After Open Enrollment for Obamacare ends in Indiana, you can still purchase affordable health insurance coverage. During the Open Enrollment period, federal tax subsidies are available to individuals, families and small businesses to help pay the premium. For private plans, household income guidelines must be met to receive financial help.
But if you missed the deadline, simply forgot about it, or decided that rates were too high, Indiana medical plans can be bought at surprisingly low prices, depending on a variety of factors. Many of these policies will provide ideal “gap” coverage until you are eligible for the next period. However, if you obtain alternative benefits through an employer, or simply can not afford a policy, you can immediately cancel the plan.
Cheap Temporary Gap Coverage
Just as it sounds, this type of plan doesn’t cost much, and is designed to be kept only 1-12 months. But that may be just enough time for you to obtain medical benefits until the next Open Enrollment, which typically begins in November. For 2020 effective dates, the OE period began on November 1st. We do not recommend a short-term policy as a long-term solution to not having qualified ACA benefits. But if bridging a gap is your goal, it’s a viable solution, despite not meeting some of the Obamacare mandate requirements.
Short-term often are the best possible solution until the following year, when new Administration plans may be partially available. Although HSA-deposits are not allowed (plans are not considered HDHP), several higher-deductible options are offered.
Short-term plans do not provide “unlimited” benefits for as long as you have the policy. Usually, the maximum payout is between $250,000 and $2 million, which still should be enough for the limited amount of time you will keep the plan. Preventive benefits, unlike regular Marketplace policies, are not covered at 100% prior to the deductible, and often are not provided at all. Primary-care physician visits, prescriptions, and Urgent-Care visits are generally subject to a deductible, although a rider can often be added to remove the deductible.
Note: Many contracts provide a $50 copay for Urgent-Care visits. Telemed video consultations are also offered with many temporary plans. In 2020, most carriers allowed COVID-19-related telemed visits to be covered with no out-of-pocket costs. Marketplace companies extended the free coverage to diagnosis and treatment.
Typical inpatient and outpatient expenses are covered fairly comprehensively, but a deductible and coinsurance will apply. Although accidents and illnesses are also covered, immunizations and, as mentioned above, physicals, are not included in benefits. Specialist visits are also covered, but subject to a deductible. You can find more information here including plan specifics and how to apply. A policy can be easily approved in less than 24 hours if there are no existing conditions or other underwriting concerns. Generally, maintenance medications (high blood pressure or high cholesterol) do not cause a denial of coverage.
For most claims, (using UnitedHealthcare as an example) the UnitedHealthcare Choice Plus Network negotiates lower prices so you pay less for all types of medical issues. About 800,000 doctors and 6,000 hospitals are included in the network, so out-of-state coverage can be utilized. NOTE: Even though a deductible applies to many services, the discount can be substantial, especially for large inpatient hospital expenses and surgeries.
For example, the cost of a typical lab test might reduce from $125 to $25, and the cost of an MRI might reduce from $1,500 to $900. For major in-hospital surgeries, the negotiated savings can often exceed $10,000. Urgent Care visits along with outpatient procedures also receive a discount. If extensive treatment is needed because of a chronic condition, a Marketplace plan with no maximum benefit, will always be available effective January 1. Maximum benefit periods of three months per policy became effective to discourage applicants from replacing Obamacare plans. However, these restrictions were relaxed and eliminated, creating new hybrid plans designed to compete with Exchange contracts.
What About Dental Coverage?
Dental plans can be purchased separately, but are not part of standard policy. However, these specific benefits can be purchased at any time, regardless if you have been previously covered. UnitedHealthcare, Humana, Aetna, and Delta Dental offer very competitively-priced plans in most areas of Indiana. You can choose different carriers for your dental and healthcare needs. Jaw injuries sustained from accidents or injury often should be submitted through a healthcare plan. Also, cosmetic surgeries are typically excluded from both group and private plans.
Although dental plans are not expensive (approximately $9-$32 per month, per person), 100% coverage is typically not available for major services, such as bridgework, tooth implants, dentures, orthodontic treatment, and wisdom teeth removal. However, basic services, such as fillings, extractions, and periodontal scaling are covered at 70%-100%. “Discount” plans are also offered and typically must be paid annually. The typical cost is $100-$180 per year.
However, a discount plan does not provide comprehensive benefits, and should not be selected when employer-group options are offered. Network dentists may require payment immediately following the completion of services. Billing is usually annually instead of monthly, and premiums tend to steadily increase.
Vision policies are not commonly offered and tend to have limited capped benefits. Monthly rates are generally between $10 and $20. Your annual eye exam and a single pair of glasses are always covered with little out-of-pocket expense. Additional pairs of glasses or non-preventative exams may not be fully covered. Many employers provide a limited vision plan that discounts basic services. Upon separation from the company, benefits usually do not continue. Many carriers (including Aetna) provide a negotiated network discount from your healthcare plan when visiting an optometrist.Coverage for glasses and frames may be provided every 12 or 24 months.
Short-Term Medical Plan Pricing
To simplify the rate calculation, we considered a 40-year-old male that resides in South Bend. The quoted plan is UnitedHealthcare’s short-term “Value Select A” plan which features $2 million of coverage for comprehensive major medical benefits. The most popular deductibles and corresponding monthly premiums are listed below:
$82 – $10,000 deductible
$101 – $5,000 deductible
$127 – $2,500 deductible
$195 – $1,000 deductible
Family prices (40-year-old parents with one child) are listed below:
$168 – $10,000 deductible
$207 – $5,000 deductible
$259 – $2,500 deductible
$398 – $1,000 deductible
An instant Indiana short-term health insurance quote is available. If you decide to apply for a policy, there are only five medical questions and you can obtain coverage the next day. We also represent additional carriers for temporary-need situations. All companies are licensed and registered with the Indiana Department Of Insurance. Additional available riders can provide benefits for dental, vision and critical illness. Upgraded office visit and prescription coverage can also be added. Depending upon the carrier, up to 12 months of guaranteed coverage is available, with the possibility of 36 months, depending upon future legislation. If a major change in health occurs, a guaranteed Exchange plan should be considered.
Special Enrollment Period
If you need comprehensive coverage, you may be eligible for a “qualifying event,” which allows you to purchase a policy through the “guaranteed approval” provision of the Marketplace. These “events” trigger situations (exceptions) regardless of the time of the year. You will be eligible for a federal subsidy and can not be declined for medical underwriting reasons. Some of the most likely exceptions are listed below:
Loss of minimum essential benefits (required by ACA legislation)
Birth of a child
Adoption of a child
New custody or guardianship of a child
Expiration of existing policy
Move to a different service area
Loss of eligibility for qualified benefits
Dependent reaches age 26 on parent’s policy
If you’re not certain if you qualify for a Marketplace exception, contact us and we’ll quickly determine your eligibility and provide a customized list of plans that best meet your specific budget and healthcare needs. There is a 60-day enrollment window that begins after the event occurs. If you miss or go beyond this window, you can apply for temporary benefits. You will not receive an instant tax credit to help reduce your premium, but the federal individual mandate penalty no longer applies.
Go Without Coverage
Although this is an option, we don’t recommend staying uninsured for any length of time. The risk of injury or illness may be minor, but one fairly significant major medical claim could impact your health and financial future for the rest of your life. Certainly, you won’t pay a premium while you are without benefits, but with several low-cost options currently offered, there is no reason to take a chance.
Previously, there was also a tax (Shared Responsibility Payment) that was imposed if you did not secure a policy that met the legislation requirements. By not having “minimum essential benefits, the annual tax was $695 per adult and $347.50 per child (under 18). However, if 2.5% of your household income was higher, then you would pay the higher amount. Beginning in 2019, the tax penalty was eliminated, so uninsured individuals and families no longer are forced to pay for an expensive plan they can not afford.
This tax had increased every year. In past years, the higher amount was based on the rate of inflation. Thus, if your household income was $50,000, your potential tax could be as much as $1,250. NOTE: Don’t forget to file IRS Form 1095-A if at any time throughout the year you received a subsidy. You could receive money back if you over-estimated your income. Often, changes in household income throughout the year will result in an increase or decrease of your eligible subsidy. You should also adjust the amount of your financial aid throughout the year, if your household income changes.
If you missed Open Enrollment, there are still many low-cost Indiana health insurance options that will get you to the next OE period. It only takes a few moments to find and compare the least expensive options that provide the benefits you need.
Open Enrollment ends in 10 days. After this date, an SEP will be needed to purchase a subsidized plan. However, as we previously discuss, many other alternatives are offered and can provide coverage for up to 12 additional months.
It’s not over! For some persons, that is. If you experienced a computer glitch that resulted in a long delay while you were attempting to enroll (before the 16th), you have until the 22nd to complete the application. This extension also applies to persons that were waiting for income verification, and the delay resulted in missing the original February 15th deadline.
The IRS reported an outage on the 14th that caused many Hoosier residents to miss the deadline because the correct subsidy could not be calculated. To receive the extension, you can not already be covered on an Exchange plan and must give verbal verification of the delays you encountered.
Policy ID cards and benefit brochures have been sent by carriers if you signed up for a 2015 plan. Although billing is often delayed, for March 1 effective dates, payments should have been received. If you are uncertain if a policy is in effect, please contact us. Usually, billing is monthly, either through an electronic withdraw or directly through the mail.
If you did not purchase coverage for 2014, and also have not enrolled in a 2015 plan, the deadline of April 30 expires in less than two weeks. This extended grace period allows you to enroll in a plan as long as you pay the penalty from last year for not purchasing qualified coverage. Typically, you pay that tax when you file your tax return.
Medicare Open Enrollment for Seniors began on October 15th and continues through December 7th. Existing plans and drug coverage can be changed (or kept) during this time. Hoosier residents under age 65 are not impacted by this OE period. If you received a notice from your carrier that your policy benefits are changing (Annual Notice Of Change Form – ANOC), a review and comparison of plan options should be completed.
Typically, this is the only time of the year that a Medicare Part D or Medicare Advantage plan can be chosen. However, if you are currently enrolled in an Advantage plan, you may opt to change to traditional government-provided coverage.
President Trump’s healthcare initiatives have been temporarily halted, as Congress failed to agree on an Obamacare replacement. An alternative proposal, with improved bi-partisan support, will most likely be introduces within 12-18 months.