Frequently asked questions about health insurance
coverage options in Indiana
Indiana relies on the federally facilitated exchange, so residents enroll through HealthCare.gov. The exchange is used by people who buy their own health insurance, including the self-employed, early retirees (not yet eligible for Medicare), and people who are employed by a small business that does not provide health benefits.
Use of the exchange is optional (people can enroll directly through the insurance companies instead), but the exchange is the only place people who buy their own health insurance can get premium subsidies that will lower their monthly premiums, as well as cost-sharing reductions that will lower their out-of-pocket medical costs.
The American Rescue Plan has made subsidies larger and more widely available, making it more important than ever for people to shop in the exchange (these subsidy enhancements have been extended through 2025 by the Inflation Reduction Act).
The open enrollment period for individual/family coverage runs from November 1 through January 15 in Indiana.
Outside of open enrollment, a qualifying life event is generally necessary to enroll or make changes to your coverage. But Native Americans can enroll year-round, as can subsidy-eligible applicants with household income up to 150% of the poverty level. And Medicaid/CHIP enrollment is also available year-round.
For 2023 coverage, there are five insurers that offer exchange plans in Indiana, including one that’s new for 2023. Plans are offered by the following insurers, with plan availability varying from one location to another:
- Anthem
- Caresource
- Celtic/MHS/Ambetter
- US Health and Life
- Cigna (new for 2023)
Read more about health insurance companies and premiums in the Indiana health insurance marketplace.
Five insurers are offering coverage in Indiana’s exchange for 2023, including one newcomer, Cigna. For the four existing insurers, the rate changes that were approved by the Indiana Department of Insurance amounted to an average rate increase of roughly 6%
During the open enrollment period for 2022 coverage, 156,926 people enrolled in private individual market plans through the Indiana exchange.
Indiana uses the federally facilitated health insurance exchange HealthCare.gov. And while former Governors Mitch Daniels and Mike Pence both opposed the ACA (Obamacare), Pence did push for – and get – federal approval to expand Medicaid using a waiver to enhance the Healthy Indiana Plan. Expanded coverage was in effect in Indiana by February 2015.
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.)
Medicaid expansion, as enacted by the Affordable Care Act (aka Obamacare), extends Medicaid eligibility to low-income adults up to 138% 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 November 2020, average monthly Indiana Medicaid/CHIP enrollment in Indiana increased by 72% (enrollment grew significantly in 2015 and 2016 as a result of Medicaid expansion; enrollment was then fairly steady through 2019, but shot up again from 2022 through 2022 as a result of the coronavirus pandemic and the resulting pause on Medicaid eligibility redeterminations). The Center on Budget and Policy Priorities (CBPP) has 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 September 2022, Indiana reported that 808,911 people were enrolled in expanded Medicaid. That was a sharp increase from about 431,000 in February 2020, but COVID pandemic has pushed Medicaid enrollment numbers higher nationwide (due in large part to the federal rule that provides states with additional Medicaid funding but also prevents states from disenrolling people during the public health emergency).
The state had projected that 427,702 people would be enrolled by January 2017, and enrollment initially took a while to catch up to that projection. But it has far surpassed it during the COVID pandemic, highlighting the importance of Medicaid as a safety net for situations like the current pandemic.
Read more about Medicaid eligibility expansion in Indiana.
Indiana has its own state regulations regarding short-term health insurance plans, but the regulations 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.
Medicare is a health coverage program run by the federal government to provide health benefits for people age 65 and older, as well as people with long-term disabilities. By mid-2022, there were 1,312,959 Indiana residents enrolled in Medicare. About 86% of those individuals qualified based on age alone, while the other 14% were under the age of 65 and 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 prescription drug plan.
Read more about Medicare in Indiana, including statistics about state Medicare spending, details about Medicare Advantage and Medicare Part plan availability, and the applicable rules for Medigap plans (Medicare Supplement) in Indiana.
Learn more about Medicare’s open enrollment period, which allows beneficiaries to change their Medicare Part D prescription coverage and Medicare Advantage coverage.
- Indiana Department of Insurance — A government entity that regulates and licenses health insurance companies and brokers and agents who sell plans. Can serve as a resource for an Indiana resident with a question or complaint about health coverage.
- HealthCare.gov — The health insurance exchange where individuals and families in Indiana can purchase health insurance coverage and obtain financial assistance (premium subsidies and cost-sharing reductions) based on household income.
- Affiliated Service Providers of Indiana, Inc. (ASPIN) — The federally-funded Navigator organization in Indiana; can answer questions and offer assistance for people enrolling in Medicaid or a private plan through the exchange.
- Indiana State Health Insurance Assistance Information Program (SHIP) — A local service that provides help and information to Medicare beneficiaries and their caregivers.
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 are not considered insurance and not regulated by the state insurance department, became available for purchase in late 2020, for coverage effective in 2021.
Indiana enacted S.B.392 in 2019. The bill passed with strong support in both chambers of Indiana’s legislature. As of July 2020, it requires Medigap insurers to offer at least one Medigap plan (Plan A) to Medicare beneficiaries who are under 65 and eligible for Medicare due to a disability.
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.
