Indiana Marketplace health insurance plans offer a substantial federal tax subsidy to many Hoosier residents. Individuals, families, and persons that are self-employed are eligible. Policy rates can reduce by thousands of dollars, and often the premium is completely eliminated. Silver-tier plans can take advantage of “cost-sharing,” and substantially reduce deductibles and out-of-pocket expenses.
The subsidy is designed to help pay for persons that can not find affordable healthcare in Indiana, either through a plan at work or through a private carrier. The mandate from the Department of Health and Human Resources requiring the purchase of coverage is no longer in effect. Therefore, not obtaining a qualified Exchange plan will not result in a tax penalty.
Indiana, like most states, has expanded Medicaid eligibility. The “Healthy Indiana Plan” (HIP) provides coverage for adults ages 19-64 with income up to 138% of the Federal Poverty Level (FPL). The most recent limits are shown below. If your single or family household income falls within these ranges, you can still purchase guaranteed Marketplace coverage although the subsidy will be impacted.
$17,460 – 1 person
$23,628 – 2 persons
$29,808 – 3 persons
$35,964 – 4 persons
$42,144 – 5 persons
$48,312 – 6 persons
$54,492 – 7 persons
$60,060 – 8 persons
$12,492 – 1 person
$16,920 – 2 persons
$21,336 – 3 persons
$25,752 – 4 persons
$30,180 – 5 persons
$34,596 – 6 persons
$39,012 – 7 persons
$43,440 – 8 persons
How Much Is Your Subsidy?
The assistance is in the form of instant tax credits that reduce your premiums. An added bonus is the lowering of out-of-pocket costs for deductibles and copays on Silver-tier plans if you qualify for the 100%-250% level. We can help you select an option that costs very little, or another choice that costs more, but has lower expenses that you potentially might have to pay.
If you are earning just 133% of the FPL, you are only required to contribute 2% of your income towards healthcare. The balance will be provided as an instant tax credit. But at 400%, 9.5% of your income is required which will make a large difference. The 200% figure requires an 8.05% contribution. You can find additional Indiana Health Marketplace pricing on our website with free online quotes. You are not required to accept a subsidy, if you qualify to receive this financial aid. Several available non-compliant plans are offered, that may have a lower premium (and less benefits).
There are four levels of coverage. They are Bronze, Silver, Gold and Platinum. The design of these policies was to provide coverage for specified percentages of anticipated medical expenses for the average single person or family. In order, these percentages are 60%, 70%, 80%, and 90%. Currently, there is not a 100% option, although, potentially, it could become available in certain states. Several HSA plans offer 100% coverage after the deductible is met. 50%, 80%, and 90% are other popular HSA coinsurance options.
The Bronze plan costs the least, since there is more potential exposure to high out-of-pocket costs. The Platinum option is the costliest since it is expected to pay the most expenses. The Silver plan is used in determining the amount of federal tax credit the consumer will ultimately receive. This is regardless of which of the four types of policies you select. Note: Many carriers do not offer Platinum or Catastrophic plans. Bronze and Silver-tier options are typically the most popular plans.
Silver-tier policies are also the only option with a “cost-sharing” feature, which lowers your deductible and copay, if your household income is no more than 250% of the Federal Income Level (FPL). Thus, low and moderate-income individuals and families can save thousands of dollars when filing a large hospital claim. Typically, the average office visit copay reduces to $0-$10 and the deductible to $0-$500 when maximum (94%) cost-sharing is utilized. Often, the monthly premium is between $0 and $100.
But you can never receive a credit that actually exceeds the cost of your coverage. Thus, if the calculated premium is $400 per month, and your subsidy is $450 per month, you will simply pay no premium, and you will not receive the extra $50 per month. Indiana has a limited number of available plans in all tiers compared to other states. NOTE: If you are a Native American, you may qualify for a zero cost-sharing plan, which results in no extra out-of-pocket expenses. A special application may be required.
Inexpensive Catastrophic Options
Persons under the age of 30 (since they tend to be the healthiest), can purchase catastrophic policies that are often lower in cost, although they will have more potential for larger out-of-pocket risk. These contracts are very popular with healthy persons that were previously uninsured. However, since they are not eligible for the Obamacare subsidy, “catastrophic” options should not be considered for lower-income situations. They are generally popular with young healthy adults. Applicants that meet “financial hardship” guidelines can purchase this plan regardless of age.
Often, carriers offer compliant policies that are not directly sold through the Exchanges (Off-Exchange). Brokers (including our own website) offer coverage and easy-enrollment applications to Hoosier residents. Prices of policies and the size of the provider networks are nearly identical to Marketplace policies. Since there is no subsidy paid, these options are especially attractive to households with income above $95,000 (single persons with income above $50,000).
Currently, there are no Catastrophic Exchange plans offered in Indiana. Ambetter and CareSource are the only available carrier providing qualified options. By 2021 or 2022, if additional companies are approved by the DOI, it’s possible that a Catastrophic policy will become available.
Health Savings Accounts (HSAs) rates in Indiana continue to be a popular option for persons over the age of 30 that wish to keep premiums at a manageable level, and also receive some tax help for additional contributions. There is still a cap to the amount of money that can be deposited into these types of contracts. And your carrier continues to negotiate pricing discounts for you.
If you have an existing HSA policy, you can keep it, or shop for a different plan option. Current available HSA plans include CareSource Marketplace HSA Eligible Bronze and Ambetter Essential Care 2 HSA.
HIP 2.0 is Indiana’s expanded Medicaid program. Comprehensive medical benefits are provided along with dental and vision coverage for qualified applicants. (Federal subsidies are not available to any individual or family receiving Medicaid benefits). You may be eligible for HIP 2.0 if you are between the ages of 19 and 64. An individual must earn less than $16,436.81 and a couple must earn less than $22,246.25 (per year) to receive benefits. Once an individual or family is no longer can qualify, a Marketplace subsidy may be offered. Medicare benefits may also be available for Seniors that have reached age 65.