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Family and Social Services Administration

Healthcare Reform

Healthcare Reform > FAQs FAQs

2016 FAQ's

  • What impact will the Affordable Care Act have on individual health insurance rates in Indiana?
    The Indiana Department of Insurance approved a 0.7 percent average cost increase for individual health insurance in 2016.

  • What factors caused the increased costs?
    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.

  • Is the State comfortable with the assumptions made by the insurance companies in their rates filings?
    One of the statutory responsibilities of the Department of Insurance is the analysis and approval of insurance rates submitted by all types of insurance carriers. The Department has a staff of professional analysts and actuaries who regularly review rate filings. In the reviews, they develop a broad perspective of projections and assumptions prepared by insurance companies. From this perspective, they can identify and question assumptions that are inconsistent or out of normal range.

  • Does this mean that all customers purchasing an individual health insurance policy will have a 0.7% increase in premiums?
    No. Individual premiums vary widely because insurance policies may include different coverage, co‐pays and deductibles. In addition, individuals purchasing health insurance through the Federally Facilitated Insurance Marketplace whose household income is less than 400% of the federal poverty level may be eligible for a sliding scale tax credit to help pay the premium.

  • Do the federal tax credits reduce the cost of health insurance?
    No. The federal tax credits do not change the cost of health insurance. These credits mean that U.S. taxpayers are helping pay for the insurance through the federal government.

  • When can I enroll for coverage for 2016?
    Open enrollment for both on and off of the federal Marketplace begins November 1, 2015, and lasts through January 31, 2016. To ensure your plan begins on January 1, 2016, you will need to make sure you have selected a plan and made your premium payment no later than December 15, 2015.

  • What if I have problems? 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.

    Indiana Navigators 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. The list of Navigators in each county in Indiana can be found here.

  • 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 known as “the individual mandate.” If you do not purchase health insurance for 2016, you will be subject to a tax penalty. The tax penalty for 2016 will be the HIGHER of the following options:
    • 2.5% of your yearly filing threshold. This penalty cannot be more than the national average premium for a bronze plan. For 2014, the annual national average premium for a bronze plan is $2,448 per individual ($204 per month per individual) and $12,240 for a family with five or more members ($1,020 per month for a family with five or more members). Additional information for calculating this penalty may be found here.
    • $695 per person at least 18 years old, and $347.50 per child under 18 years old, in your household for the year. The total penalty cannot be more than $2,085.

  • Who are the insurance companies writing individual health insurance on the federal Marketplace for Indiana in 2015?
    The following companies have been recommended for Marketplace Certification in Indiana. If you want to claim a premium tax credit, you must enroll through healthcare.gov and choose coverage from one of the following companies. See map to find carriers in your state.
    • Anthem Insurance Company
    • Celtic Insurance Company (Ambetter)
    • CareSource Indiana Inc.
    • IU Health Plans
    • MDwise Marketplace
    • Physicians Health Plans of Northern Indiana
    • Southeastern Indiana Health Organization
    • All Savers Insurance Company (United Healthcare)

  • 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. You may also contact an insurance agent who sells individual policies outside of the federal Marketplace. The chart below shows 100% and 400% of federal poverty level for different family sizes.

    2016 Federal Poverty Level (FPL), by Family Size

    Family Size 100% FPL 133% FPL 150% FPL 250% FPL 300% FPL 350% FPL 400% FPL

    1

    $11,880

    $16,590

    $17,820

    $29,700

    $35,640

    $41,580

    $47,520

    2

    $16,020

    $22,371

    $24,030

    $40,050

    $48,060

    $56,070

    $64,080

    3

    $20,160

    $28,153

    $30,240

    $50,400

    $60,480

    $70,560

    $80,640

    4

    $24,300

    $33,935

    $36,450

    $60,750

    $72,900

    $85,050

    $97,200

    5

    $28,440

    $39,716

    $42,660

    $71,100

    $85,320

    $99,540

    $113,760

    6

    $32,580

    $45,498

    $48,870

    $81,450

    $97,740

    $114,030

    $130,320

    7

    $36,730

    $51,293

    $55,095

    $91,825

    $110,190

    $128,555

    $146,920

    8

    $40,890

    $57,103

    $61,335

    $102,225

    $122,670

    $143,115

    $163,560

    For each
    additional person, add:

    $4,160

    $5,810

    $6,240

    $10,400

    $12,480

    $14,560

    $16,640

     

  • 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. You may also choose to contact an insurance agent in your area who sells individual products outside of the federal Marketplace:

    • Anthem Insurance Company
    • All Savers
    • Caresource
    • IU Health Plans
    • MDwise Marketplace
    • Southeastern Indiana Health Organization
    • Physicians Health Plans of Northern Indiana
    • United Health Care Insurance Company
    • Celtic Insurance Company

  • Should I plan for my premium to go up next year?
    Companies are raising rates an average of 0.7%, but individual increases vary widely because insurance policies may include different coverage, co-pays and deductibles.
    In addition, individuals purchasing health insurance through the federal Marketplace whose household income is less than 400% of the federal poverty level are eligible for tax credits to help pay the premium, and their portion of the premium payment may go up or down depending on various factors.
    It is important for people to update their financial information throughout the year at healthcare.gov. This will help you to receive the appropriate amount of financial assistance and reduce the chances that you will need to pay back a large amount come tax time. It is also EXTREMELY important to shop for health insurance EVERY year. What was a good deal for you last year may not be a good deal this year. For some individuals, premium increases may exceed hundreds of dollars per month. Additional information for the 2015 Federal Poverty Level guidelines can be found here.

  • How did the Department of Insurance come up with the 0-1% average premium increase for Indiana individual rates for 2016?
    The Department of Insurance reviewed the premiums in the rate filings for 2015. We then reviewed the premiums in the rate filings for 2016. From this comparison we found the average change to be from 0-1% premium increase.

  • I received a notice from my insurance company that it’s not going to offer the policy I had before the ACA requirements went into effect. Will I have to pay more for a new policy?
    The Indiana Department of Insurance projects a 70-100% cost increase for individual health insurance for those individuals who have a “transitional” or “grandfathered” policy that is terminating in 2015 and are moving to an ACA compliant product . The cost increase is consistent with the projections made by the State’s external actuaries in 2011 report. In March 2014, the Department of Insurance released Bulletin 205 instructing insurance companies on the options to renew or non-renew transitional policies. Additional information may be found here.

  • How did the State calculate the 70-100% increase in individual insurance costs attributable to ACA requirements in 2014?
    First, we calculated the average “per member per month” cost for 2012, which is based on actual filings submitted to the Department of Insurance by Indiana health insurance companies. We then compared this number to average “per member per month” cost for 2014. After subtracting normally expected cost increases or “trend” costs, we arrived at a 72% average cost increase for 2014 compared to 2012. This is the increased amount in insurance costs directly attributable to the ACA.

  • 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.

  • 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). Federal poverty level guidelines for 2016 will be published in January 2016.

  • I am receiving premium tax credits through the federal Marketplace and make just under 400 percent of  the federal poverty level (FPL). What happens if I make 401 percent of FPL?
    If you exceed 400 percent FPL, then you will need to pay back (at tax time) any premium tax credits you received that year. This could be thousands of dollars.

    Example:
    A married couple tells healthcare.gov that they make 400 percent FPL. Over the course of the year they receive $3,000 in Advance Premium Tax Credits (APTC’s). At tax time, they realize that their income was actually 401 percent FPL, which means they actually do not qualify for the tax credits they have been receiving in advance throughout the year, and they have to pay back the full $3,000 with their taxes. For anyone near 400 percent 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.

    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 make even one dollar more than 400% of the federal poverty level, it could cost you thousands of dollars more to purchase your coverage.

  • I’m not sure how much I’ll earn in 2016. Should I put a low amount so I pay less of my premium?
    It is important to provide accurate financial information on your application. If you provide a lower amount of income on your application than what you will actually earn in 2016, you may have to pay back a large amount of taxes in 2016. If you are not sure how much income you will earn in 2016, review your income from 2015. You can then increase your 2015 income by an estimated additional income for 2016 to get an accurate estimate for your 2016 income. You may want to speak with a tax adviser.

  • 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. 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.

  • 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 and for which the Marketplace does not really have an answer. 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.


  • What if I do nothing and auto-renew in the Marketplace plan that I had last year?
    If you received tax subsidies in 2015 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 2015, there are many new plans available for sale in the federal Marketplace. This means that the second lowest silver plan from 2015 offered in your area may NOT be the second lowest silver plan available for sale in 2016, and your subsidy amount could be lowered.

  • 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 2015. 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 2016. 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’s the process for getting coverage?
    You should take the following steps to ensure you select the right plan option, either on or off the federal Marketplace.
    1. Review: Review your coverage and look for a letter from your plan about how your benefits and costs may change next year.
    2. Update: Starting November 1, log in to the federal Marketplace and update your 2016 application - make sure your household income and other information is up-to-date for next year.
    3. Compare: Compare your current plan with other plans that are available in your area.
    4. 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 (providers) 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.
    5. Enroll: Open enrollment both on and off of the federal Marketplace begins on November 1. Make sure to review, update, compare and choose by December 15, 2015, to be sure that any changes will take effect on January 1, 2016. Contact your plan after you’ve enrolled and make sure to pay your first month’s premium.