What’s the process for getting coverage?
You should review your plan each year to ensure it meets your health and budget needs. You should take the following steps to ensure you select the right plan option, either on or off the federal Marketplace.
- Review: Review your coverage and look for a letter from your plan about how your benefits and costs may change next year.
- Update: Starting November 1, log in to the federal Marketplace and update your 2017 application - make sure your household income and other information is up-to-date for next year.
- Compare: Compare your current plan with other plans that are available in your area.
- Choose: Select the health plan that best fits your budget and health needs. Contact an insurance agent or certified Navigator to enroll in your plan. Make sure you discuss:
- What doctors are “in network”?
- What hospitals are “in network”?
- If there are medications you are currently taking, verify the medications are covered by the plan.
- Each plan selected may use a different drug list known as a formulary. It is important to verify:
- Does the plan cover this medication?
- Is there a deductible associated with the medication?
- Is a prior authorization required in order to have this medication covered?
- Request to look at a summary of the plan's offerings known as a summary of benefits and coverage. This document provides an overview of what is covered under the plan as well as any costs to you associated with using the benefits.
- Enroll: Open enrollment both on and off of the federal Marketplace begins on November 1, 2016. Make sure to review, update, compare and choose by December 15, 2016, to be sure that any changes will take effect on January 1, 2017. Contact your plan after you’ve enrolled and make sure to pay your first month’s premium.
Are any insurance companies dropping out of the 2017 market?
Yes, All Savers, Physicians Health Plan of Northern Indiana (PHP), Southeastern Indiana Health Organization (SIHO) and United Healthcare (UHC) have exited the individual market beginning in 2017.
When can I enroll for coverage for 2017?
Open enrollment for both on and off of the federal Marketplace begins November 1, 2016, and lasts through January 31, 2017. Open enrollment is the only time you can sign up for health coverage during the year unless you have a special circumstance. To ensure your plan begins on January 1, 2017, you will need to make sure you have selected a plan and made your premium payment no later than December 15, 2017.
What if I do nothing and auto-renew in the Marketplace plan that I had last year?
If you received tax subsidies for 2016 for your Marketplace plan, the tax subsidies are based on what is known as the benchmark plan. The benchmark plan itself can differ from county to county. For 2017, there are many new plans available for sale in the federal Marketplace. This means the second lowest silver plan from 2016 offered in your area may NOT be the second lowest silver plan available for sale in 2017, and your subsidy amount could be lowered. So it makes sense to shop around every year.
- I received a notification in the mail from my insurance company discussing renewal/discontinuance of my Marketplace plan. What do I do now?
The Department of Insurance strongly suggests you shop around and review all plan offerings in your area with a certified Indiana Navigator or licensed insurance agent. If you had a Marketplace plan that will not be available for 2017, your plan may be available off the Marketplace. However, you cannot receive premium tax credits for off-Marketplace plans. To find a Navigator in your area, click here. To locate a Marketplace certified agent in your area, click here and scroll down to the Agent and Broker completion list.If you currently have a Marketplace plan, you will be auto-renewed into a new plan by the federal government. You will receive a notice from the federal government containing information about your new plan prior to the beginning of Open Enrollment. Please review this plan to make sure it meets your health and budget needs. If it does not, you will need to enroll in a different plan on www.healthcare.gov. Please see the notice from the federal government for additional details.
- What does it mean to have a Marketplace (Exchange) plan?
A Marketplace plan is an ACA-compliant plan that offers minimum essential coverage and contains the 10 essential health benefits. It is purchased through www.healthcare.gov. Premium tax credits can be used to lower the cost of the premium.
- Who are the insurance companies writing individual health insurance on the federal Marketplace for Indiana in 2017?
The following companies are writing individual health insurance on the federal Marketplace for Indiana in 2017. If you want to claim a premium tax credit, you must enroll through www.healthcare.gov and choose coverage from one of the following companies. See the attached map to find carriers in your state.
- Anthem Insurance Company
- CareSource Indiana Inc.
- Celtic Insurance Company (Ambetter)
- MDwise Marketplace
- How do I know if I am eligible for premium tax credits?
If your household income is less than 400% of the federal poverty level, you may be eligible for premium tax credits through the federal Marketplace, if you are not eligible for HIP 2.0. If your household income is not less than 400% of the federal poverty level, you may still enroll in the federal Marketplace. Alternatively, you may contact an insurance agent who sells individual policies outside of the federal Marketplace. The chart below shows 100% and 400% of 2016 federal poverty level for different family sizes.
2016 Federal Poverty Guidelines
100% 133% 150% 200% 250% 300% 400%
What is “federal poverty level”?
Federal poverty level guidelines are used to show income levels and to help determine if a consumer is eligible for a premium tax credit. Consumers whose incomes are less than 400% of the federal poverty level are eligible for premium tax credits. They are also used to determine the amount of premium tax credits that consumers can claim on their tax returns. Federal poverty level guidelines are updated every year by the Department of Health and Human Services (HHS).
What does it mean to have an Off-Marketplace (Off-Exchange) plan?
An off-Marketplace plan is also an ACA-compliant plan that offers minimum essential coverage and contains the 10 essential health benefits. However, this type of plan is purchased directly from the insurance company, not through www.healthcare.gov. Furthermore, premium tax credits CANNOT be used to lower the cost of the premium for an off-Marketplace plan.
If I don’t qualify for tax credits, what are my options for individual health insurance?
If you do not qualify for premium tax credits, you may still enroll in the federal Marketplace. Alternatively, you may choose to contact an insurance agent in your area who sells individual products outside of the federal Marketplace through one of the following issuers:
- Anthem Insurance Company
- Caresource Indiana Inc.
- Celtic Insurance Company (Ambetter)
- IU Health Plans
- MDwise Marketplace
What if I don't want to buy health insurance?
Every consumer has the option to forego purchasing health insurance. However, the ACA requires everyone to have health insurance under what is know as "the individual mandate." If you do not purchase health insurance for 2017, you will be subject to a tax penalty. Additional information for calculating this penalty may be found here.
Should I plan for my premium to go up next year?
All companies' rates are changing. Please click here for more information.
- What causes rates to increase?
In addition to the normal “trend” costs, the following requirements of the Affordable Care Act have significant impact on the insurance costs:
- Guaranteed issuance
- Community rating (insurance rates are basically the same regardless of occupation, age or health conditions)
- Essential health benefits (mandated coverages)
- Minimum loss ratios (insurance companies are required to pay out 80 percent of all premiums collected in claims)
- Taxes and fees on insurance companies
What if I have problems with my marketplace enrollment? Who do I call?
Call center representatives are available to help complete your application, compare the plans available in your area, enroll you in a plan, and answer any questions that you may have about the enrollment process. The call center phone number is 1-800-318-2596 and is open 24 hours a day, seven days a week except for Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day.
Navigators and agents are also available to help you with each step of the enrollment process and can answer any questions you may have about the enrollment process. To find a Navigators in your area, click here. To locate a Marketplace certified agent in your area, click here and scroll down to the Agent and Broker completion list.
- Why do ACA compliant plans cost so much more?
There are two primary reasons:
1) Guaranteed Availability: Before the ACA, insurance companies could decide not to sell someone health insurance if they had costly “pre-existing conditions.” This made it easier for insurance companies to sell insurance at lower rates. After the ACA, companies have to sell insurance to anyone. This makes it easier for people with pre-existing conditions to buy health insurance, but also means that rates must increase so there is money to pay for these new and often expensive bills.
2) Richer Benefits: The ACA set a new standard for what is considered “basic coverage.” Many new benefits, like maternity, were not traditionally included in individual health insurance. The ACA defined these benefits as “Essential Health Benefits” (or EHBs), which now must be covered in all plans.
I got a raise this year. What if I am above the federal poverty level guidelines (100%-400%) for receiving premium tax credits through the federal Marketplace?
If your income is no longer less than 400% of the federal poverty level and you are receiving premium tax credit assistance, you may be required to pay for the entire premium of the plan you selected. If you even make one dollar more than 400% of the federal poverty level, it could cost you thousands of dollars more to purchase your coverage.
A married couple ages 43 and 45 in Marion County make $62,920 a year, which is 400% FPL. The full cost of their premiums is $9,228/yr or $769/mo. If their income doesn't change, then throughout the year they can receive a total of $2, 822 in Advance Premium Tax Credits (APTC's) and will pay the difference of $9,228-$2,822=$6406 (or $534/mo). If their income goes up (even just a little), then they will no longer qualify for APTC's and will then be responsible for the full premium. All tax credits that have been received would need to be paid back at tax time. For anyone right at 400% FPL who wants to qualify for APTC, caution is urged to carefully monitor your income, since working a few extra hours could end up costing you several thousand dollars. Individual experiences may vary and it is important to discuss this impact with your tax professional.
It is very important to log onto www.healthcare.gov or call 1-800-318-2596 and report any changes to your income and/or household makeup.
- Can I purchase a Marketplace plan if I am receiving Medicaid Disability?
Yes, you may enroll in a Marketplace plan if you are receiving Medicaid Disability. However, you will not be eligible for any premium tax credits for a Marketplace plan even if your income level is within the premium tax credit guidelines, which can cause confusion during enrollment. However, for many individuals, the extra coverage will be worth the trouble involved in sorting out premium tax credits. Consumers should consult a tax advisor to determine any possible tax implications or consequences.
Individuals on income-based Medicaid may not enroll in a Marketplace plan.
- I have a marketplace plan and was not eligible for a premium tax credit last year, but I lost my job. I am now within the limits for eligibility. How do I get a premium tax credit?
The amount of premium tax credit that you can claim is based on your household income and the members of your household. To obtain a premium tax credit, you must file a tax return with the IRS for 2016. You will also need to fill out an application on www.healthcare.gov and provide information about your household members and your estimated income for 2017. The federal Marketplace will then estimate the amount of premium tax credit that you can claim on your tax return. Once the amount of premium tax credit has been determined, you can choose to accept all, accept a portion, or deny the premium tax credit. If you did not have a marketplace plan, you need to apply on www.healthcare.gov during your special enrollment period (SEP).
What is a Special Enrollment Period?
A special enrollment period (SEP) is a time outside of Open Enrollment when you can enroll in a health plan if you become eligible due to certain events. The federal government determines whether an individual is eligible for SEP. For additional information, please go to https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/.