Indiana Health Insurance - Federal Requirements
Most health insurance is regulated on the state level. The federal government has several laws that protect Americans and help to assure availability and affordability of health insurance coverage. These include:
The Affordable Care Act - The health reform legislation, signed into law in March 2010, makes significant changes to the U.S. healthcare system. Most of the changes deal with the availability of affordable health insurance.
COBRA - Provides some former employees, retirees, spouses, and dependents the right to buy temporary continuation of group health plan coverage at group rates. COBRA may be an option for health insurance if you have been laid off.
HIPAA - Provides protection for you and your family when you need to buy, change, or continue your health insurance. Among others, these protections include limits on the use of pre-existing condition exclusions and usually guarantees that you can renew your coverage regardless of any health conditions in your family.
A Dr. Mike Tip: If you have concerns about how your employer administers your job-based health coverage - for example, if you think you should have been offered COBRA continuation coverage, but were not - contact the regional office of the U.S. Department of Labor (DOL) Employee Benefits Security Administration. You can find the contact information on the DOL website.
The federal government also funds and sets guidelines for Medicare, Medicaid, Veterans Health Benefits, many federal employees (including members of Congress), and health coverage for members of the Armed Forces.
However, most health insurance plans are regulated by your state government. Since the states differ considerably in the rules they set for health plans – such as mandating certain benefits – and the types of state health insurance programs offered, it is important that you understand what is unique about your state.
Health Insurance in Indiana
People with pre-existing medical conditions
Indiana Pre-Existing Condition Insurance Plan
The Pre-Existing Condition Insurance Plan (PCIP), which is administered by either your state or the U.S. Department of Health and Human Services, may provide health coverage for you if you have been uninsured for at least six months, you have a pre-existing condition or have been denied health coverage because of your health condition, and are a U.S. citizen or are residing here legally.
In Indiana, the PCIP will be run by the U.S. Department of Health and Human Services:
Indiana Comprehensive Health Insurance Association (ICHIA)
ICHIA may offer coverage if you are not able to buy health insurance because you have a pre-existing health condition. You must apply for individual coverage and be rejected by at least one health plan before you become eligible for ICHIA - unless you are eligible for HIPAA. If you qualify for HIPAA, you are eligible for ICHIA regardless of your health status.
Note: On the home page of the ICHIA website, click on “Guest” to find information about the Indiana Plan.
Indiana Medicaid Programs
Indiana’s Medicaid program oversees several of the state’s public health programs each of which is designed to meet the healthcare needs of a certain group of state residents. Each program has different eligibility criteria depending on family income and health status. These programs include:
Indiana's health care program for low income families, pregnant women, and children up to age 19. The program covers doctor visits, medications, mental health care, dental care, hospitalizations, and family planning at little or no cost to the member or the member's family. Hoosier Healthwise includes Indiana’s Children's Health Insurance Program (CHIP).
Healthy Indiana Plan (HIP)
The HIP plan covers individuals who do not live with a dependent child, and parents who earn up to approximately $44,000 annually for a family of four, have been uninsured for six months and do not have access to insurance through their employer. HIP may require you to pay a small monthly fee based on the amount of your income.
Indiana’s Traditional Medicaid provides coverage for people who are in one of the following categories:
- Physically and mentally disabled
- Have both Medicare and Medicaid
- Reside in nursing homes or other long-term care facilities
- Are in a hospice program
- Undocumented aliens
MED Works is Medicaid for Employees with Disabilities. Many disabled people feel that they may be able to return to work, but are fearful of losing their Medicaid benefits. MED Works is a program designed to allow disabled employees to work without fear of losing their Medicaid.
Care Select serves people who may have special health needs or benefit from specialized attention, including individuals who may be aged, blind, disabled, on M.E.D. Works, foster children, and children receiving adoptive services.
Medicare and Senior Health Insurance Assistance Program (SHIP)The Indiana SHIP is a free and unbiased counseling program provided by the Indiana Department of Insurance for Medicare beneficiaries in Indiana. Indiana’s SHIP webpage also includes additional helpful information about Medicare.
Buying an Individual Health Insurance Policy in Indiana
To learn about the different plans available in Indiana speak with an independent insurance agent or broker. One resource is the NAHU, the National Association of Health Underwriters. You also can find information about plans in your area of the state at eHealthInsurance.com or HealthCompare.