After Open Enrollment for Obamacare ends in Indiana, you can still purchase affordable health insurance coverage. During the Open Enrollment period, federal tax subsidies are available to individuals, families and small businesses to help pay the premium. For private plans, household income guidelines must be met in order to receive financial help.
But if you missed the deadline, simply forgot about it, or decided that rates were too high, Indiana medical plans can be bought at surprisingly low prices, depending on a variety of factors. Many of these policies will provide ideal "gap" coverage until you are eligible for the next period. However, if you obtain alternative benefits through an employer, or simply can not afford a policy, you can immediately cancel the plan.
Cheap Temporary Gap Coverage
Just as it sounds, this type of plan doesn't cost much, and is designed to be kept only 1-12 months. But that may be just enough time for you to obtain medical benefits until the next Open Enrollment, which typically begins in November. For 2017 effective dates, the OE period began on November 1st. We do not recommend a short-term policy as a long-term solution to not having qualified ACA benefits. But if bridging a gap is your goal, it's a viable solution, despite not meeting some of the Obamacare mandate requirements. It's often the best possible solution until the following year, when Trump Administration plans may be partially available.
Short-term plans do not provide "unlimited" benefits for as long as you have the policy. Usually, the maximum payout is between $250,000 and $2 million, which still should be enough for the limited amount of time you will keep the plan. Preventive benefits, unlike regular Marketplace policies, are not covered at 100% prior to the deductible, and often are not provided at all. Primary-care physician visits, prescriptions, and Urgent-Care visits are generally subject to a deductible, although a rider can often be added to remove the deductible.
Typical inpatient and outpatient expenses are covered fairly comprehensively, but a deductible and coinsurance will apply. Although accidents and illnesses are covered, immunizations and, as mentioned above, physicals, are not included in benefits. Specialist visits are also covered, but subject to a deductible. You can find more information here including plan specifics and how to apply. A policy can be easily approved in less than 24 hours.
For any claim, (using UnitedHealthcare as an example) the UnitedHealthcare Choice Plus Network negotiates lower prices so you pay less for all types of medical issues. Almost 800,000 doctors and 6,000 hospitals are included in the network, so out-of-state coverage is included. NOTE: Even though a deductible applies to many services, the discount can be substantial.
For example, the cost of a typical lab test might reduce from $125 to $25, and the cost of an MRI might reduce from $1,500 to $900. For major in-hospital surgeries, the negotiated savings can often exceed $10,000. Urgent Care visits along with outpatient procedures also receive a discount. If extensive treatment is needed because of a chronic condition, a Marketplace plan with no maximum benefit, will always be available effective January 1. Maximum benefit periods of three months per policy became effective to discourage applicants from replacing Obamacare plans.
What About Dental Coverage?
Dental plans can be purchased separately, but are not part of the main policy. However, these specific benefits can be bought at any time, since they are not mandated by the Affordable Care Act. UnitedHealthcare, Humana, Aetna, and Delta Dental offer very competitively-priced plans in most areas of Indiana. You can choose different carriers for your dental and healthcare needs. Jaw injuries sustained from accidents or injury often should be submitted through a healthcare plan. Also, cosmetic surgeries are typically excluded from both group and private plans.
Although dental plans are not expensive (approximately $9-$32 per month, per person), 100% coverage is typically not available for major services, such as bridgework, tooth implants, dentures, orthodontic treatment, and wisdom teeth removal. However, basic services, such as fillings, extractions, and periodontal scaling are covered at 70%-100%.
Vision policies are not commonly offered and tend to have limited capped benefits. Monthly rates are generally between $10 and $20. Your annual eye exam and a single pair of glasses are always covered with little out-of-pocket expense. Additional pairs or non-preventative exams may not be fully covered.
Short-Term Medical Plan Pricing
To simplify the rate calculation, we'll use a 40 year-old male that resides in South Bend. The plan we are quoting is UnitedHealthcare's short-term "Value" plan which features $1 million of coverage for comprehensive major medical benefits. The most popular deductibles and corresponding monthly premiums are listed below:
$53 - $10,000 deductible
$66 - $5,000 deductible
$82 - $2,500 deductible
$108 - $1,500 deductible
$126 - $1,000 deductible
Family prices (40 year old parents with one child) are listed below:
$125 - $10,000 deductible
$155 - $5,000 deductible
$193 - $2,500 deductible
$253 - $1,500 deductible
$297 - $1,000 deductible
An instant Indiana short-term health insurance quote is available. If you decide to apply for a policy, there are only 3-5 medical questions and you can obtain coverage the next day. We also represent additional carriers for temporary-need situations. All companies are licensed and registered with the Indiana Department Of Insurance. Additional available riders can provide benefits for dental, vision and critical illness. Upgraded office visit and prescription coverage can also be added.
Special Enrollment Period
If you need comprehensive coverage, you may be eligible for a "qualifying event," which allows you to purchase a policy through the "guaranteed approval" provision of the Marketplace. These "events" trigger situations (exceptions) regardless of the time of the year. You will be eligible for a federal subsidy and can not be declined for medical underwriting reasons. Some of the most likely exceptions are listed below:
Loss of minimum essential benefits (required by ACA legislation)
Birth of a child
Adoption of a child
New custody or guardianship of a child
Expiration of existing policy
Move to a different service area
Loss of eligibility for qualified benefits
Dependent reaches age 26 on parent's policy
If you're not certain if you qualify for a Marketplace exception, contact us and we'll quickly determine your eligibility and provide a customized list of plans that best meet your specific budget and healthcare needs. There is a 60-day enrollment window that begins after the event occurs. If you miss or go beyond this window, although you can apply for temporary benefits, you will not receive an instant tax credit to help reduce your premium, and the federal individual mandate penalty will need to be paid the following year.
Go Without Coverage
Although this is an option, we don't recommend staying uninsured for any length of time. There is a "grace period" of about three months that will avoid the non-compliance ACA tax, but the risk of a large hospital or surgery bill is too much to avoid securing coverage. Certainly, you won't pay a premium while you are without benefits. But with several low-cost options currently offered, there is no reason to take a chance.
There is also the tax (Shared Responsibility Payment) that is imposed if you don't have a policy that meets the legislation requirements. By not having "minimum essential benefits, the annual tax is $695 per adult and $347.50 per child (under 18). However, if 2.5% of your household income is higher, then you would pay that amount.
This tax will increase each year. In 2017 and future years, the higher amount will be based on the rate of inflation. Thus, if your household income is $50,000, your potential tax could be as much as $1,250. NOTE: Don't forget to file IRS Form 1095-A if at any time throughout the year you received a subsidy. You could receive money back if you over-estimated your income.
If you missed Open Enrollment, there are still many low cost Indiana health insurance options that will get you to the next OE period. It only takes a few moments to find and compare the least expensive options that provide the benefits you need.
February 2015 - Open Enrollment for 2015 ends in 10 days. After this date, an SEP will be needed to purchase a subsidized plan. However, as we previously discuss, many other alternatives are offered and can provide coverage for up to 12 additional months.
February 2015 - It's not over! For some persons, that is. If you experienced a computer glitch that resulted in a long delay while you were attempting to enroll (before the 16th), you have until the 22nd to complete the application. This extension also applies to persons that were waiting for income verification, and the delay resulted in missing the original February 15th deadline.
The IRS reported an outage on the 14th that caused many Hoosier residents to miss the deadline because the correct subsidy could not be calculated. To receive the extension, you can not already be covered on an Exchange plan and must give verbal verification of the delays you encountered.
March 2015 - Policy ID cards and benefit brochures have been sent by carriers if you signed up for a 2015 plan. Although billing is often delayed, for March 1 effective dates, payments should have been received. If you are uncertain if a policy is in effect, please contact us. Usually, billing is monthly, either through an electronic withdraw or directly through the mail.
April 2015 - If you did not purchase coverage for 2014, and also have not enrolled in a 2015 plan, the deadline of April 30 expires in less than two weeks. This extended grace period allows you to enroll in a 2015 plan as long as you pay the penalty from last year for not purchasing qualified coverage. Typically, you pay that tax when you file your tax return.
October 2015 - Medicare Open Enrollment for Seniors began on October 15th and continues through December 7th. Existing plans and drug coverage can be changed (or kept) during this time. Hoosier residents under age 65 are not impacted by this OE period. If you received a notice from your carrier that your policy benefits are changing (Annual Notice Of Change Form - ANOC), a review and comparison of plan options should be completed.
Typically, this is the only time of the year that a Medicare Part D or Medicare Advantage plan can be chosen. However, if you are currently enrolled in an Advantage plan, you may opt to change to traditional government-provided coverage.
March 2017 - President Trump's healthcare initiatives have been temporarily halted, as Congress failed to agree on an Obamacare replacement. An alternative proposal, with improved bi-partisan support, will most likely be introduces within 12-18 months.