Can you get free healthcare in Indiana? A legitimate policy that covers office visits, prescriptions, hospital stays, the ER, maternity and most other medical expenses? Thanks to Obamacare, the Indiana Health Exchange and "The Affordable Care Act," Hoosier residents can qualify for the federal subsidy that can potentially pay up to 100% of premiums. Many persons refer to this as a very gratuitous Marketplace.
Who Gets Free Coverage?
Actually, millions of persons will qualify for this benefit. Under the ACA legislation, your household income and how it relates to the "Federal Poverty Level" calculation (FPL) determines how much financial aid you will receive. If the amount is between 100% and 400% of the FPL. you're entitled to assistance. You can possibly qualify for Medicaid if you are at or below 100% of the FPL. You would not have to pay for coverage, and you could transfer benefits to Medicaid when you turn age 65.
For incomes above the 100% level, using the diagram a few paragraphs below, substantial amounts of your Indiana healthcare costs will be covered. For example, a 30 year-old single person making about $17,000 per year could purchase a "Bronze" level policy for about $22 per month. A Silver option would still keep the premium under $50 per month. At age 45, the monthly premiums would actually reduce to $10 for the Bronze option.
At $25,000 of income per year, the same 30 year-old will pay about $112 and $133 respectively per month for the two plans. However, with one child added, the dependent may be eligible for CHIP. That's free healthcare in Indiana, courtesy of the new federal subsidy.
Platinum and Gold options are available and have lower deductibles and copays. However, prices are higher, and they typically are most cost-effective for high-income earners with expensive treatment resulting from existing conditions. Prescription coverage is much more robust on these types of plans.
For higher incomes, premiums increase. For example a single 40 year-old with an income of $50,000 per year receives no aid for the Silver plan and the least expensive rate is approximately $286 per month. However, a Bronze option costs only $263 per month.
For bigger families, the subsidy becomes much greater. Based on $63,000 of household income and a family of four (parents ages 45 with two children), a Silver plan costs about $407 per month. A Bronze plan would only cost about $331.
However, if the parents are age 55 (still two children and same income), the cost of the Silver plan remains relatively unchanged at $393, and the cost of the Bronze plan is only $288! Reducing the household income to $35,000 will result in a whopping subsidy of almost $17,000! Your monthly cost for a Silver plan becomes only $115 per month!
If you have a larger family, you will receive substantial maximum financial help. Let's use an example of 50 year-old parents with five children between the ages of 1 and 25. The household income is $90,000. All children may be eligible for CHIP benefits.However, at the $95,000 income level, a subsidy of approximately $600 per month is offered since no CHIP coverage is available.
NOTE: We used Hendricks County for the previous examples. Graph courtesy of RIM.
Buying Coverage Away From The Exchange
If your higher income prohibits you from qualifying for a tax subsidy, you could be facing large premiums. If you are not being treated for any conditions, you will probably pay for benefits that won't be utilized. But there is help.
However, "Off-Marketplace" policies are designed for residents with larger disposable incomes. Doctors and specialists are usually more accessible since the carriers can often negotiate attractive deals with providers. Pediatric dental services are also required as part of the "Essential Benefits" packet of coverage. But rates on these plans are sometimes less than what is otherwise available. And many of the largest companies offer these policies as options.
Medicaid In Indiana
Although Medicaid was not expanded, the HIP (Healthy Indiana Plan 2.0) has provided coverage for almost 400,000 persons. This program serves low income residents of the Hoosier state that make too much money to qualify for Medicaid. It's similar to an HSA since contributions are made to a savings account (POWER) and all preventive services are covered in full.
Incentives are offered to maintain good health, and persons between the ages of 19-64 are eligible. About 70% of all persons eligible to make contributions are taking advantage of this great feature. Also, the number of available network doctors and other facilities is quite large compared to other State programs.
To be eligible for Medicaid, the requirements are fairly straightforward. The main eligibility criteria is based on how much money you make (from all sources including social security and disability) and the number of family members that will be covered. Your age (see above) is also a factor since specific programs are designed to cover children and/or young adults. SNAP (food stamps) and TANF (cash assistance) may be offered, depending on family income and assets.
Sometimes, the amount of money you have (checking and savings accounts plus other assets) plus your existing medical conditions will be considered. For example, if you are being treated for a chronic illness, you may qualify for an option different than someone with no major issues. Applications can be submitted or by visiting a local DFR office. If you are approved, a welcome packet with helpful tips and instructions is sent to your home.
Four Free Indiana Health Insurance Options
Hoosier Healthwise, HIP, Hoosier Care Connect, and Medicaid, are four free (or nearly free) Indiana health insurance options for low-income, elderly or special-needs residents. Each choice fills a specific need. For example, if you are currently pregnant, Hoosier Healthwise may be the best choice. (picture courtesy of in.gov)
The Care Select program ended on July 1, 2015. Hoosier Care Connect is its replacement. Special medical needs for the blind or disabled are sometimes best served by this program. Some of the specific conditions you must have for eligibility include depression, serious mental illness, heart and kidney disease, diabetes and congestive heart failure. Wards of the court and former and current foster children are often recipients of the available benefits. Behavioral, health, and social problems are discussed and treated.
If you are disabled, M.E.D. Works is an ideal solution. Under this program, you can try working again without putting your Medicaid eligibility at risk. For many years, this has been a major concern of many disabled Hooosiers attempting to return to the workforce. It is important to understand that M.E.D. benefits are "single only" since dependents and your wife/husband are not eligible. Also, your household income must be less than 350% of the Federal Poverty Level (FPL).
Health Exchange rates in Indiana are lower than anticipated. Although free medical coverage isn't available for every adult and child, the new laws are certainly making it easier to purchase low-cost benefits.
December 2014 - The Indiana Family and Social Services Administration (FSSA) is continuing coverage for approximately 10,000 Hoosiers that were originally scheduled to lose benefits on December 31st. The extension will be for an additional four months and will provide extra time to enroll in a Marketplace plan. It's expected that many of these persons will qualify for large federal subsidies that could reduce premiums by 10%-100%.
The FSSA had previously notified many current "Healthy Indiana" participants of the change. Most of these persons had household earnings that were too high to continue to qualify for the low-cost coverage. The guideline was based on 100% of the Federal Poverty Level guidelines. The cost of extending benefits will be paid out of the trust money accumulations.
February 2015 - "Right To Try" legislation is being considered that will help consumers that are terminally ill. Currently available in many other states, the legislation would allow certain patients to use existing drugs that are considered safe, but are not yet ready for national distribution.
Of course, positive results are not guaranteed and not all patients will be candidates. The Food And Drug Administration also hopes to shorten the process of approving medications that would also help anyone in this situation.
August 2015 - Indiana inmates may be getting free healthcare coverage thanks to House Bill 1269 which becomes active in September. Taxpayers may also benefit, since the inmates, by qualifying for Medicaid, will actually cost less to the state. HIP 2.0 enrollment will be assisted by the sheriff, who can also help if/when the inmate is released from the detention facility.
January 2016 - More than 200,000 Hoosiers have signed up for coverage so far (for 2016 effective dates). January 31st is the last day to enroll for a policy without an SEP exception. However, CHIP, Medicaid, and Medicare are available throughout the year, if you meet eligibility requirements.