Indiana's Uninsured: Affording Coverage

Indiana offers a variety of health insurance options for its residents, including private insurance companies, Medicare, and Medicaid. For those who cannot afford health insurance, Indiana has several options. The Healthy Indiana Plan (HIP) is a health insurance program for adults aged 19 to 64 with income levels up to $20,121 in 2023. It provides comprehensive benefits like vision, dental, and chiropractic services at low monthly costs, with members paying what they can afford based on their income. Indiana also expanded Medicaid under the Affordable Care Act (ACA), making it available to more low-income adults. Additionally, individuals may be eligible for subsidies or tax credits to help cover the cost of health insurance.

Indiana's Medicaid expansion

In January 2015, Indiana received approval from the Centers for Medicare and Medicaid Services (CMS) for its amended Healthy Indiana Plan, known as HIP 2.0. This expansion of Medicaid eligibility included non-elderly, non-disabled adults, but with state-specific variations from the standard expansion outlined by the Affordable Care Act (ACA). Indiana began accepting applications for Medicaid under HIP 2.0 in late January 2015, with coverage beginning as early as February 1, 2015.

HIP 2.0 removed Healthy Indiana's enrollment caps, opened the program to those making less than 138% of the federal poverty level, and introduced cost-sharing requirements (premiums and copayments) for many enrollees. Enrollees in HIP 2.0 can pay premiums to receive more generous benefits, called HIP Plus. The premiums are as low as one dollar per month for people with an income under 22% of the federal poverty level and are in the form of contributions to a "Personal Wellness and Responsibility" (POWER) health savings account.

For enrollees with incomes between 101% and 138% of the federal poverty level, premiums are required to enroll in HIP 2.0, although they're capped at 2% of income. For those who don't pay premiums, there is a lesser benefit package called HIP Basic, which doesn't require premiums but also doesn't include some benefits like adult dental and vision coverage. Enrollees in HIP Basic have to pay copays for services.

The implementation of Indiana's Medicaid expansion program occurred during the Trump administration, when Mike Pence, who was then governor of Indiana, and Seema Verma, who directed CMS, played key roles. This expansion has contributed to a notable increase in the number of Indianans covered by Medicaid and the Children's Health Insurance Program (CHIP).

The Healthy Indiana Plan

Sick people in Indiana can afford insurance through the Healthy Indiana Plan (HIP), a health insurance program for qualified adults. The plan is offered by the State of Indiana and pays for medical costs for members, including vision and dental coverage. It also rewards members for taking better care of their health.

The HIP uses a consumer-driven approach, where the first $2,500 of medical expenses for covered services are paid with a special savings account called a Personal Wellness and Responsibility (POWER) Account. The state pays most of this amount, but HIP Plus or HIP State Plan Plus members are responsible for paying a portion. After the $2,500 in the POWER Account has been spent, the insurer will begin paying for the member's healthcare.

HIP Plus is the best-value plan, including dental, vision, and chiropractic services, with no copayments except for non-emergency use of the emergency room. To enrol in HIP Plus, eligible individuals must make a monthly contribution to their POWER Account to help cover initial health expenses. On the other hand, HIP Basic does not cover dental, vision, or chiropractic services and charges a copayment for each service received.

Hoosier Healthwise

• Package A - This is a full-service plan for children and pregnant individuals. Members do not have any cost-sharing obligations.
• Package C - This is a full-service plan for children enrolled in the Children's Health Insurance Program (CHIP). There is a small monthly premium payment and a co-pay for some services based on family income. CHIP provides low-cost comprehensive health coverage for children and, sometimes, pregnant women, for families that earn too much money to qualify for Medicaid.

To be eligible for Hoosier Healthwise, you must be a resident of Indiana and meet the following criteria:

• Either be 18 years of age or younger or a pregnant woman
• Be a U.S. Citizen, National, or a Non-Citizen legally admitted to the U.S.
• Have an annual household income (before taxes) that is below the maximum income level (varies depending on household size)

The application process for Indiana health coverage programs can take approximately 45-90 days. Eligibility for any Indiana health coverage program will typically need to be renewed each year.

Short-term health insurance

In Indiana, short-term health insurance plans are governed by both state and federal laws. The state has implemented regulations related to consumer protection, such as guaranteed renewal of policies and coverage for pre-existing conditions. Additionally, Indiana has expanded Medicaid under the ACA, providing coverage to low-income adults who meet specific income criteria.

When considering a short-term health insurance plan in Indiana, it is important to review the plan's details, including coverage limits, exclusions, and out-of-pocket costs, to ensure it meets your specific needs and budget. While short-term insurance can provide a cost-effective solution for temporary coverage, it may not offer the same comprehensive benefits as long-term plans.

• Between jobs: If you're transitioning between jobs and don't have access to employer-sponsored coverage, short-term insurance can provide a temporary solution.
• Waiting for ACA Coverage: If you've enrolled in an ACA plan during the Open Enrollment Period but need immediate coverage, short-term insurance can fill the gap.
• Missed Open Enrollment: If you missed the Open Enrollment Period for ACA plans and don't qualify for Special Enrollment, short-term insurance can offer coverage until the next Open Enrollment Period.
• Early retirees: Individuals who retire before becoming eligible for Medicare at 65, or those who aren't eligible for Medicaid, may use short-term insurance as a bridge until they can enroll in Medicare.
• Temporary residents: Short-term insurance can be suitable for individuals temporarily residing in Indiana, such as students or seasonal workers.

Premium tax credits

Sick people in Indiana can afford insurance through a combination of premium tax credits, subsidies, and other financial assistance programs. Premium tax credits are a form of financial assistance from the government that helps reduce your monthly premium payments. The amount of the premium tax credit is based on household income compared to Federal Poverty Levels (FPL). The FPL is the minimum income a family requires for basic needs like food or shelter and is decided by the government. Individuals with incomes up to $20,121 in 2023 may qualify for coverage under the Healthy Indiana Plan (HIP), which offers comprehensive benefits like vision, dental, and chiropractic services for low monthly costs.

In Indiana, nearly nine out of ten exchange enrollees were eligible for premium subsidies on 2023 plans, with an average monthly savings of about $455. Cost-sharing reductions (CSR) are also available to help lower deductibles and out-of-pocket costs. CSR benefits are automatically built into Silver-level plans for those with incomes up to 250% of the federal poverty level. Additionally, Indiana expanded its Medicaid program under the Affordable Care Act (ACA), providing coverage for more low-income adults.

To be eligible for premium tax credits, individuals must meet certain criteria, including income, household size, age, financial resources, and medical needs. Indiana offers several health coverage options for qualified low-income individuals, individuals with disabilities, and the elderly with limited financial resources. Each program uses a different set of measures to determine eligibility and is designed to meet the specific medical needs of that group.

It's important to note that the open enrollment period in Indiana, during which residents can sign up for a new ACA health insurance plan, typically runs from November 1 to January 15. However, individuals who miss the open enrollment period may still be able to purchase a short-term plan or qualify for a special enrollment period if they experience a qualifying life event.

Frequently asked questions