Get the cheapest major medical insurance in Indiana from top-rated insurers. Protect yourself against large hospital and emergency room expenses, and still have preventive and office visit copay benefits at a price you can afford. You can choose from several deductible and maximum out-of-pocket expense options that keep premiums low. Unexpected sickness, injuries, and other expenses are typically covered under these types of plans. Qualified Exchange plans feature 100% coverage for preventative expenses with no out-of-pocket costs.
Indiana catastrophic medical coverage is the least expensive type of benefit available for individuals, self-employed persons, small business owners, and families. Prices are often about 20%-50% lower than comprehensive plans, and many participating Hoosier carriers offer this type of policy as private individual, non-Obamacare, or group plans. However, the federal subsidy only applies to Platinum, Gold, Silver and Bronze-tier plans through the Marketplace. Benefits include QHP (Qualified Health Plans) requirements and flexible deductible choices.
“Catastrophic” Exchange plans are available for persons under age 30, and financial assistance is not provided. Typically, three primary-care physician office visits are provided with a small or $0 copay. A hardship exemption is required to apply for any applicant that has reached age 30. Often, other tiers offer more competitive options since the instant tax credit can be applied. Bronze and Silver-tier options often provide copays for office visits, Urgent Care visits, and many prescriptions. These types of medical plans that meet the requirements of a QHP, and only provide the mandatory three primary care office visits (not subject to the policy deductible).
Within the next few years, it’s possible that several additional and alternative low-cost options will be introduced, with reduced premiums, and discounts for applicants with no pre-existing conditions. Previously, “hospitalization only” plans were offered by many insurers, including the popular “Saver 80” policy offered by UnitedHealthcare. Many additional benefits are now required, so only supplemental plans will offer that type of option. Additional private non-Obamacare plans may become available in 2024 or 2025.
We explain the different types of coverage and guide you through the process of selecting the policy that is ideal for your needs. It is also very easy to apply for a policy, compared to the initial Exchange process from several years ago. Application time has been reduced from about an hour to 10-15 minutes. Applying and enrolling for coverage can be completed by phone or online.The initial payment is not required at the time of the enrollment, and additional documents are rarely required. Occasionally, proof of income may be requested.
Senior high-deductible coverage is offered through Medicare Supplement coverage Plan F (HD) and Plan G (HD). The current deductible is $2,700, which increased slightly from last year. These plans are the least expensive of all Supplement options. Once the deductible is met, your coverage matches a Part F plan without out-of-pocket expenses. Many Hoosier carriers offer these plans, including Aetna, Humana, Cigna, United World Life, Medico, and Great Southern Life. Note: Plan G (HD) is available for current and new enrollees.
Marketplace (Exchange) policies are available during Open Enrollment (begins November 1), and are also offered throughout the year during “special enrollment periods.” The four Metal tiers are Platinum, Gold, Silver and Bronze. A “catastrophic” tier of policies is offered to anyone under age 30. You may also qualify if you meet specific financial hardship guidelines (more information regarding eligibility is below). Bronze-tier plans are often more cost-effective, since rates may be lower, and maximum out-of-pocket expenses are also sometimes less. But the most important difference is that Bronze-tier plans are eligible for large federal subsidies that can reduce the premium to $0.
If Medicare or Medicaid-eligible, the subsidies are not offered. Senior OE periods begin October 15th and end December 7th. However, applicants that become eligible for Medicare have a specific period of time to enroll in a Supplement or Advantage plan, along with Part D prescription drug coverage.
CareSource, Anthem, and Ambetter feature quality low-cost plans (under age-65) that are easy on your budget, provide great value, but still provide outstanding large-claim and preventive benefits. US Health And Life began offering private plans last year. UnitedHealthcare, Aetna, and Medical Mutual no longer sell private plans in the state. However, Aetna and UnitedHealthcare could possibly return, if additional or revised legislation is approved and implemented.Cigna began offering plans in 2023.
Allstate, Anthem Blue Cross, UnitedHealthcare, and several additional carriers offer high-deductible temporary plans. 360 consecutive days (or longer) of short-term coverage is typically available. These plans are available at any time throughout the year, and although medically-underwritten, policies are often approved within 24 hours. Applications are very brief, and coverage for most benefits begins without a waiting period. Lifetime benefits are typically capped at $1 million or $2 million.
Deductible options range from $0 (Silver-Tier cost-sharing) to $9,100, and several coinsurance choices are also available. Another advantage of this type of policy is that historically, premiums increase less rapidly for high-deductible plans compared to other policies with richer benefits. And occasionally, rates reduce, since the number of submitted claims is less than all other types of coverage. Increased federal subsidies can also help lower premiums.
Preventive expenses (routine annual physicals, OBGYN visits, Mammograms etc…) are covered at 100% and several plans offer three non-preventive physician visits are not subject to a deductible (Catastrophic-tier only). More specific details are discussed later in the article. Typically, if you have very few or no medical expenses throughout the year, this type of policy should always be considered. Your maximum out-of-pocket expenses are capped, regardless of the number of medical procedures.
Elective and cosmetic procedures and surgeries may not be fully covered, although a network-negotiated reduction may apply. Dental and vision expenses, if directly related to an illness, injury, or accident, may be covered without an ancillary policy. Otherwise, private dental and vision plans are available from major companies including UnitedHealthcare, Anthem, Cigna, Humana, and Aetna.
When purchasing a “catastrophic” policy as an Exchange or Marketplace plan through Open Enrollment, you must qualify, since benefits are designed for younger healthier applicants. This began seven years ago, when most of the ACA (Affordable Care Act) legislation went into effect. These qualifications are not needed for the four “Metal” contracts. But don’t worry…Your eligibility is not based on your health. Annual physicals are not required and medical underwriting has been eliminated.
For example, if you are under age 30, automatically, you qualify to enroll in this type of plan, regardless of your income. If you have reached your 30th birthday, a “hardship exemption” must be used. Otherwise, the cheapest available option would likely be a “Bronze” plan, that is sometimes more expensive.
Some (not all) of the most common “hardship exemptions” are:
Death of a family member
You are homeless
Bankruptcy within the last six months
Unpaid medical expenses within the last two years
Natural disaster (flood, fire, earthquake etc…) impacted your property
Caring for sick, disabled or older family member created unanticipated financial hardship
Eviction or foreclosure
Current policy was terminated, and all other Exchange options are too expensive
Received shut-off notice from utility company
Grandfathered plan is no longer offered
Unexpected increases in living expenses due to providing care for an ill, disabled, or older member of the family
Major Medical Pans With 100% Preventive Benefits
Currently, there are no statewide Marketplace catastrophic options offered. The only catastrophic plan offered in Indiana four years ago (On-Exchange) was the Anthem Catastrophic Pathway X 7150. Previously, the Marquee Catastrophic 6850 was available through Physicians Health Plan of Northern Indiana. However, PHP no longer underwrites private coverage in the Hoosier State. Currently, the cheapest available Bronze-tier plans offered are CareSource Marketplace Bronze, Caresource Marketplace Bronze First, Ascension Personalized Care Balanced Bronze 1, and Ascension Personalized Care Balanced Bronze 2.
The Anthem plan also featured 0% coinsurance but had a $40 copay on primary-care office visits. So, in situations where a family member has a flu, a cold, ear infection or another symptom, instead of paying as much as $80, $100 or more, $40 was your only out-of-pocket expense. The BCBS network was also larger with many more facilities available. Out-of-state coverage was also available.
Bronze plans are also typically inexpensive and are considered subsidized plans. Therefore, if you qualify for Obamacare financial aid, Bronze contracts will likely cost less than every other option. The plan deductibles typically range from $5,400 to $9,100 and maximum out-of-pocket expenses range from $6,900 to $9,100. ER visits are subject to the deductible and possibly coinsurance and an additional copay.
The Cigna Simple Choice 9100 plan is often the least-expensive available policy. The plan has a $9,100 deductible and non-preventative benefits are subject to the deductible. Cigna also offers an additional inexpensive option – Cigna Simple Choice 7500. Office visit copays are $50 and $100, with a $75 copay for Urgent Care visits. The generic drug copays are $25 and $75 (mail order).
Our website makes it easy for you to shop for the best deals and apply online for a policy. We represent all major companies and provide the lowest filed published rates by each carrier. Very quickly, you can pick the best plans, compare benefits and prices, and purchase coverage. You can apply online or have an application faxed, emailed or mailed to you. There are never any fees and we will continue to provide support after your policy is approved.
If you forgot to apply for coverage during Open Enrollment, additional low-cost policies can be purchased at any time throughout the year. The most common (and perhaps the least expensive) plan is a “temporary” contract that allows you to pay for coverage monthly, and cancel at any time. Larger claims are well-covered, but smaller expenses are generally subject to a deductible.Qualified preventative benefits are covered, but generally, only a network discount will apply.
If you have a short-term gap to cover you until the following Open Enrollment, this type of policy is quite suitable. However, it is important to understand that temporary policies do not contain many of the “essential health benefits” (such as maternity) that are required on Exchange plans. However, Aetna and UnitedHealthcare PPO networks are available, providing large network coverage in most areas. Provider discounts are often substantial, and can easily reduce large medical bills by thousands of dollars.
What Items Are Covered?
Catastrophic (not short-term) policies typically cover major items, such as inpatient and outpatient hospital expenses, emergency room charges, facility fees, additional fees charged by doctors, surgeons and nurses, anesthesia, and many other expenses associated with a hospital stay. Office visits and outpatient prescriptions are often not covered without a copay or deductible, although previous medical reform changes (Obamacare) now require these types of policies to include preventive benefits.
This includes many required expenses for children and adults, including annual physicals and well check visits. Many diagnostic tests and screenings fall under the “preventive” umbrella, resulting in no out-of-pocket expense. For persons over the age of 50, many additional procedures including blood pressure, cholesterol, colorectal cancer and diabetes screenings are included at no cost. Network-provided and negotiated discounts offer savings on more expensive procedures, including MRIs and PET scans.
Policies From The Past
UnitedHealthCare’s “Saver 80” plan was one of the most popular and affordable catastrophic plans in Indiana. For example, a family of three (ages 40, 40 and 8) in the Indianapolis area, prior to 2014, payed approximately $190 per month for a plan with a $5,000 deductible and $225 per month if the deductible was lowered to $2,500. Individual rates were substantially lower. These prices, of course, did not include the federal subsidy, since it was not yet available.
A $1,000 deductible was also available and a “vanishing” feature lowered the potential out of pocket expense each year (subject to policy provision). If the deductible was not met during the calendar year, it reduced. The maximum policy discount was 50% and this feature was an effective money-saver if you had a hospital claim.
A “Plan 80” option was also available that featured richer office visit and RX benefits after a deductible had been met. It was a simple concept. Once the deductible had been reached, you only paid 20% of expenses, although it changed to 0% after a small cap was reached. And although this specific plan is no longer offered, the new Marketplace options offer similar benefits with some preventive additions.
The most common type of catastrophic coverage is a “High Deductible Health Plan” (HDHP), which must be used to open an HSA. An HDHP has minimum deductibles of $1,500 for an individual and $3,000 for a family. Once the deductible is met, covered medical expenses are paid by the insurer. However, qualified preventive expenses are not subject to the deductible.
Annual out-of-pocket expenses must not exceed $7,500 for single plans and $15,000 for a family. These guidelines and limits are updated each year. Since an HSA is more popular for healthy households, the deductible is rarely met. However, accumulated savings from previous years provide funds to pay the deductible when used.
Two Senior Medicare Supplement plans are also available (Plans F and G) as a high-deductible (HD) option. Election of this option provides lower premiums, although you are required to pay for Medicare expenses up to the $2,700 deductible. Once deductible is met, there is no out-of-pocket expenses for many items, including Part A hospital deductible, hospital days 61-150, skilled nursing facility days 21-100, Part B annual deductible, and ambulance charges. Costs of Medigap policies vary, and a traditional Plan F is also offered, but has a lower deductible.
HSAs became available in 2004 and are a favorite among small business owners. We expect them to remain popular for a long period of time. When the State Marketplace opened for business six years ago, these types of policies were among the most cost-effective options and are still an Exchange-favorite. Employer-provided plans have also become increasingly popular.
Since an HDHP costs substantially less than traditional healthcare, the difference in premium can be deposited into the Health Savings Account. Money in the contract is managed and handled by you, and can be used to pay for qualified medical, dental and vision expenses on a tax-favored basis. Many low-cost HSAs are offered by Indiana insurers. When you use the quote feature on our website, you’ll be able to compare specific rates. Maximum allowed 2023 HSA deposits are $3,850 per individual, and $7,750 per family. Available HSA plans in the state are: CareSource Marketplace HSA Eligible Bronze, Ascension Personalized Care HSA Eligible Bronze, Ascension Personalized Care Balanced Silver, and Ambetter Essential Care 2.
Although it’s hard (almost impossible) to accurately predict the medical expenses you are going to incur, traditionally, catastrophic plans work best when all children in the household are at least 12 years-old and all family members rarely visit the doctor or take any prescriptions. The savings can be thousands of dollars per year which is an attractive option to consider. We will help you make the right decision by reviewing which plans best fit within your budget, but still provide the coverage you are likely to use.
Senior Medicare Catastrophic Coverage
Most Medicare Part D (Prescription Drug) plans have a “coverage gap commonly referred to as “The Donut Hole.” The coverage gap starts after you have spent $4,660 in covered drugs. Each year, the amount can increase or decrease. Seniors receiving “Extra Help” do not enter the gap. Applicants can qualify for “Extra Help” by meeting specific income and resource requirements. Assistance is provided when paying copays, coinsurance, or deductibles. For example, the limit paid on generic drugs can be $4.15, and $10.35 for covered brand-name drugs. 25% is the maximum you pay for brand-name drugs.
The drug manufacturer pays 70% of the cost and the plan pays 5%. The remaining balance is paid by the consumer. The manufacturer also pays 75% of the dispensing fee. Medicare pays for 75% of the cost of generic drugs. Note: The policy premium is not counted towards the coverage gap. Out-of-pocket costs for non-covered prescriptions are also not counted. Initially, the catastrophic feature was set up to help protect persons with multiple chronic conditions and multiple prescribed drugs.
Specialty drugs are designed to help patients with complex medical conditions and typically have the highest out-of-pocket expenses. The 25% out-of-pocket cost that you pay plus the manufacturer’s 70% discount, counts towards the TrOOP. For 2023, the TrOOP (Total out-of-pocket expenses) is $7,400. Medicare Part D catastrophic coverage begins when this amount is reached.
A high deductible (HD) Plan G Medicare Supplement plan is available in all counties. Once the deductible of $2,700 has been met, benefits are provided at 100%. Coverage is identical to the standard Plan G. Sample monthly rates for a 65-year-old female residing in Lake County are shown below. Male rates are typically slightly higher.
$29 – New Era Life
$29 – United American
$35 – Medico
$38 – Mutual Of Omaha
$39 – Bankers Fidelity
$39 – Ace Property And Casualty
$39 – Humana
$40 – United States Fire
$45 – Elips Life