Health care reform in Indiana continues. The “Affordable Care Act,” also known as “Obamacare” is helping many Hoosier consumers with their medical insurance benefits. But the legislation, now nine years old, remains very controversial. Although it helps many residents find affordable (and sometimes free) healthcare, for others, it means losing existing coverage that is replaced by plans that cost thousands of dollars more.
Highlights of ACA
One of the key components of the Affordable Care Act legislation was the removal of waiting periods and deductibles from approved preventive services. Along with annual physicals, well-child visits, and mammograms, other covered benefits include adult blood pressure and cholesterol screening, depression and Type 2 diabetes screening, immunizations, and many other items. Regardless of the impact of future ACA changes, this part of the legislation will undoubtedly remain.
Other changes already implemented include the elimination of lifetime caps on paid covered benefits, termination of “state high risk pools” and eliminating the practice of rescinding policies. Children can stay on their parent’s policy until age 26 (subject to certain restrictions) and a policy can not be terminated because you submitted too many claims. All transitions are very consumer-friendly and have only nominal impact on premiums (assuming a significant amount of healthy young persons enroll).
The “risk pools” were a helpful alternative for applicants that had been declined for coverage multiple times. In previous years, regardless of medical issues and treatment, if you were previously uninsured for six months or longer, there was a good chance you were going to be accepted. Rates were competitive, and the program was ideal for providing quick benefits for major medical expenses such as cancer or heart disease.
But the program was no longer needed with the passage of Obamacare. Now, whether you are considered a “preferred” risk or a “high” risk, the rate is identical. Although your nicotine usage will impact the price you pay, no other medical information is ever asked. You also will never be asked to reveal your height and weight for any Marketplace-based coverage.
Upcoming medical treatment and prior coverage does not impact pricing.
NOTE: Your household income determines your eligibility for a federal subsidy, and the amount. Tax form 1095-A is provided by your insurer at the end of the year. It states the amount of subsidy you received. If your actual income is different than your original projected income from the beginning of the year, a higher refund, or extra tax could be added.
You also can raise or lower the subsidy amount at any time throughout the year. For example, if your household income unexpectedly increases or decreases, the monthly subsidy can be raised or lowered. However, the plan can not be changed, unless you qualify for an approved qualifying live event. If you become eligible for Medicare or Medicaid, the Marketplace plan should be terminated.
The Indiana Marketplace
The Exchange (also known as a “Marketplace”), issues policies for persons that are eligible for financial subsidies. Our website shows your prices that have been reduced by the subsidy, and helps you enroll for coverage during Open Enrollment. You may also select a qualified “off-Exchange” plan, which is not impacted by a federal subsidy.
Pre-existing conditions are still covered, and many major carriers offer this option. Because of the lack of subsidy-eligibility, only upper-income households should consider these options. Off-Exchange plans also may not offer free 100% preventative benefits, and office visits and prescriptions may have to meet a deductible.
If you miss the Open Enrollment period, we review other affordable options, although some contracts may be underwritten. An “SEP” (Special Enrollment Period) exception is later discussed. These situations may allow you to qualify for any available qualified medical plan, subject to specific requirements. Although your calendar year will be shorter, the annual deductible still must be met before December 31st for any applicable benefits.
Some of the non-SEP options include policies that only provide up to 12 months of coverage, and feature limitations on length of hospital visits, along with caps on daily inpatient and outpatient expenses. Although benefits are limited, they are a viable option to consider after Open Enrollment has ended. Office visit and limited prescription drug benefits can be added, along with copays for Urgent Care visits.
“Limited Benefit” options offer fixed-coverage amounts on major medical procedures, along with basic office visit and prescription benefits. Although available at any time of the year, they are most suitable for individuals or families that have no serious medical issues and prefer to pay a low rate without maternity or mental-illness coverage.
We do not endorse or offer these types of plans. They also often require a large enrollment fee to be paid in addition to the initial premium. The enrollment fee is typically non-refundable. “Scheduled limitations” often place a maximum benefit on surgery and daily hospital expenses.
Special Enrollment In Indiana After Deadline Expires
After December 15th, applicants can continue to receive Marketplace plans and subsidies by qualifying for a “special event.” For example, if you deliver a child, divorce, become ineligible for Medicaid or your dependent reaches age 26, a new policy can be written as if it was during the regular enrollment period. Losing your current job (with qualified benefits) or being notified that a plan will not be renewed are two additional covered situations. Another common situation is moving from another state to Indiana.
The tax for not complying (owning a health insurance plans that meets ACA mandates) was a maximum of 2.5% of family income. Thus, if your income was $80,000 per year, you had to pay a $2,000 tax unless you were properly covered. $25,000 of household income resulted in a $625 tax. However, the tax penalty has been eliminated, and non-Obamacare plans have become more popular. Therefore, although remaining uninsured is not financially wise, it also is not illegal.
This special tax was pro-rated, so if you were able to obtain coverage at some point throughout the year, you were only penalized for the months you were not covered. Often, purchasing a non-compliant plan and paying the penalty, was cheaper than buying an unsubsidized plan. However, an illness or injury that required expensive non-generic medication, often resulted in substantial out-of-pocket expenses.
Obamacare And Brokers
So far, Obamacare has reduced rates for many Hoosiers and hurt others. Consumers that meet the requirements of the government subsidy, typically are helped. The Indiana Health Exchange, is utilized through our website so our customers always receive the lowest offered prices and the maximum allowable subsidy. All available plans are shown in every county.
If you work in a different state for a portion of the year, you are still eligible for coverage. Dependents can also work in a different state for a portion of the year. However, if a permanent residency changes, a new plan will have to be issued for that area.
Without the assistance of experienced licensed professionals, consumers often have to navigate themselves on an impersonal government website. Site delays, glitches and lost information are often experienced on the .gov domain. We understand that frustration, which is one of the reasons we choose the quickest and most user-friendly methods to help you buy a policy – Our Website!
Live help is always available, and policy rates are updated daily. When new plans become available, almost instantaneously, you can review benefits and rates, and apply for coverage.
That’s also why we always remind our customers to allow us to handle the enrollment process for you. You’ll receive accurate advice regarding determining your maximum allowable subsidy, comparing the best available options, and properly enrolling in a plan that is best suited to pay the expenses you are most likely to incur over the next 12-24 months. There are no fees or charges.
Easily Compare And Enroll Through Our Website
The Department of Health and Human Services (HHS) agrees that brokers must play a vital role in helping consumers with the “Exchange.” Plan details and tax credits are two topics that need professional and immediate help. Discussing and comparing how policies pay pre-existing condition expenses are also critical. Our website guides you every step of the way with either live or online help. The choice is yours.
Our services continue after you have enrolled in a plan. For example, income verification may be requested, which requires several documents to be provided. We simplify the process and offer free downloading and transfer of required information. Proof of citizenship may also be required in rare situations. Complete descriptions (in a pdf file) of all plans are available. Price comparisons with other policies are also offered.
The submission of claims is always another area where we can help. Understanding your benefits, and learning how claims are filed and paid, allows you to properly manage your family healthcare, so that you are utilizing all of the free and low-cost features of your policy. Balanced billing issues may require unanticipated out-of-pocket expenses to be paid. If this occurs, we will help find a solution. Often, this occurs with a visit to the ER.
Lowering the out-of-pocket cost for the medications you take, is also vital. We search and review all plans to determine which specific policies minimize the cost of your medications. For example, if you are currently taking a common medication, such as Nexium, Lipitor, or Plavix, minimizing your copay and eliminating a deductible could save hundreds of dollars each year. Private plans often greatly vary when comparing policy copays and deductibles (and formulary lists).
Navigators – Not The Best Choice
Inexperienced temporary employees (navigators) provide limited assistance, and lack fundamental training to warrant the millions of dollars spent on their behalf. And the report of convicted felons acting as navigators was especially disturbing, considering they have access to your financial information. For those reasons, we never hire or employ this type of worker. Funding for this program has been decreased.
However, we welcome any legislation that is passed that substantially increases the amount of training that navigators must complete and requires state licensing with annual compliance and review. We do not anticipate that these changes will occur. However, their services are rarely needed, unless you don’t have access to reliable websites or experienced brokers. Often, in rural areas, navigators are popular.
Healthcare reform in Indiana continues to evolve. However, despite all of the positive changes, and increases in affordability and accessibility for many persons, the cost you pay for your coverage is what determines its success. Progress has been made, but many additional changes are still needed.
Value Of Experienced Brokers
Although there are a few government websites that offer medical coverage information, the vast majority of consumers prefer to work with experienced licensed brokers that are unbiased and work with Indiana medical plans on a regular basis. And yes…that’s us!
We don’t just review plans and show you the most competitive prices. We walk you through the application or enrollment process and continue to provide free service for the lifetime of the policy. Whether you have an unpaid claim or a billing inquiry issue, we will always assist you.
Our website continues to provide consumers with current rates from the major insurance companies in the state, which include Anthem Blue Cross, UnitedHealthcare, Humana, Ambetter, and CareSource. Until fairly recently, Cigna, Medical Mutual and Aetna offered competitive plan options, but these carriers have ceased writing individual business in the state. It’s always possible that additional companies might follow.
Please feel free to check this page on a regular basis for updates to Indiana health reform issues. The “Affordable Care Act” is constantly changing with new updates, exceptions and rule interpretations.
Updates From The Past:
We finally have a date! March 26-28 is when the Supreme Court will meet and listen to testimony regarding the legality of Obamacare. So far, 26 states have joined together to overturn part or all of the legislation. An official determination will probably be made by the Court in June.
The Supreme Court ruling on the federal mandate requiring consumers to purchase health insurance is being discussed and determined. A decision should be announced within 45 days.
Still no news, but the decision is getting closer!
The mandate was upheld so the government can (and will) impose a tax on any person that does not buy qualified health insurance. We don’t expect this to change regardless of which candidate wins the election in less than two weeks.
Health Exchange rates in Indiana are now available on our website. You can request a free quote on any of the pages. Open Enrollment for single or multiple-person policies has begun. You can no longer be denied for coverage when you apply! There are four tiers (Metal plans) of coverage that can be purchased. And of course, the federal administration is offering large subsidies that will reduce your cost.
As Open Enrollment winds down (16 more days), there’s still time to qualify for a federal subsidy. However, if you miss the deadline there are many exceptions that provide a special 60-day window for you. Also, short-term temporary coverage can be purchased for as long as 12 months to cover a gap in benefits. These plans, however, are not as comprehensive as ACA-approved options.
A special 14-day extension was granted to any person that attempts to purchase a Marketplace plan but can not complete the process. Because it is on the “honor system,” no proof is needed. We do not anticipate any additional extensions. But that’s what we said last time!
UnitedHealthcare chose not to participate in the Indiana Exchange. But what about future years? UHC officials have indicated they will be participating in more Marketplaces next year. Will the Hoosier state be on their list? We should know within the next few months. If they choose to offer policies to consumers that are eligible for subsidies, additional competitive plan options will suddenly become available.