It’s never been easier to shop for a health insurance plan online. Do you still need coverage for the upcoming decade? Use our handy guide before you buy so you understand all of your insurance options.
Best Health Insurance in Indiana:
- Best Overall in Indiana: Ambetter
- Most Affordable in Indiana: CareSource
- Best for Short Term Health Insurance: UnitedHealthcare
- Best for Short Term Health Insurance: Independence American
What is Health Insurance?
Health insurance is a type of coverage that helps you pay for medical bills. Health insurance is important because an accident or illness can strike at any time. If you don’t have insurance and you need to go to the hospital, you could end up stuck with a bill for tens of thousands of dollars.
How does health insurance help you cover your bills? Health insurance works a little bit differently compared to other types of insurance. When you enroll in a health insurance plan, you pay your insurance provider a monthly premium. This premium goes toward keeping your coverage current and is due every month — even if you don’t use your benefits during a certain month.
Most health insurance plans also have a deductible that you need to meet before you can start using your benefits. A deductible is a dollar amount that you need to contribute toward your own medical expenses before your insurance starts to pay out. For example, if you have a plan with a $1,000 deductible, you can’t use your insurance until you pay at least $1,000 out of pocket toward your medical care. Your deductible “resets” at the end of the year. Your premiums don’t count toward your deductible.
Once you meet your deductible, you only pay your coinsurance percentage. A coinsurance percentage is a percent of your medical care bills that you need to cover. The remaining percentage is paid for by your insurance company. For example, if you have a plan with a 20% coinsurance rate and you get a medical bill for $1,000, you’d pay $200 toward this expense. Your insurance company covers the rest. This continues until you hit your out-of-pocket maximum, which is the maximum amount of money you’ll pay toward your care costs.
Most Americans get their health insurance through their employer or a government program like Medicare. However, if you’re self-employed or not eligible for insurance through your workplace, you can buy an independent plan. We’ll go over the different types of plans and how you can buy them in later sections.
Average Cost of Health Insurance in Indiana
The average resident of Indiana pays about $420 a month for a private individual health insurance plan. The specific amount you pay for coverage depends on a number of factors, ranging from your age to whether you use tobacco.
You might qualify for a subsidy from the federal government to cover the cost of your premium if you live in a low-income household. Begin by creating an account on Healthcare.gov, the official government website for the Affordable Care Act (ACA) Marketplace.
Types of Health Coverage
There are multiple types of health insurance plans. Let’s take a look at some of the different plan types you’ll see when you shop on the ACA Marketplace.
- Health maintenance organizations (HMOs): HMO plans are usually the most affordable health insurance option you’ll see on the Marketplace. However, they also give you the least amount of freedom to use your benefits. You’ll need to choose a primary care provider within the plan’s network when you enroll in an HMO. You can only see doctors and care providers in your network and you typically need a referral before you can see a specialist.
- Preferred provider organizations (PPOs): You can see any doctor or specialist you like without worrying about networks with a PPO plan. You also usually don’t need a referral before you can make an appointment with a specialist. PPO plans are more expensive than HMOs but might be worth the money if you want to keep your doctor.
- Point-of-service (POS) plans: POS plans are sort of like a hybrid of HMO and PPO plans. You can see any doctor with a POS plan, whether they’re in your network or not. You’ll save money if you elect to visit an in-network provider. You need a referral from your doctor before you can see a specialist if you have a POS plan.
You may also have the option to buy a short term health insurance plan outside of the ACA Marketplace. Short term plans are exceptionally affordable compared to long-term ACA-compliant plans — but don’t get too drawn in by this low price. Short term plans have much looser regulations and don’t need to provide all of the ACA’s required benefits.
For example, 71% of short term plans don’t offer any form of coverage for prescription drugs and 100% of short term plans don’t cover maternity and pregnancy-related care. These plans can also engage in practices that are now illegal thanks to the ACA. They might drop you from coverage after your medical bills reach a certain dollar amount or deny coverage based on a preexisting condition.
By law, short term health insurance plans in Indiana cannot have a term longer than 364 days and cannot be renewed more than 3 times. A short term plan is not a substitute for an ACA-compliant plan. Only consider buying a short term plan to fill a gap in coverage before you buy a long-term plan.
What Does Health Insurance Cover?
The ACA established a number of essential benefits that every insurance provider needs to cover it wants to sell long-term insurance plans. If you see an insurance plan on the ACA Marketplace, you have coverage for at least the following benefits and treatments:
- Ambulatory patient services: This is treatment and care that you receive without being admitted to a hospital. For example, you might be treated for a UTI in a quick-service clinic.
- Emergency services: Your insurance company needs to cover treatment at any emergency room, even if it’s out of your network. In a true emergency, don’t contact your insurance company or look at your plan benefits before seeking treatment. Always visit the hospital closest to you.
- Hospitalization: This includes overnight stays in the hospital and surgery.
- Prescription drugs: Your insurance company needs to cover all major classes of prescription drugs. However, your insurance company doesn’t need to cover every drug in each category. Your insurance company can require you to try a generic version of brand-name prescription drugs before it’ll cover the non-generic version.
- Preventive and wellness services. This includes preventive services and screenings as well as chronic disease management.
- Rehabilitative and habilitative services. This includes both treatments and devices to help you regain mobile and mental capabilities after an illness or trauma.
- Lab tests. This includes special testing and laboratory work you get to diagnose a health condition.
- Pregnancy and newborn care. Your insurance needs to cover all of the treatments and services you need before, during and after you give birth.
- Mental health and substance abuse treatments. This includes both inpatient and outpatient treatments for mental illness and substance abuse disorders.
- Pediatric services. Your insurance provider needs to cover all essential benefits for any children on your plan, plus dental and vision services.
- Birth control. Your insurance needs to cover birth control if you’re a woman. Your coverage must extend to hormonal, physical and emergency contraceptive methods.
What Does Health Insurance not Cover?
The ACA’s essential benefits are the only federally-required long-term insurance benefits. This means that most plans only cover these services. Some of the most common exclusions you’ll see include the following:
- Dental and vision services for adults: The ACA requires health insurance companies to offer pediatric dental and vision services on all of their plans. However, this mandate doesn’t extend to adult protections. If you want coverage for adult dental and vision treatments, you’ll almost always need to buy a separate plan for each.
- Cosmetic or elective surgery: No health insurance plan will cover a surgery unless it’s medically necessary. It also won’t cover elective medical surgeries like LASIK.
- Travel vaccinations: The ACA only requires insurance companies to cover vaccinations included in the CDC’s list of necessary protections. Vaccinations you need before travel typically aren’t covered by insurance.
- Male birth control: Only female methods of birth control are covered by the ACA’s essential benefits mandate. You’ll almost always need to cover male birth control out of pocket.
Best Health Insurance Providers in Indiana
Now that you understand how health insurance in the United States works, let’s take a closer look at some of the best health insurance providers in Indiana.
- Affordable health insurance plans with generous benefits
1. Best Overall: Ambetter
Ambetter has a lot more to prove than its competitors — it’s one of the newest providers of health insurance in Indiana. However, the company offers a large number of benefits to policyholders. You can earn rewards through Ambetter’s My Health Pays program by sticking to healthy habits and taking an active role in your health.
It also has specific programs and information resources for expecting mothers and you can quickly add both dental and vision services to any online plans. Comprehensive and online-oriented, Ambetter puts a fresh new spin on ACA-compliant health insurance coverage.
2. CareSource
Another top provider of health insurance in Indiana, CareSource provides long-term family and individual insurance solutions. You can use CareSource’s comprehensive website to view plan offerings, find a doctor near you and learn more about which prescriptions are covered on your plan.
CareSource’s customer service team offers assistance for policyholders with hearing impairments and those whose first language isn’t English. Finally, CareSource’s website offers a host of health information that you can use to make this year your healthiest yet.
Best Short Term Health Insurance Providers in Indiana
Are you looking for a short term health insurance plan to fill the gap until open enrollment? Consider a policy from one of these providers.
- Same day coverage available
1. UnitedHealthcare
Looking for an affordable way to fill a health insurance gap? Consider a plan from UnitedHealthcare. UnitedHealthcare offers a wide selection of policies in most parts of Indiana. You can choose from over 15 plan choices with varying deductibles and benefits.
Plans begin at just $61 a month and you can find up to $2 million in benefits. Many of UnitedHealthcare’s plans also include coverage for prescription drugs, which is rarely included for short term plans.
2. Independence American Insurance
Independence American Insurance offers a wide variety of short term plan options. You can get a plan for up to 12 months (the longest allowable by Indiana law) and as short as 30 days.
Plans from Independence begin at $75 a month and many of their plans include generous 20% coinsurance rates. You can easily find up to $2 million of coverage on even the most affordable options and deductibles begin at as little as $2,500.
Get the Coverage You Need Today
Still not totally sure how you can get health insurance and use your benefits? Start by visiting Healthcare.gov. Healthcare.gov is the federal government’s official website for the ACA Marketplace. Create an account on Healthcare.gov, enter a bit of personal information and you’ll be able to view the plan options available to you.
About Sarah Horvath
Sarah Horvath is a highly respected freelance senior copywriter specializing in insurance content. With a wealth of experience, she is recognized as one of the top insurance copywriters in the industry. Sarah’s expertise encompasses various aspects of insurance, including home warranties, life insurance, health insurance, and more. Her insightful articles and guides are regularly featured on major finance sites, providing invaluable information to readers seeking to navigate the complexities of insurance policies. Known for her clear, concise writing style and comprehensive understanding of insurance products, Sarah is dedicated to empowering individuals with the knowledge they need to make informed decisions about their insurance coverage.