Anthem Blue Cross Blue Shield offers affordable health insurance plans in Indiana. During Open Enrollment, medical questions are not asked, and a large federal subsidy is available that can potentially pay a portion or all of the premium payments. We help you compare Anthem policies (when offered) and easily enroll for guaranteed benefits. OE runs from November 1st to December 15th. However, options are still available if you miss the OE deadline.
Competitive rates, experienced customer service, and coordination of benefits between providers, gives Hoosier residents several attractive BCBS options. Office visit, prescription, ER, inpatient and outpatient hospital, maternity, and mental illness benefits are included in all Group plans. Pediatric dental and vision are available to children under age 19.
Regardless if you are pregnant, have scheduled a surgery, or need to start or refill an expensive non-generic prescription, it will be covered on your policy. Since deductibles and coinsurance may apply, it’s important that we determine the options that minimize the out-of-pocket expense you pay. Sometimes, a slightly higher premium can save you thousands of dollars of medical expenses. If you are being treated for a chronic medical condition, and know you will meet your deductible, often a Silver-tier or Gold-tier plan is the best choice. Although private under-65 Marketplace plans are not available, it’s possible in 2020 they may return.
Seniors that are eligible for Medicare, can choose quality Anthem Medigap plans. Open Enrollment begins in October, although a seven-month window of enrollment is also provided when you reach age 65 and have signed up for Medicare Parts A and B. Supplement and Advantage plans help consumers pay many out-of-pocket expenses that “Original” benefits omit.
Part D prescription drug coverage is also available, although many Advantage contracts also include these benefits. Policies are issued as single plans, so married couples will have two separate policy numbers. Each spouse can choose a different carrier to better match specific medical expenses. It’s also possible that one spouse will have an Advantage Plan while the other spouse has Supplement and Part D prescription drug plans.
What Under Age-65 Individual Plans Were Previously Offered?
Below, we have listed and briefly described policy options. Although not presently available, in 2020 or 2021, Exchange plans may return to the Hoosier State. Of course, more specific information and easy 10-minute enrollment can be found through our web-direct link here. Note: This link provides instant comparison and enrollment for all current Marketplace options.
Catastrophic Pathway 7150 – $40 copay on first three primary-care physician (pcp) office visits. $7,150 deductible applies to all other expenses. Coinsurance is 0%.
Bronze Pathway 7150 – Least expensive Bronze-tier plan. $7,150 deductible with maximum out-of-pocket costs of $7,150 and 0% coinsurance. Once deductible is met, covered expenses are paid at 100%.
Bronze Pathway 5850 – $5,850 deductible with $7,150 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 drugs subject to 30% coinsurance, and Tier 3 and Tier 4 drugs subject to 40% coinsurance.
Bronze Pathway 4950 – $4,950 deductible with maximum out-of-pocket expenses of $7,150 and 40% or 50% coinsurance.
Bronze Pathway POS 5000 – $50 pcp office visit copay for first three visits, but specialist visits must meet deductible and coinsurance. Deductible is $5,000 with $7,150 maximum out-of-pocket expenses and 40% coinsurance. Coinsurance applies to all drugs.
Bronze Pathway 20% For HSA – HSA-eligible option with $5,100 deductible and $6,550 maximum out-of-pocket expenses and 20% coinsurance. Level 1 and 2 drugs are subject to 20% coinsurance while Level 3 and 4 drugs are subject to 40% coinsurance.
Bronze Pathway 6000 – $45 copay for first three pcp office visits although specialist visits must meet deductible. $6,000 deductible with $7,150 maximum out-of-pocket expenses and 30% coinsurance. Level 1 and 2 drugs are subject to 30% coinsurance while Level 3 and 4 drugs are subject to 40% coinsurance.
Bronze Pathway 6400 – $50 copay for the first two pcp office visits, and like previous plan, specialist visits must meet deductible. $6,400 deductible with $7,150 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 drugs receive $20 and $80 copays. Tier 3 and Tier 4 drugs are subject to 40% coinsurance.
Bronze Pathway 6600 – $6,600 deductible with maximum out-of-pocket expenses of $6,600 and 0% coinsurance. All non-preventative expenses must meet deductible.
Silver Pathway 1850 – $40 pcp office visit copay for first three visits only. Specialist visits must meet deductible and coinsurance. Low $1,850 deductible with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. $15 and $50 copays for Tiers 1 and 2. Tiers 3 and 4 are subject to 40% coinsurance.
Silver Pathway 2500 – $40 pcp office visit copay, but unlike previous plan, number of covered visits is unlimited. Specialist visits, however, must also meet deductible and coinsurance. $2,500 deductible with maximum out-of-pocket expenses of $7,150 and 10% coinsurance. Prescription drug benefits are identical to previous plan.
Silver Pathway For HSA – HSA-eligible plan with $2,700 deductible, $5,000 maximum out-of-pocket expenses, and 10% coinsurance.
Silver Pathway 3000 – $30 pcp office visit copay, with specialist visits subject to deductible and coinsurance. $3,000 deductible with $7,150 maximum out-of-pocket expenses and 15% coinsurance. $15 and $50 copays for Tiers 1 and 2. Tiers 3 and 4 are subject to 40% coinsurance.
Silver Pathway 4250 – $25 and $50 office visit copays with $90 copay for Urgent Care visits. $4,250 deductible with maximum out-of-pocket expenses of $5,750 and 25% coinsurance. $10 and $40 copays for Tiers 1 and 2. Tiers 3 and 4 are subject to 40% coinsurance.
Silver Core Pathway 5100 – $35 pcp office visit copay and deductible applies to specialist and Urgent Care visits. $5,100 deductible with maximum out-of-pocket expenses of $6,600 and 25% coinsurance. $10 and $40 copays for Tiers 1 and 2. Tiers 3 and 4 are subject to 40% coinsurance.
Gold Pathway 1250 – $30 pcp office visit copay and deductible applies to specialist and Urgent Care visits. $1,250 deductible with maximum out-of-pocket expenses of $6,200 and 10% coinsurance. $10 and $40 copays for Tiers 1 and 2. Tiers 3 and 4 are subject to 40% coinsurance.
The Network is used for most options, which allows for easy access to the top-rated doctors, specialists and hospitals in the area. Labs, Urgent-Care and durable medical equipment providers are also provided. For example, in the central part of the state, Community Health Network can also be found in schools and homes. It’s non-profit and has more than 200 site locations. Group Anthem plans through an employer are also available with large networks.
NOTE: Plan provider networks are often different than grandfathered plans that were previously issued. If you are forced to convert your grandfathered plan, please contact us to verify that your physicians and hospitals are still “in-network.” For expenses that are subject to a deductible, your portion of the bill is often substantially reduced (an MRI, for example) because of Anthem’s influence on negotiating better pricing. Lab tests, X-rays and many other diagnostic tests are often reduced as much as 50%-80%. However, it’s important to request the network repricing by submitting the claim even if a deductible applies to the coverage.
The statewide network includes hospitals, medical facilities, physicians, specialists, Urgent Care locations, pharmacies, skilled nursing facilities, ambulatory surgical centers, and many more treatment centers. Members can easily find local options by utilizing free online tools. For example, listed below are Indianapolis-area participating hospitals within seven miles of the city:
Midwest Specialty Surgery Center
Washington Healthcare Center
Forest Creek Village
Indiana University Health (all facilities)
Meridian South Surgery Center
Franciscan Health Mooresville
IU Methodist Hospital
Senate Street Surgical Center
Franciscan Health Indianapolis
Community Hospital South
Essential Health Benefits
“Essential Health Benefits,” which are required by the Affordable Care Act, are covered, regardless of which policy you select. These 10 coverages are:
Preventive and wellness
Emergency services including the ER
Prescriptions and drugs
Habilitative and Rehabilitative services
Substance abuse and mental health services
Maternity including care of newborn
Any policy that does not contain ALL of these benefits is considered “non-compliant” and is not eligible for a federal subsidy. All Marketplace plans described and/or quoted on our website are compliant. Therefore, pre-existing conditions are not excluded or surcharged. Catastrophic plans, although considered “compliant,” are not eligible for federal subsidies.
How Do I View My Rates?
We have made the process extremely easy for you. After you provide your zip code and answer a few questions, shortly, you will be able to view and compare prices of all of the Anthem Indiana plans. We also help you compare options with the other major carriers and simplify the enrollment. If you qualify for an Obamacare subsidy (we’ll calculate it for you), it will be directly applied to your premium. You won’t have to worry about waiting for reimbursement from the government.
If you don’t qualify for the federal subsidy, you can instantly view prices on a direct link we will provide upon request, quickly compare policies and apply in less than 10 minutes. These “off-Exchange” plans allow you to avoid a longer application process, but still retain all of the advantages of the ACA legislation. In several states, specific carriers offer off-Exchange options, but do not participate on the Marketplace.
Is It Hard To Enroll For An Anthem Plan?
Actually, the process is now much easier than when Open Enrollment began for the first time (ever) in October (2013). Here’s what we do: After reviewing and comparing policy rates, benefits and your subsidy eligibility, we pick the plan(s) that meets the budget and benefit needs that fit you best. And of course, we discuss the specifics with you, and show you what policies will cost you the least (taking into account premium, subsidy and what medical expenses you are expected to have).
Our direct online link (located earlier on this page) makes it VERY easy to compare, enroll, and get covered. The combination of updated and more modern software allows you to skip the constant glitches and delays that plagued Indiana Marketplace enrollment years ago. Changing to a different plan or Metal tier is allowed during designated times. At any time, you can review or compare other alternative plans.
More Than One Option
There are several enrollment options, depending upon which company is chosen to provide the coverage. Typically, there are a series of online questions to answer (no medical questions!) that take approximately 15 minutes. The topics covered include your subsidy eligibility, members in the household that will be insured, and of course, the specific plan you are applying for. You may be asked to estimate your 2019 earnings.
Our “step-by-step” instructions along with our live help (online or via phone) will eliminate any frustration that often accompanies this part of the enrollment. Once completed, you are assigned a unique ID number, and we can monitor and track the progress of the paperwork. Once approved, we are always available if you have concerns about coverage, claims, payments or any change that needs to be made.
One of the big advantages of utilizing our assistance is ease of application, accurate calculation of your federal financial aid package, and having the most experienced resources working in your corner. Obviously, we are aware of the help provided by “navigators.” However, we don’t feel that a few weeks of comprehensive training is a substitute for decades of experience. It’s your money, and a simple mistake can cost you thousands of dollars. Although the mandate requiring the purchase of “qualified” coverage is no longer active, utilizing the most accurate data to estimate the federal subsidy remains extremely important.
How Does The Subsidy Work?
To qualify for these premium tax credits, your household income must be between 100% and 400% of the Federal Poverty Level. Income under 100% automatically qualifies for Indiana Medicaid. Your age, county of residence, and of course, household income, determines your subsidy amount. We have listed below the estimated monthly federal subsidy you will receive in various situations. Lake County was used for these calculations.
25 year-old with $25,000 of income – $77
25 year-old with $30,000 of income – $11
35 year-old with $30,000 of income – $59
45 year-old with $35,000 of income – $36
55 year-old with $40,000 of income – $165
55 year-old with $25,000 of income – $344
63 year-old with $25,000 of income – $502
30 year old couple with $45,000 of income – $153
50 year old couple with $45,000 of income – $437
You can also view more information here. We constantly update the article to stay current.
These subsidies can pay a very large portion of your premium. For example, a household with four members (age 50 with two teens) and an income of $65,000 will receive an estimated $585 per month in aid. Thus, the cost of a $700 plan reduces to only $115. That’s a huge savings! A $75,000 income will generate a subsidy of approximately $454, and an $85,000 income will still yield a $373 per month amount. NOTE: It is important to adjust your household income (for subsidy purposes) if there has been a significant change.
You’ll often see the Federal Poverty Level referenced. This calculation, based on your income, determines the level of your financial aid. The government officially established the criteria on this website. Of course, we use this calculation to determine how much your rates will be discounted. NOTE: Each year, the amount of federal aid is re-calculated. Also, if you move from one county to another, but stay in-state, your subsidy could still change.
Don’t Gamble With Plan Selection
Let us help you pick out the policies that will pay for your medical expenses at the lowest cost to you. While you select benefits once per year, we do it dozens of times each day. You may be shocked to realize how different seemingly-similar plans can be. Although deductibles, rates, and copays must always be considered, the MOP (maximum out-of-pocket expenses) is the biggest determinant of how much you will pay for a large claim.
Can I Change To A Different Policy?
You can change policies at any time during Open Enrollment. Although a new application will need to be completed (we will handle the paperwork), you will not need to provide evidence of insurability. You also will be able to change coverages or choose a different carrier. Since your income and medical conditions may have changed, it may be appropriate to allow us to review and compare the most suitable new plans for you. In rare situations, proof of residency or citizenship or income verification may be required.
Am I Covered If I Travel Out Of State On Vacation Or On Business?
Yes, you are. Utilizing your BlueCard covers you (subject to policy limitations) anywhere in the US for an emergency room or urgent-care visit. Often, when away from home, unexpected situations can arise that require immediate treatment. This benefit will cover you any day of the week. Routine office visits may also be covered with a copay, depending on the type of policy you have and network-participation in the area you are visiting. You can request a current list of network doctors, specialists, and other medical facilities in any area of the US.
What Happens If I Am Eligible For Medicare?
If you have reached age 65, then you probably are Medicare-eligible. You would not be able to buy a Marketplace plan. However, you could purchase a Medigap (Medicare Supplement) contract that would pay Parts A and B daily expenses that are not covered. There are 10 standardized plan options and various sets of benefits are offered.
Anthem offers many affordable Medicare-Supplement (Medigap) plans in Indiana. Plans N, A, and F are offered at very attractive rates. Plan F is the most expensive option, since it includes the Part B deductible and excess charges, which are not covered by Plan N. Plan F also covers several other benefits not included in Plan A, such as the Part A deductible, skilled nursing coinsurance, Part B copayment, and foreign travel emergency treatment. Shown below are a few of the most popular policies:
Plan N – Covers Part A deductible, hospital coinsurance or copayment, Part B copayment, skilled nursing coinsurance, and foreign travel emergency. Pays first 90 days of hospitalization.
Plan A – You pay $1,260 of first 60 days of hospitalization and up to $157.50 per day for skilled nursing.
Plan F – Most expensive of three options. Similar to Plan N with Part B deductible and excess charges covered.
Plan G – Pays for most expenses (Part A deductible, hospital coinsurance and copayment, skilled nursing coinsurance, Part B copayment and excess charges). However, Part B deductible is not covered. Only Plan N is less expensive.
Anthem MediBlue Plus (HMO) is an “Advantage” plan with a $0 premium. The pcp copay is only $10 and the specialist office visit copay is only $40. The maximum out-of-pocket limit is $4,900. Urgent Care visits are subject to a low $45 payment while lab services feature only a $15 copay.
Anthem MediBlue Access – Regional PPO with a very low premium. Office visit copays of $15 and $40 with maximum out-of-pocket costs of $6,400. $45 copay for Urgent Care visits.
Anthem MediBlue Dual Advantage – Designed for persons covered under Medicaid, this HMO plan has no premiums. Primary-care physician and specialist visits have a $0 copay while the maximum in-network out-of-pocket costs limit is $6,700.
Blue MedicareRx Standard provides Part D prescription benefits at a low cost. A $405 policy deductible does not apply to preferred generic (Tier 1) or select care (Tier 6) drugs. After the total yearly out-of-pocket cost has been reached you would only pay $3.35 for generic drugs and $8.35 or 5% for all remaining drugs. Preferred retail cost-sharing (30 days) copays are $1 (Tier 1), $5 (Tier 2), $30 (Tier 3), 40% (Tier 4), 25% (Tier 5), and $0 (Tier 6). Preferred retail cost-sharing (90 days) copays are $3 (Tier 1), $15 (Tier 2), $90 (Tier 3), 40% (Tier 4), NA (Tier 5), and $0 (Tier 6).
Blue MedicareRx Plus – Similar to prior plan but more expensive since out-of-pocket costs are less. For example, there is no deductible (instead of $405). Preferred retail cost-sharing (30 days) copays are $1 (Tier 1), $3 (Tier 2), $40 (Tier 3), 39% (Tier 4), 33% (Tier 5), and $0 (Tier 6). Preferred retail cost-sharing (90 days) copays are $3 (Tier 1), $9 (Tier 2), $120 (Tier 3), 39% (Tier 4), NA (Tier 5), and $0 (Tier 6).
Blue MedicareRx Premier – Similar to prior two plans but more expensive since out-of-pocket costs are the lowest. The policy has no deductible. Preferred retail cost-sharing (30 days) copays are $1 (Tier 1), $3 (Tier 2), $28 (Tier 3), 35% (Tier 4), 33% (Tier 5), and $0 (Tier 6). Preferred retail cost-sharing (90 days) copays are $3 (Tier 1), $9 (Tier 2), $84 (Tier 3), 35% (Tier 4), NA (Tier 5), and $0 (Tier 6).
Do I Pay More For Anthem Health Insurance In Indiana By Using A Broker Website Like This One?
No. Prices are set and approved by the Department of Insurance, and rates are no different whether you are assisted by a broker or attempt to enroll yourself. And of course, there are no fees or charges. The overwhelming consensus is that consumers save more money and are matched with better coverage when assistance is provided. We “search, compare and enroll” so you can get the best available healthcare.
Why Are The Silver Plans So Popular?
First, let’s explain what the “Silver” plans are. There are four available Metal policies through the Indiana Health Insurance Exchange. They are: Platinum, Gold, Silver, and Bronze. If your income does not exceed 250% of the Federal Poverty Level, special “cost sharing” is offered on Silver plans. Potentially, you can save thousands of dollars with this feature if you have fairly-significant medical expenses throughout the year. And sometimes, a few visits to a specialist and an outpatient procedure will be enough to justify the Silver-tier options.
The standard Silver policy pays an estimated 70% of medical expenses. However, you may qualify to have up to 94% (also 73% or 87%) of expenses covered. This could substantially reduce the deductible. For example, at the maximum level, a $3,500 deductible could reduce to $150, without negatively impacting any other part of the policy. In many situations, the Silver plans should be selected instead one of the more expensive Gold options.
Information From The Past:
Anthem is terminating between 25,000 and 30,000 policies of existing members, and providing the option to change to a current Marketplace plan. These “grandfathered” plans were previously given the option of remaining active. Among the reasons for the change is the difficulty in providing the proper service for two sets of in-force policies.
Since new contracts must include 10 “essential health benefits,” (discussed earlier), premiums on the new plans will be higher…possibly as much as 25%-50%. Also, the number of available hospitals and other providers will be lower than the network that is being used by older policies. For instance, St. Vincent and Franciscan Alliance Hospitals will not be included.
The cyber-attack against Anthem may also affect existing AND past policyholders since stolen security information may include canceled and lapsed policies. Regardless, the insurer issued a statement warning persons to beware of scam emails that request you to click on a link or provide personal information.
Prices continue to be very competitive for persons under age 65 and also for Seniors eligible for Medicare. If you reach age 65 while you are currently covered under a Marketplace plan, you can easily transition to a Medigap or Advantage plan so there is no lapse in benefits. You should begin the process about 60-90 days before your 65th birthday. Our assistance is free and will save you time and frustration!
Anthem will have less competition, since UnitedHealthcare, Aetna, and Physicians Health Plan (PHP) will not be offering on-Marketplace plans. We believe increased competition helps lower rates, so we don’t view the situation as a positive development.