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Indiana health insurance

Two insurers offer 2020 coverage on Indiana's exchange; short-term plans can be sold with 364-day terms, but must have benefit caps of at least $2 million

Health insurance in Indiana

Indiana’s marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Indiana is among the states that have done the least to preserve the Affordable Care Act’s gains.

Indiana relies on the federally facilitated exchange, so residents enroll through HealthCare.gov.

Open enrollment for 2020 health plans has ended, although Indiana residents with qualifying events can still enroll or make changes to their coverage for 2020 (including anyone who loses employer-sponsored health insurance amid the coronavirus pandemic). The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.

Two carriers are offering 2020 coverage in the state’s individual market.

Read our overview of the Indiana health insurance marketplace.

Indiana Medicaid

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 September 2019, average monthly Indiana Medicaid/CHIP enrollment in Indiana increased by 30 percent – an increase of 338,438 enrollees (the enrollment growth happened in 2015 and 2016; enrollment has been fairly steady since then). The left-leaning Center on Budget and Policy Priorities (CBPP) noted, 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 complexity (and premiums) that’s built into the state’s approach to Medicaid expansion.

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.

By February 2020, Indiana reported that 430,777 people were enrolled in expanded Medicaid. The state had projected that 427,702 people would be enrolled by January 2017, but enrollment took a while to catch up to that projection. This could be 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, but they changed in mid-2019. The state now allows short-term plans to follow the federal rules in terms of duration (terms of up to 364 days, and total duration, including renewals, of up to three years), but the state imposes various other restrictions, including a benefit cap of at least $2 million.

Read more about short-term health insurance in Indiana.

The Affordable Care Act’s history in  Indiana

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, 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 passed in the House in May 2017, but failed in the Senate. It 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. Coverage for most members was extended until January 31, 2014, in order to give members sufficient time 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

By late 2019, there were 1,263,526 Indiana residents enrolled in Medicare. 83 percent of those individuals qualified based on age alone, while the other 20 percent were eligible due to a disability.

Compared with the national average, Indiana Medicare beneficiaries are less likely to select a Medicare Advantage plan, and more likely to select a stand-alone Medicare Part D plan.

Read more about Medicare in Indiana.

Indiana health care reform legislation

Indiana enacted H.B.1631 in 2019, changing the rules for short-term health plans in the state.

Indiana enacted S.B.184 in 2020, allowing the Indiana Farm Bureau to start offering medically underwritten plans in the state. The plans, which will not be considered insurance and not regulated by the state insurance department, will be available for purchase in late 2020, for coverage effective in 2021.

Other recent health reform legislation at the state level includes: