Health insurance in Indiana
- Indiana relies on the federally facilitated exchange, so residents enroll through HealthCare.gov.
- Open enrollment for 2019 coverage in Indiana ended on December 15.
- Enrollment is still possible for Indiana residents with qualifying events.
- Short-term health plans are available in Illinois with initial plan terms up to six months.
- Two insurers are offering 2019 coverage in the state and rate increases are on average smaller than a year ago.
- Indiana accepted the ACA’s Medicaid expansion in 2015.
Indiana relies on the federally facilitated exchange, so residents enroll through HealthCare.gov.Open enrollment for 2019 coverage is from November 1 through December 15, 2018. About 167,000 Indiana residents enrolled in coverage during the open enrollment period for 2018 coverage.
Two carriers are offering 2019 coverage in the state’s individual market. Both exchange insurers plan to expand their coverage areas for 2019. The average filed rate increase for 2019 coverage was 5.1 percent, which is smaller than the rate hikes that applied for 2018.
Medicaid expansion, as enacted by the ACA, extends Medicaid eligibility to low-income adults up to 138 percent of the federal poverty level. Indiana did not expand Medicaid in 2014, but their second waiver proposal was approved by CMS in January 2015, paving the way for Medicaid expansion to begin in February 2015.
From 2013 to June 2016, average monthly Indiana Medicaid/CHIP enrollment in Indiana increased by 31 percent – an increase of 349,336 enrollees. The left-leaning Center on Budget and Policy Priorities (CBPP) notes, however, that Indiana’s Medicaid enrollment is lower than it would be if the state had simply expanded coverage as called for in the ACA, without the modifications that are included in the state’s waiver.
Indiana has two levels of Medicaid coverage: HIP Basic and HIP Plus. HIP Plus includes dental and vision coverage, and no copays unless enrollees use the emergency room for non-emergency care. HIP Basic has copays and does not include dental and vision coverage. People with income above the poverty level enroll in HIP Plus, and must pay premiums. People with income below the poverty level can enroll in HIP Basic without premiums, or can pay premiums and enroll in HIP Plus.
But the complexity of the design, confusion about premiums, and some enrollees’ lack of financial resources mean that enrollment has lagged behind expectations. The CBPP analysis found that in any given month, there are about 30,000 people who have been determined eligible for Indiana Medicaid in the previous two months, but have not finalized their enrollment because they have not paid their premiums.
By January 2017, Indiana reported that 403,142 people had enrolled in expanded Medicaid. In most states where Medicaid has been expanded, enrollment has been tracking above expectations. But in Indiana, the state had projected that 427,702 people would be enrolled by January 2017, so enrollment is lagging behind projections. This is likely due to the complicated nature of the state’s expansion, and the premiums that enrollees must pay in order to enroll in HIP Plus.
Read more about Medicaid expansion in Indiana.
Short-term health insurance in Indiana
Indiana has its own state regulations regarding short-term health plans, so short-term plan terms can’t have durations more than six months in the state, and can’t be renewed.
Read more about short-term health insurance in Indiana.
The Affordable Care Act’s history in Indiana
When the Affordable Care Act was passed in 2010, Indiana’s senators and representatives voted along party lines, with former Sen. Evan Bayh voting yes, former Sen. Richard Lugar voting no, and representatives voting 5-4 in favor of the measure. Currently, Indiana’s House delegation is dominated by Republicans, and its Senate seats are split between the parties. As described above, virtually all of the state’s Republican Representatives in the US House were in favor of the AHCA, which would have repealed or changed many of the ACA’s spending-related provisions.
Indiana uses the federally facilitated health insurance exchange HealthCare.gov. And while former Governors Mitch Daniels and Mike Pence both opposed the ACA, Pence did push for – and get – federal approval to expand Medicaid using a waiver to enhance the Healthy Indiana Plan. The federal government rejected the state’s first proposal, but a second proposal was approved in January 2015, and expanded coverage was in effect by February 2015. Former Gov. Pence became Vice President of the United States in January 2017. in the 2016 election.
Former Gov. Pence became Vice President of the United States in January 2017. in the 2016 election. In the 2016 election, Republican Eric Holcomb won the gubernatorial election in Indiana. Holcomb is opposed to the ACA, and supported House Republicans in their quest to pass the AHCA (the legislation was pulled before a vote, but would have frozen Medicaid expansion funding for new enrollees at the end of 2019, and would have resulted in smaller overall premium subsidies in the individual market, along with significantly higher premiums for people over the age of 50).
Does Indiana have a high-risk pool?
Before the ACA reformed the individual health insurance market, applications were medically underwritten in nearly every state, including Indiana. As a result, people with pre-existing conditions were often ineligible to purchase private plans, or were only able to get policies that excluded their pre-existing conditions or charged them significantly higher premiums for comprehensive coverage.
The Indiana Comprehensive Health Insurance Association (now terminated) was created in 1982 to provide an alternative for residents who were unable to obtain coverage in the private market because of their medical history.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This aspect of healthcare reform meant that plans in the individual market could be purchased regardless of medical history, making high-risk pools largely obsolete. ICHIA stopped enrolling new members at the end of September 2013. They had originally planned to cease operations and terminate all policies at the end of 2013, but the glitches in Healthcare.gov made it difficult for members to enroll in an exchange plan by mid-December.
The Indiana Insurance Commissioner extended ICHIA coverage until January 31, 2014, in order to give members another month to secure new plans. Coverage was extended until April 30, 2014, for members with HIV, and until the end of 2014 for the 12 members with end-stage renal disease.
Medicare enrollment in Indiana
In 2015, Indiana Medicare enrollment reached 1,150,553, about 17 percent of the state’s population and consistent with the percentage of people enrolled in Medicare across the U.S. 82 percent of those individuals qualified based on age alone, while the other 20 percent were eligible due to a disability.
As of 2009, Indiana ranked 15th in overall Medicare spending with $9.7 billion per year. Per Indiana enrollee, IMedicare spends about $9,141 per year – higher than the national average of $8,970.
Indiana Medicare recipients who want additional benefits beyond what original Medicare offers can instead select a Medicare Advantage plan. In Indiana, 24 percent of Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2016 (instead of traditional Medicare), compared with 31 percent nationwide.
Medicare Part D plans are also available to Indiana Medicare enrollees who want stand-alone prescription drug coverage. More than half (53 percent) of Indiana Medicare enrollees have stand-alone Rx coverage compared with 45 percent nationwide.
Other recent health reform legislation at the state level includes: