Category Individual Healthcare

Every year the insurance companies participating in the Indiana Individual Health Insurance market must submit their rates and plan designs to the Indiana Department of Insurance for approval.

Any Hoosier who has had to purchase health insurance in the Indiana Individual Health Insurance market know that we have only a few carriers offering coverage in the last few years. This has bee a point of frustration from network access and cost on premiums and out of pockets. With the impact of COVID, we have seen many Hoosiers lose their employer-sponsored insurance benefits, leading them to the individual market.

For 2021, we have just three health insurance companies participating in the Indiana Indiana Individual Health Insurance market:

  • CareSource Indiana Inc.
  • Celtic Insurance company (MHS/Ambetter)
  • Anthem Insurance Companies, Inc.

CareSource offered health insurance in all 92 Indiana counties in 2020 and will continue in 2021. They have requested an average rate increase of 4.30% for their 2021 plans. They will offer 3 Bronze, 6 Silver, & 2 Gold plans.   

Celtic/ Ambetter- Will offer coverage in all 92 Indiana counties, and the average requested rate increase is 14.30%. They will offer 4 Bronze, 16 Silver, & 4 Gold plans on the exchange.   

Ambetter is also going to offer off-exchange plans in 2021. This is worth noting as these plans may cost less than plans on the exchange. Off-exchange, they will offer 12 silver plans and 4 gold plans in all 92 Indiana counties.

Anthem is going to offer Indiana Individual Health Insurance plans in 8 counties, which is an expanded form 2020. Off-exchange, Anthem will offer a 1 catastrophic plan in Benton, Jasper, Newton, Warren, and White Counties.  

On-exchange Anthem will offer 2 bronze, 1 silver, and 1 gold plan in Lake, LaPorte, and Porter counties. With estimated 700k residents of these three counties, this is Anthem return to the individual exchange market. The cost of Anthem plans higher than CareSource and Ambetter, but depending on which anthem offers, this could be a solution. It would a surprise if Anthems offers their PPO network, but instead, their HMO network called Health Sync.

We hope to have all plans approved and released by the middle of October.

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One question we field almost on a weekly basis is: “What is health insurance going to cost if I retire before 65?” Under the Affordable Care Act, it is not an easy question to answer because everyone’s situation is different.

When trying to budget for individual health insurance it’s important what time of year you decide to retire. Other factors include both incomes, out of pocket expenses, and policy effective date.

medicine, age, health care and people concept - senior woman, man and doctor with tablet pc computer at hospital ward

For Indiana and the rest of the country, an early retiree will have access to the federally facilitated marketplace to purchase an individual insurance policy. One can qualify for premium assistance if their income is under 400% of the federal poverty level. If you retire in the middle of the year, your yearly income could be above that threshold. This would disqualify you for premium assistance. If you retire at the beginning of the year, your taxable income could drop, and you could qualify for assistance. Premium Assistance can be the difference of paying $400 or $1,400 a month per couple depending on when you retire.

The time of year in which you retire could also impact your out of pocket maximum. If you or your spouse have paid toward your deductible or out of pocket maximum. You will want to elect Cobra continuation for the rest of the year. An individual policy will not give you credit for having already paid into your deductible.

From a health insurance standpoint, an early retiree should consider retirement at the beginning of the calendar year.

In 2020, individual health insurance options for Indiana are from just two carriers CareSource & Ambetter. Both carriers only offer their plans through the federally facilitated marketplace. Click here to use our tool to review your options.

If your household income is above 400% of the federal poverty level you will not qualify for premium assistance. With an early retiree, your taxable income may drop below that 400%, which would make the monthly cost more affordable.

For a 60-year-old in Marion County, the lowest costing plan without assistance would cost $716 month. With a projected income of $40,000, your monthly cost drops to $105 for the same plan with assistance. That is a big difference especially if there are two members of the family to be insured.

When it comes to the plan designs, these Indiana health insurance plans have large deductibles and out of pocket maxes. The lowest deductible being offered is $950. This would cost a 60-year-old $1,273 a month without premium assistance. The lowest costing plan would have a $7,700 deductible. Most of the time electing Cobra for 18 months may provide a better plan at a lower cost.

Network access with individual plans may have limitations. It’s important to research each individual carriers’ network. Be sure to confirm you are searing the correct network with your provider. Even if a physician shows in your network, you may want to call their office to confirm. It’s not unusual to have a physician listed as in the network, but who has chosen not to participate anymore. When it comes to retirement, you want to save as much as you can where you can, so it’s important to check all of your options.

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This is Nefouse & Associate’s sixth open enrollment since the affordable care act has gone into effect. We are one of the last Indiana based agencies to still be active in the individual market. There has been a lot of changes, but one thing has stayed the same, costs continue to rise.

We have just two carriers offering coverage in the individual market, Ambetter & CareSource. Both companies will be offering personal coverage through the marketplace in every Indiana county. Insurance companies are required to file their rates and plan for approval with the Indiana Department of Insurance.

  • CareSource average approved rate increase is 4.90%, with an average premium of $532.95.
  • Ambetter average approved rate increase is 18.9% with an average premium of $567

Each plan design and county will have a different increase and some decrease.

  • CareSource will have a -13.8% decrease and as high as 26.9%.
  • Ambetter will have as low as 5.4% increase and as high as 30.60%.

Plan options are continuing to have a large deductible and out of pockets maxes.

Lowest Costing Plans Deductibles:
CareSource $7,700 deductible.
Ambetter $8,150 deductible.

2020 Health Saving Accounts:

CareSource: $5,300 deductible with 50% co-insurance
Ambetter: $6,750 deductible with 100% coinsurance
The Caresource H.S.A is about costs about 10% below Ambetter.

Network Access:
CareSource: Health Maintenance Organization (HMO)
Ambetter: Exclusive Provider Organization (EPO)

CareSource has increased its participating medical providers in central Indiana.
Ambetter appears to have greater network access with EPO vs. the HMO.
It is essential to research your physicians to see if they are participating in these networks. The networks can change, and physicians may not be accepting new patients.

Drug Formulary:
Both offer similar drug formularies, but cost-sharing does vary from plan. Most tier 3 brand name drugs will apply towards the deductible.

The 2020 Individual open enrollment is through November 1st -December 15th.

Use our Quote Engine to review and enroll in health insurance for 2020: https://www.healthsherpa.com/?_agent_id=tony-nefouse.

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