Health insurance in Indiana
- Indiana relies on the federally facilitated exchange, so residents enroll through HealthCare.gov.
- Open enrollment for 2021 health plans ended on December 15, 2020. Residents with qualifying events can enroll outside of open enrollment.
- Short-term health plans in Indiana can have 364-day terms, but must have benefit caps of $2+ million.
- Three insurers offering 2021 health plans for 2021, including Anthem, which is rejoining the exchange after a previous exit.
- Indiana accepted the ACA’s Medicaid expansion in 2015; nearly 559,000 people are covered under the expansion guidelines as of 2020.
- By August 2020, there were more than 1.28 million Indiana residents enrolled in Medicare.
Indiana’s health insurance marketplace
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.
Two insurance companies offer 2020 coverage for individuals and families in the Indiana health insurance marketplace. For 2021, that will increase to three companies, with Anthem’s return to the marketplace.
CareSource, Celtic (MHS/Ambetter), and Anthem will all offer plans in the Indiana marketplace for 2021, albeit with varying service areas. The average proposed rate increase for 2021 amounts to more than 10 percent.
Read more about health insurance companies and premiums in the Indiana health insurance marketplace.
Indiana open enrollment period and dates
Open enrollment for 2021 health insurance in Indiana ran from November 1 through December 15, 2020. Outside of this window, Indiana residents need a qualifying event in order to enroll or make changes to their coverage, both on-exchange and outside the exchange.
The open enrollment period is an opportunity for individuals and families to newly enroll in coverage or to renew or make a change to an existing policy. It’s also a good time to update financial information on file with the exchange (for subsidy eligibility determinations), to ensure that subsidy eligibility determinations are accurate.
Read our overview of the Indiana health insurance marketplace.
Medicaid expansion in Indiana
Medicaid expansion, as enacted by the ACA aka Obamacare, 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 May 2020, average monthly Indiana Medicaid/CHIP enrollment in Indiana increased by 40 percent – an increase of more than 450,000 enrollees (significant enrollment growth happened in 2015 and 2016; enrollment was then fairly steady through 2019, but shot up again in 2020 as a result of the coronavirus pandemic and the resulting job losses). The 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 August 2020, Indiana reported that 558,714 people were enrolled in expanded Medicaid. That was a sharp increase from about 431,000 in February 2020, but the widespread job losses caused by the coronavirus pandemic have pushed Medicaid enrollment numbers higher nationwide. 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.
Short-term health insurance 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.
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 (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.]
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 coverage and enrollment 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 August 2020, there were 1,280,707 Indiana residents enrolled in Medicare. 83 percent of those individuals qualified based on age alone, while the other 20 percent were under the age of 65 and eligible due to a disability.
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 health insurance resources
- 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 healthcare reform legislation
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.
A summary of other recent Indiana health reform legislation is at the bottom of this page.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.