Having medical insurance provides peace of mind in the event of an illness, accident or other medical emergency. You can receive lower costs for services, such as visits with doctors who are on your plan, or on prescription medications that are on your formulary (or approved list of medications).
Under the Affordable Care Act
Health insurers cannot refuse to sell you coverage because of a preexisting condition.
Health insurers cannot charge you far more after an illness or injury or because you were born with or developed a preexisting condition.
Health insurers cannot “rescind” your coverage after a serious diagnosis to avoid paying for your care.
Health insurers cannot drop your children from your family policy after their 18th birthday if your kids didn’t or couldn’t stay in school. Now they can stay on your policy until they turn 26 if they can’t find a job that offers coverage.
If you lose your job, you’re far more likely to find a policy you can afford, especially if you’re eligible for a federal subsidy.
If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. (The fee is sometimes called the "penalty," "fine," or "individual mandate.") This fee is paid when you file federal taxes for that year.
You will pay either the higher of 2.5 percent of your household income (up to the cost of the yearly premium for the national average price of a Bronze plan sold through the Marketplace) or a per-person fee of $695 per adult and $347.50 per child under 18, up to $2,085.
You owe the fee for any month you, your spouse, or your tax dependents don’t have qualifying health coverage.The fee is paid when you file your federal tax return for the year you don’t have coverage.
In some cases, you may qualify for a health coverage exemption from the requirement to have insurance. If you qualify, you won’t have to pay the fee.
Indiana’s health insurance program for Healthy Indiana Plan now covers households with incomes up to 138% of the federal poverty level. That works out to $16,243 a year for one person or $33,465 for a family of four.
What is Healthy Indiana Plan?
Healthy Indiana Plan, or "HIP 2.0," is offered by the State of Indiana and pays for medical costs for members and could even provide vision and dental coverage. It also rewards members for taking better care of their health. The plan covers Hoosiers ages 19 to 64 who meet specific income levels.
Can I get HIP 2.0 insurance?
Healthy Indiana Plan covers Indiana adults who meet the following criteria:
Income under approximately 138 percent of the federal poverty level (FPL)
Not eligible for Medicare or other Medicaid coverage
What HIP 2.0 health insurance plans does Franciscan accept?
The plan you enroll in determines whether you can use your local Franciscan Alliance hospital or physicians. To use your health insurance at Franciscan, you must choose one of the following insurance companies:
Indianapolis/Central Indiana, including Carmel and Mooresville: Anthem or MHS
Lafayette/Western Indiana: Anthem or MHS
Northern Indiana: Anthem or MHS
How do I apply for Healthy Indiana Plan?
You can apply for HIP 2.0 any time of the year. Call 1-877-GET-HIP-9 to find more information about the application process or to locate your nearest Division of Family Resources (DFR) office. Send in the application with all required information. Apply online at in.gov/fssa/hip/2450.
In Indianapolis, by visiting the Franciscan Neighborhood Health Center at Garfield Park
At enrollment events in the fall (see upcoming events, below)
To complete the application, you will need:
Social Security numbers (or document numbers for legal immigrants) for you and your family
Employer and income information (pay stubs or W-2 forms) for every member of your household who needs coverage
Information about any current coverage you have
Information about health plans that you and your family are offered from the company where you work, even if you are not covered by that plan
Number of people living in your house that may need health insurance
The Health Insurance Marketplace – called the “Marketplace” – can help you get health insurance coverage that meets your needs and fits your budget. You can enroll Nov. 1, 2016 through Jan. 31, 2017. You can enroll in or change plans outside of open enrollment only if you qualify for a Special Enrollment Period. This includes getting married, having a baby or losing other health coverage.
What is the Marketplace?
The Marketplace is one way to find affordable health insurance. It can help you if you don’t have coverage or if you have it but want to look at other options.
The Marketplace will tell you if you or your family members can get free or low-cost coverage through Medicaid (such as Healthy Indiana Plan – HIP 2.0) and Children’s Health Insurance Program (CHIP).
When you go online to the Marketplace at www.healthcare.gov, you can review all of the health insurance plans in your area and compare your options. If you currently have medical insurance, you can also find out if you qualify for health plans with a lower monthly payment and learn about plans with lower out-of-pocket costs for medical visits or prescription medications.
Can I get Marketplace insurance?
You may be able to buy health insurance through the Marketplace if you:
Live in the United States
Are a U.S. citizen or national (or you are legally present)
Are not currently in jail or prison
What Marketplace health insurance plans does Franciscan accept?
There are several insurance companies that sell medical plans on the Marketplace.The plan you enroll in determines whether you can use your local Franciscan Alliance hospital or physicians. To use your health insurance at Franciscan, you must choose one of the following insurance companies:
Indianapolis/Central Indiana, including Carmel and Mooresville: MDwise or United All Savers
Lafayette/Western Indiana: Anthem, MDwise, MHS Ambetter, United All Savers
Northern Indiana: Anthem, MDwise, MHS Ambetter, United All Savers
Unlike other health insurance programs, you can apply for Medicaid any time of the year. You can find out if you qualify by contacting your state Medicaid agency or by filling out an application through the Health Insurance Marketplace.
What is Medicaid?
In Indiana, there are several Medicaid programs:
Hoosier Healthwise is Indiana's health care program for children and pregnant women.
Hoosier Care Connect covers a variety of individuals who are not eligible for Medicare, including:
Individuals receiving Supplemental Security Income (SSI)
The Traditional Medicaid program is for individuals who have both Medicaid and Medicare, for individuals who are residing in long-term care facilities, receiving home and community-based waiver services, or are refugees.
Can I get Medicaid for my health insurance?
There are many categories of eligibility and several different Medicaid programs. While different Medicaid programs have different eligibility criteria, in general four main criteria are used to determine eligibility.
Income/Family Size: Both earned (wages from a job) and unearned income (Social Security Disability payments). Income limits are adjusted to account for the number of people in your family.
Age: Certain programs are designed for people in specific age groups.
Resources/Assets: Certain things you have are taken into consideration when determining eligibility. Different programs count different resources/assets.
Medical Needs: Specific medical needs may determine your eligibility, and they may also determine which program can best serve your needs. Some programs are designed to meet the medical needs of a targeted group.
Benefits you get now (or got in the past), such as Social Security, Supplemental Security Income (SSI), veterans' benefits, or child support
Family and tax relationship information
If you are aged, blind, disabled, or receiving Medicare, the amount of money in your checking accounts, savings accounts, or other resources you own
Payments for adult or child care health coverage and/or medical benefits you currently have
Help Affording Health Insurance
Even with healthcare reform, thousands of working Hoosiers struggle to afford basic health care or their employer’s health plan coverage.
There are options that may help.
HIP Link is a new premium-assistance program that helps eligible, working Hoosiers afford their employer-sponsored health insurance plans.
Employees who qualify for HIP Link must HIP eligibility requirements, and their employers must register their health plans with the state to participate. Once an employee is enrolled in the employer-sponsored health plan, the employer will deduct the cost of premiums charged from the employee’s pay, per normal procedures. In turn, the State will reimburse the employee directly for the amount of the deduction, minus a small contribution made by the employee.
If you enroll in Marketplace insurance and your estimated income falls between 100 percent and 400 percent of the federal poverty level for your household size, you qualify for a premium tax credit. These can be used to help lower your monthly premium.
Before you become sick is the best time to learn your options for medical care. Regular checkups can help you catch problems sooner or get diagnosed more quickly when you are sick. Here’s how to get connected with your health care:
If you don’t have a doctor, find one. Check your plan’s list of providers, ask people you trust, or call (317) 782-6699. Call now to see if that doctor is accepting new patients and to schedule your first appointment. Don’t wait until you’re sick.
Schedule a wellness visit. Your wellness visit helps you and your doctor get to know each other and address any health concerns before the problems become worse. Bring your photo identification (like a driver’s license), insurance card and any forms they mail you. Share with your doctor your family health history, medical records, medications you are taking and questions and concerns about your health. You should schedule a wellness visit yearly, and your insurance company may cover one wellness visit each year at no cost to you.
Learn about your health coverage. Know if you will need to pay monthly premiums or POWER account contributions, and what co-payments and deductibles may be charged if you need medical care or prescriptions.
Ask for a specialist referral, if you need one. Work with your primary care physician to identify any specialists you may need to see. They can refer you to a specialist in your area if you need additional care. There are specialists for a variety of conditions from heart care to diabetes management.