Beginning October 1, the federal government will launch an online Marketplace in Indiana where Hoosiers can compare and purchase health insurance. As part of the Affordable Care Act, the Marketplace aims to offer health insurance to Hoosiers without employer-provided coverage and will offer financial assistance to help many people afford coverage. A number of plans will be offered in varying levels of coverage, however all plans will cover essential benefits like preventative care, prescription drugs and other care. The state’s actuary, Milliman, estimated that as many as 650,000 Hoosiers could gain coverage through the Marketplace by 2017.
Log on to HEALTHCARE.GOV or call toll-free (800) 318-2596 and get started today.
To utilize the Marketplace, Hoosiers must meet certain requirements. To be eligible, a person must reside in Indiana, be a US citizen, national or non-citizen who is lawfully present for the entire enrollment period, and not be incarcerated.
The coverage options available to Hoosiers will vary depending on benefits and the amount an enrollee pays towards a plan but must all cover a number of key benefits. Those essential benefits include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventative and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Hoosiers purchasing insurance cannot be denied coverage as the result of a preexisting condition. Plans will be offered in four levels – bronze, silver, gold and platinum and vary in the average amount enrollees will pay toward coverage.
Young adults under 30 years old are eligible for catastrophic coverage, a lower cost alternative for those seeking health insurance. Catastrophic plans have higher deductibles but lower premiums and cover primary care visits and preventative services with no out-of-pocket costs.
Covering more Hoosiers means less use of the emergency room as a primary care provider and a reduction in uncompensated care, a practice that cost Indiana hospitals nearly $3 billion in 2011. To make coverage affordable for more Hoosiers, premium tax credits will be widely available to help offset the cost of insurance.
Nearly 50% of uninsured Americans eligible for the online Marketplace will pay $100 or less for health care coverage in 2014.
Tax credit eligibility is dependent on income, those making between 100 percent and 400 percent of the federal poverty line are eligible for assistance on a sliding scale. Hoosiers making lower incomes are eligible for a higher offset.
To date, Republican leadership has blocked Senate Democrats’ efforts to increase Hoosiers’ access to health care services by expanding Medicaid. Expanding Medicaid to Hoosiers earning incomes up to 138 percent of the Federal Poverty Line (FPL) would have meant guaranteed health care coverage for those who don’t make enough to meet the 100 percent FPL amount needed to qualify for subsidies. A Supreme Court decision made expanding Medicaid to cover more working families optional for the states. While a number of states, including Ohio, Kentucky, Illinois and most recently, Michigan, have elected to expand Medicaid and offer their citizens better access to medical services, the Republican leadership in Indiana continues to prevent Hoosiers from taking advantage of the economic benefits.
Benefits like up to 30,000 new jobs, $3.4 billion in new economic activity and as many as 300,000 Hoosiers previously going without health insurance gaining coverage according to a report from the Indiana Hospital Association.
The coverage gap
As a result of this inaction, uninsured Hoosiers earning an income that disqualifies them from Medicaid (those earning greater than 23 percent of the FPL or around $7,000 annually for a family of four) but not be earning enough to qualify for financial assistance on the Marketplace (100 percent of the FPL or about $23,500 annually for a family of four), may continue to go without health insurance. Hoosiers with incomes between those ranges will fall into a coverage gap.
Online, over-the-phone and in-person assistance is available for Hoosiers with questions while shopping for coverage on the marketplace.
Online support via a live chat function is available 24 hours a day through Healthcare.gov. Hoosiers will be connected with experts who can help guide the decision-making process and answer questions. Toll-free over-the-phone assistance is also available 24 hours, seven days a week at (800) 706-7893.
To simplify the application process and provide guidance for those applying for coverage, Hoosiers can turn to a number of in-person assistance options. Federally, four organizations have been awarded grants to assist Hoosiers through the application process.
The state will also certify individuals or ‘navigators’ to assist Hoosiers with applications and Marketplace enrollment at no cost. Both federal and state navigators can help with enrollment, search both lists for assistance close to your community.
The Small Business Health Options Program (SHOP) is a parallel online marketplace where small business owners can compare and purchase plans for their companies. Eligible small businesses will have access to tax credits to help make coverage affordable. The state’s actuary estimates nearly 50,000 Hoosiers could be enrolled through SHOP by 2017. Find application information at HEALTHCARE.GOV or call (800)-706-7893.