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Health Insurance Marketplace Information

This webpage offers information about the Marketplace Plans, also called Quality Health Plans, as well as the new HIP 2.0 coverage.

Next Marketplace Enrollment Period  - Nov. 1, 2015 - Jan. 31, 2016.  Exception - Special Enrollment Periods 

Apply for HIP, CHIP and Medicaid anytime.  No enrollment periods

HIP 2.0 Highlights

At any time, residents can now enroll for HIP 2.0 online, by phone, the DFR office or in person with a navigator. For information on how to enroll in the Healthy Indiana Plan (HIP), visit www.HIP.IN.gov or call 1-877-GET-HIP-9. (1-877-438-4479).  On this webpage, find links to the online application, comparison of the three MCEs' plan features, helpful resources for providers that including income eligibility chart.  

The New Healthy Indiana Plan (or HIP 2.0) is a health insurance program from the State of Indiana that pays for medical expenses and provides incentives for members to be more health conscious. HIP 2.0 provides coverage for qualified low-income Hoosiers who are interested in participating in a low-cost, consumer-driven health care program.

WHO IS ELIGIBLE? Indiana Residents ages 19-64 with incomes up to $16,297 annually for an individual, $21,967 for a couple or $33,307 for a family of four are generally eligible to participate in HIP 2.0.

WHAT'S COVERED? There are two distinct levels of coverage: HIP Plus and HIP Basic. Each covers medical expenses such as doctor visits, hospital care, therapies, medications, prescriptions and medical equipment. HIP Plus offers members the best value including vision, dental care and bariatric surgery.

Direct link to the HIP 2.0 application is online.  https://secure.in.gov/fssa/hip/2442.htm  The online application will assign consumer to the appropriate Medicaid program, e.g. CHIP, HHW, HIP, etc. Applicants may apply for themselves and their family members with one application.  Household income and social security numbers will be needed.   

Applicants may select their preferred provider and plan at the time of application to ensure families stay together if there are adequate panel openings.

Provider reimbursement for HIP is the Medicare Rate or 130% of Medicaid rate if no Medicare rate exists. (exception: inpatient claims for low income parents, caretakers and 19 - 20 year old are reimbursed at the HHW rate.)

If members schedule a wellness visit they will be able to roll over any left over funds in their Power Account and apply them to their HIP Plus monthly contribution which is 2% of the Household Income or $1 /month if they report no income.      

Marketplace Highlights

For years, millions of Americans were denied coverage; they had limited choices; or they just couldn't afford it. 

The Health Insurance Marketplace is a new, simpler way to purchase health insurance. Consumers are able to compare plans online.  They can't be denied coverage or charged more because of a pre-existing condition. The online application asks consumers a short series of questions, and based upon their answers, they are routed to Indiana Medicaid / HIP or low cost Marketplace Plans. Plans are regional, so plans may vary based upon zip codes.  

8 out of 10 consumers with household incomes between 138 - 400% FPL are eligible for a premium tax credit.  Consumers above the 400% FPL can purchase a QHP; however, there will be no premium tax credits to lower the price of the premium, i.e. similar to traditional commercial insurance plans. 

Indiana's Federally Facilitated Marketplace can be found at  HealthCare.gov.  Consumers can enroll themselves as well as call their 24/7 call center at 1-800-318-2596 (TTY 1-855-889-4325) where help will be available in 150 languages.  If new to insurance, assistance is recommended.  Free assistance is available in most counties. 

  • Consumers can find information and apply online.  HealthCare.gov was designed to be user-friendly. The most obvious information for consumers to use to compare plans is the cost, e.g. premium, deductible and out of pocket costs. Consequently, new consumers need education about insurance terms.   Some purchase a plan with the lowest premium, only to discover that they are in trouble when they learn they are responsible for the full cost of tests and visits until they meet the deductible.   

  • Providers can access and order free educational materials for their patients and official resources by going to marketplace.cms.gov.  The Coverage to Care Booklet is a great resource to help newly insured learn how to use their insurance. These are free and shipped to your office. There are graphics to catch attention for your website and social media.  Select from [GRAPHICS

  • Navigators are trained and certified to help consumers understand health coverage options and assist them with enrollment in a plan. Indiana Navigator Organizations include: ASPIN (serves statewide),IPHCA serves statewide through the FQHCs, and CASI (serves SE counties).  Insurance Agents can assist, but need to use Healthcare.gov website for the premium tax credits. i.e. discounts.   

Healthcare. gov offers a  24/7 call center at 1-800-318-2596 (TTY 1-855-889-4325) where help will be available in 150 languages.   

The 2016 penalty is $695/adult and $347.50/child  or 2% of family income, whichever is greater.

SHORT VIDEO RESOURCES:  

 

Use on your website and social media outreach and education. 

CMS Marketplace Matters : This series of videos provided by the Centers for Medicare and Medicaid Services (CMS) provides information about what consumers should include as their annual income in Marketplace applications, items to keep in mind when re-enrolling in coverage, the appeals process, and how to deal with transitions in coverage such as turning 26 or losing job based coverage.

The Affordable Care Act and Taxes:
This series of videos provided by the Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) provides information on the health insurance coverage and taxes, Form 1095, the Individual Shared Responsibility payment, and Premium Tax Credits.

Understanding Health Insurance : The Kaiser Family Foundation put together a series of quick informational and light-hearted videos to make insurance concepts such as premiums, deductibles, out of pocket costs, and provider networks accessible to a wide audience.

Visit Marketplace.cms.gov for more official resources

IRHA is recognized by the Health Insurance Marketplace and CMS as a Champions for Coverage Organization.  

This page was developed to help uninsured Hoosiers and rural providers learn more about coverage available through the Health Insurance Marketplace and answer Indiana's HIP 2.0 questions.

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