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Health Care Reform:

Health Insurance & Affordable Care Act

Indiana Health Insurance Marketplace

Benefits

What's Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Indiana, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In Indiana, this includes physical and occupational therapy and services for people diagnosed with autism spectrum disorder or other pervasive developmental disorders.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care

Some services not included: infertility treatment, acupuncture, long-term care, weight loss programs, and weight loss surgery.

Health Insurance Advisor: Check out WebMD's Health Insurance Advisor to compare different kinds of plans based on your needs.

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what's available:

Premium Subsidies (also known as Tax Credits ): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014. 

You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost-sharing subsidies are available only if you buy a silver-level plan. 

Medicaid Expansion: Some states expanded Medicaid so more people can get health insurance coverage. In Indiana, Gov. Mike Pence has asked the federal government to allow the state to expand coverage to more than 400,000 residents through the state's Healthy Indiana Plan rather than the traditional Medicaid program. Healthy Indiana is a high-deductible health plan with a health savings account.

CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid. 

Check with Healthcare.gov to see if you are eligible for these programs.

Available Resources

There are several ways you can get help with your insurance decisions:

  • Call Center: You can call the federal government's help line, 800-318-2596, 24 hours a day, seven days a week for information, help, and to buy insurance.
  • Web site: Because the U.S. Department if Health and Human Services is operating the Marketplace in Indiana, the web site HealthCare.gov is the best place to start. On that site you can create an account, find out information about different plans, and buy insurance, once you have decided which plan you want. 
  • Apply by Mail: You also can use a paper application to check whether you are eligible for Medicaid, the Children’s Health Insurance Program, or the new subsidies offered through the Marketplace. Download the application from How do I apply for Marketplace coverage. After you send it in, you’ll be notified of your eligibility. You can complete your enrollment online or by calling the Marketplace Call Center at 800-318-2596.
  • Navigators and assisters: They will teach you about the Marketplace and guide you through your insurance decisions. They are supposed to be fair and impartial helpers and cannot take any money from insurance companies. Here are the organizations approved to operate navigator programs.
    •  Affiliated Service Providers of Indiana Inc.
    •  Plus One Enterprise, LTD, LLC, 
    •  Health and Hospital Corporation of Marion County
    •  United Way Worldwide
  • Local, state, and federal organizations: Many health and community organizations, public libraries, and hospitals are offering help. Some organizations will have volunteers who can answer questions for you. Other groups will have trained and certified helpers who can take you through the whole process by computer or by using a paper application. Certified helpers must complete required training. They also are supposed to protect your personal information. 

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