordable “Gold” tier policies.
Bronze Choice HSA 5500 – HSA-eligible option with $5,500 deductible.
Bronze Choice 6500 – $6,500 deductible with $45 and $100 office visit copays.
Silver Choice HSA 3000 – HSA-eligible plan with $3,000 deductible.
Silver Choice 2000 1 – $2,000 deductible with office visit copays of $30 and $60.
Gold Choice 0 – $0 deductible with $30 and $60 office visit copays.
IU Health Plans
Bronze Simple HSA – HSA-eligible plan with $6,500 deductible.
Bronze Value – $40 pcp office visit copay and $6,000 deductible.
Silver HSA – Another HSA-eligible plan with $3,000 deductible and $4,500 maximum out-of-pocket expenses.
Silver Value – $40 pcp office visit copay and $2,500 deductible.
Gold Value – $750 deductible with $20 and $50 office visit copays.
Each state has designated geographic “Rating Areas” that help determine price and availability of plans. Indiana has 17 areas which consist of specific counties. The sizes of these territories are not uniform. For example, Territory Nine one of the largest, consisting of the following counties: Adams, DeKalb, Huntington, LaGrange, Noble, Steuben, Wabash, Wells, and Whitley.
Territory 15 is the other largest area, consisting of these counties: Daviess, Dubois, Greene, Knox, Martin, Orange, Perry, Pike and Spencer. By dividing the state into 17 separate districts, insurers can more easily determine the most appropriate premium. You can view a full breakdown of the makeup of each territory here.
What Happens If You Miss Open Enrollment?
Don’t fret. Thousands of persons will miss the deadline for various reasons. Whether it’s “my dog ate my enrollment paper,” or “I slept through it,” we speak to many consumers each day that are in this predicament. But fortunately, if you don’t have any significant health conditions, such as cancer, heart disease or diabetes, you may be able to get coverage within 24 hours.
UnitedHealthcare, The IHC Group, and HCC Life Insurance Company offer the most competitive “short-term” pans in Indiana. Although all four carriers are very reputable, we’ll focus on UnitedHealthcare since they are the biggest of the four companies and feature a larger in-state and national network of providers.
The premise is simple. If you can answer a few medical questions “no,” you’ll be approved and the policy can often get issued that day. A deductible applies to all claims and this type of coverage is not going to contain many of the mandated benefits required by Obamacare (such as maternity, dental, free preventive and psychiatric counseling).
Sample rates for a 36-year old non-smoking male in Putnam County: (“Plus” and “Value” Plans)
$45 – $10,000 deductible and 30% coinsurance
$54 – $5,000 deductible and 30% coinsurance
$66 – $2,500 deductible and 30% coinsurance
$81 – $2,500 deductible and 20% coinsurance
$85 – $1,500 deductible and 30% coinsurance
$100 – $1,000 deductible and 30% coinsurance
It’s important to understand that since short-term policies do not meet Affordable Care Act guidelines, you may incur a 2.5% (household income) penalty that will have to be paid the following year. Naturally, enrolling before the end of Open Enrollment is the best option. However, for various reasons, the deadline is often missed. Prices for someone older will be higher, and conversely, the cheapest rates apply to the youngest applicants. Temporary contracts are underwritten, so you can be denied coverage.
If this type of policy is issued, we recommend reviewing Marketplace-eligible policy options before the next guarantee-issue period ends. That will allow us to compare more comprehensive policies that are subsidy-eligible. However, low-cost high-deductible plans will also be offered. A short-term is designed to protect you for 1-12 months, but not a few years.
There are also many special “exceptions” that allow you to buy subsidized policies despite being outside of the OE period. Termination from existing coverage and moving to a different service area are two examples of these exceptions. However, if you voluntarily terminate an existing plan (regardless of reason), it will not qualify as a “Special Enrollment Period.” Also, if you have been without coverage for an extended period of time, typically, your options will be limited.
About $2 million in federal funds is on the way from the Department of Health and Human Services. The money is part of “Navigator Grant Awards” that are designed to help consumers with Marketplace information and enrollment. Although navigators lack the experience and expertise of experienced brokers (and websites like ours), they do specifically help persons that are not comfortable with viewing plan options and information online.
Persons eligible for Medicaid and CHIP are also helped since their application, eligibility rules and requirements are typically more challenging. Often, a face-to-face meeting is needed for these situations. Household income can quickly change, resulting in instant eligibility of specific benefits.
Ambetter is not available in all areas, but their prices are very attractive. They offer several plans that provide copays instead of deductibles on many office visits and drug charges.
Aetna, as expected, did not return to the Indiana individual market. With their impending merger with Humana expected to be completed next year, can we expect a new major Aetna/Humana presence in the state for 2017. It’s possible, and we’ll probably know by June of next year.