All state insurance regulations will be subject to change over the next two years as the full provisions of the 2010 Patient Protection and Affordable Care Act come online. The primary changes that have already taken effect involve children, who may now remain on their parents’ health insurance to age 26 even if they are not enrolled in school, or if they have married. Additionally, children may not be excluded from coverage for pre-existing conditions, a protection adults will enjoy in 2014.
Currently, the states have worked with the federal government to establish high-risk insurance pools for those with pre-existing conditions, and in planning the establishment of health insurance exchanges, which will become active on January 1, 2014.
General Insurance Regulations
In Indiana, if you allow your health insurance coverage to lapse for more than 63 days, insurers have the right to impose a waiting period before a new policy is issued. Group plans must extend the same premium level to all members of the group based on the overall health level of the group. No health insurance policy can be cancelled as long as the terms of the contract are met and the premiums are paid.
Applicants may be turned down for private insurance policies for any reason with the exception of newborns, who are covered under their parent’s policy for the first 30 days of life.
Health Care Exchanges
By an Executive Order from the Governor’s office, Indiana has announced its intention to establish the Indiana Insurance Market, Inc., a nonprofit corporation, however no legislative action has been forthcoming. On May 5, 2011, the Governor signed a bill prohibiting qualified health plans purchased through any health exchange that is formed from covering abortions, except in the case of rape, incest, or a life-threatening condition of the mother.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in Indiana is run by the U.S. Department of Health and Human Services and includes benefits for primary care, specialized care, hospitalization, and prescription medication. Depending on age and option applicable, premiums range from $124 to $532, with deductibles in the range of $1000 to $3000. (There may be a separate drug deductible.) All co-pays are under $40. Out-of-pocket expenses for care in and out of the network may not exceed $7,000 annually.
Medicaid
Medicaid eligibility is figured as a percentage of the Federal Poverty Level. In Indiana, infants under 1 year of age qualify at 200% FPL, while the 1-5 age group is at 133% and includes a 150% FPL qualification for CHIP Medicare Extension benefits. The age 6-19 group is at 100% FPL for Medicaid and 150% for CHIP.
Pregnant women qualify for Medicaid at 200% FPL, parents at 25%, parents and childless adults (HIP qualifed) at 200%, and non-elderly disabled Social Security recipients at 76%.
Medicare
There are more than 958,000 Indiana residents enrolled in Medicare, with some 966,000 relying on Medicare prescription drug coverage. Approximately $6,900 is spent per Medicare enrollee annually.
Indiana Medicare Assistance Programs
The Indiana Association of Area Agencies on Aging (IAAAA) assists elderly citizens in evaluating health insurance plans that will best serve their needs. Additionally, counseling is available to connect with programs that may provide benefits, which can be used to defray out-of-pocket costs.
In addition to these assistance programs, Indiana also offers the State Health Insurance Program, or SHIP, which counsels Medicare recipients with unbiased information and can help with plan selection.
