Different types of health insurance plans meet different needs. When you compare options, it's important to understand how they are structured.
Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.
High Deductible Health Plan (HDHP)
High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1250 per year for individual coverage and $2500 for family coverage.
Catastrophic Health Insurance Plan
A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher. This means you must pay thousands of dollars out-of-pocket before full coverage kicks in.
In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received "hardship exemptions". Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs.
Some states are choosing not to expand their Medicaid programs in 2014. In these states, some people won’t qualify for either Medicaid or lower Marketplace insurance costs.
You should still apply for Medicaid, a program that covers millions of lower-income Americans, because you may qualify under existing rules.
Some states are expanding their Medicaid programs in 2014
The health care law provides states the choice and additional federal funding to expand their Medicaid programs to cover people who make up to 133% of the federal poverty level.
That’s about $15,800 a year for 1 person, or about $32,500 for a family of 4. (These are 2013 figures, and likely to be slightly higher in 2014.)
Some states are expanding their Medicaid programs in 2014. Other states are choosing not to. This leaves some people with fewer options for coverage.
If you have lower income and live in a state that isn’t expanding Medicaid
If you live in a state that’s not expanding Medicaid and you don’t qualify for Medicaid under your state’s current rules, one of two situations applies to you:
If your income is more than about $11,500 a year as a single person (about $23,500 for a family of 4, or 100% of the federal poverty level), you will be able to buy health insurance in the Marketplace and get lower costs based on your household size and income.
If you make less than about $11,500 a year as a single person (about $23,500 for a family of 4), you’ll be able to get insurance in the Marketplace--but you won’t be able to get lower costs based on your income. If you buy insurance in the Marketplace, you will have to pay full price.
Uninsured people in states that aren’t expanding Medicaid don’t have to pay a fee
Under the law, anyone who has health care coverage available and can afford to buy it must have coverage or pay a fee.
But you won’t have to pay this fee if:
you live in a state that isn’t expanding Medicaid to cover people in your situation, and
you don’t qualify for either Medicaid or lower costs on Marketplace coverage. This is called an exemption. You can get an exemption when you apply for coverage in the Marketplace.
Apply for Medicaid, even in states that aren’t expanding it in 2014
Even if your state is not expanding Medicaid, you should apply for coverage to see if you qualify. Your medical needs or unique circumstances might mean you qualify.
You can apply today by contacting your state Medicaid office. Find contact information for your state Medicaid office by using the dropdown menu near the bottom of this page.
You can also apply through the Marketplace as early as October 1, 2013.
People with low incomes in states that are expanding Medicaid
If you live in a state that is expanding its Medicaid program, you will likely qualify for Medicaid coverage if you make up to about $15,800 a year for 1 person ($32,500 for a family of 4). You can apply for this coverage as soon as October 1, 2013. Coverage can begin as soon as January 1, 2014.
You can apply for Medicaid coverage today to see if you qualify under current rules. Even if you are not eligible now, you may be eligible in 2014, when the new rules take effect in your state. You can find contact information for your state’s Medicaid page by using the dropdown menu near the bottom of this page.
You can apply as early as October 1, 2013 to see if you qualify under the 2014 rules. Learn more about Medicaid.
Find out if your state is expanding Medicaid
Use the dropdown menu near the bottom of this page to find contact information for your state Medicaid program. Ask whether the state will expand Medicaid and what its rules will be for 2014.
There is no deadline for states to decide to expand Medicaid coverage. States could decide to offer this coverage at any time.
Why this coverage gap exists
When the health care law was passed, it required states to provide Medicaid coverage for adults with low incomes (up to 133% of the federal poverty level), regardless of their health.
Under the law, the federal government will pay 100% of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.
The U.S. Supreme Court later ruled that states could decide not to expand their Medicaid program.
Some states are choosing not expanding Medicaid for 2014.
This means some low-income people in these states are not eligible for an insurance affordability program in their state -- at least at this time. Their incomes are too high to get Medicaid under their state’s rules but too low to qualify for reduced costs in the Marketplace.
States may decide to expand Medicaid at any time. States are continuing to consider this important decision.
Health care options for those who fall into the coverage gap
The health care law has expanded funding to community health centers, which provide primary care for millions of Americans. These centers provide services either for free or on a sliding scale based on your income.
Learn more about getting care at a community health center.
Get State Information:
Medicaid in Indiana
Each state has different rules about who qualifies for Medicaid. You can find out whether you can get Medicaid in Indiana right now. Even if you don’t qualify now, you may qualify in 2014. Starting October 1, apply on this website or through the Marketplace to find out whether you qualify for Medicaid in Indiana in 2014. Learn more about Medicaid in Indiana.
Who Is Covered?
HIP is for uninsured Hoosier adults between the ages of 19-64. Parents or caretaker relatives of children in the Hoosier Healthwise program are likely candidates for HIP.
The Plan provides:
Why a POWER Account?
What Is Covered
Other Plan Specifics
* Caretaker relatives/parental adults in this income bracket contribute 4.5%, and the childless adults contribute 5%
If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They also have to pay for all of their health care.
When the uninsured need care
When someone without health coverage gets urgent—often expensive—medical care but doesn't pay the bill, everyone else ends up paying the price.
That's why the health care law requires all people who can afford it to take responsibility for their own health insurance by getting coverage or paying a penalty.
People without health coverage will also have to pay the entire cost of all their medical care. They won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
The fee in 2014 and beyond
The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.
In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
It's important to remember that someone who pays the fee won't get any health insurance coverage. They still will be responsible for 100% of the cost of their medical care.
After open enrollment ends on March 31, 2014, they won't be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event.
Minimum essential coverage
To avoid the fee in 2014 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:
Other plans may also qualify. Ask your health coverage provider.
Who doesn't have to pay the fee
Uninsured people won't have to pay a fee if they:
If you don't qualify for these situations, you can apply for an exemption asking not to pay a fee. You do this in the Marketplace.
What kinds of health insurance don't qualify as coverage?
Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include: