Indiana residents looking to enroll in a new individual health plan via the new federally-facilitated Indiana Health Insurance Marketplace may find their choice of doctors and hospitals to be limited by some of the plan options available to them.
FOUR COMPANIES COMPETE FOR IN-NETWORK STATUS
According to a September 14, 2013, article on IBJ.com, “Anthem to omit some big hospitals from exchange network,” most of the major hospital networks in the Indianapolis area will be absent from the Anthem insurance products available via the health insurance exchange. IBJ’s J.K. Wall reports that under Anthem exchange plans, members will have to seek services from the Community Health Network in Indianapolis, Anderson, and Kokomo, or hospitals in neighboring cities of Danville, Franklin, Greenfield, Lebanon, New Castle, and Noblesville or face paying out of network rates or out of pocket for medical costs.
However, Indianapolis-based MDwise has succeeded in bringing in IU Health, Franciscan Alliance, and St. Vincent into their network for their health insurance exchange plans. Two other companies are currently approved as qualified health plans for Indiana’s health insurance exchange. Physicians Health Plan of Northern Indiana and Coordinated Care Corporation (a subsidiary of Centene Corporation which also administers the Managed Health Services in Indiana) also will provide health insurance options via Indiana’s exchange.
Costs among the plans being offered by the four companies will vary based on the levels available: catastrophic, bronze, silver, and gold. A fifth category, the platinum level, currently has no plans available for Hoosiers. Those levels provide varying combinations of premium, deductible, and out-of-pocket costs for consumers. Lower level plans offer lower premiums and higher deductible and out-of-pocket costs. Higher level plans offer the opposite. All plans offer “essential health benefits” as outlined in the Patient Protection and Affordable Care Act (PPACA), including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, and preventive and wellness services and chronic disease management.
Enrollment in the health insurance exchange begins October 1, 2013, through March 31, 2014, for coverage beginning as early as January 1, 2014. The Health Insurance Marketplace attempts to provide affordable health insurance options for individuals to comply with individual shared responsibility provision of the PPACA. Known popularly as the “individual mandate,” this provision calls for each individual to have health insurance coverage (known as minimum essential coverage), qualify for an exemption, or make a shared responsibility payment when filing a federal income tax return. Some individuals may also quality for subsidy to help cover the cost of insurance.
ICHIA TO BE DISSOLVED
As coverage through the Indiana Health Insurance Marketplace becomes available on January 1, 2014, the Indiana Comprehensive Health Insurance Association (ICHIA), which provides health insurance coverage to high risk Hoosiers who do not qualify for health insurance elsewhere, will no longer accept new enrollment as of October 1, 2013. Additionally, the program will terminate all coverage as of December 31, 2013, since participating individuals will now be eligible for affordable insurance through the health insurance exchange. The program will be officially dissolved as of June 30, 2014. All claims must be submitted by March 1, 2014.
HIP COVERAGE EXTENDED
Also, the Healthy Indiana Plan (HIP), a health insurance option for low-income Hoosiers, was extended by the Centers for Medicare and Medicaid Services (CMS) through December, 31, 2014. Previously, it was scheduled to expire on December 31, 2013 after a one-year extension was granted in September 2012.
In early 2013, the Indiana legislature voted to allow HIP, a consumer-directed Medicaid alternative, to be Indiana’s vehicle for Medicaid expansion provided for in the PPACA. While that option is still being considered by CMS, Governor Pence also requested in April 2013that the current HIP program be extended.
In its approval of the one-year extension, CMS also limited coverage of the HIP program to certain adults with incomes under the 100 percent federal poverty level ($11,490 for a single adult). Previously, program eligibility guidelines included adults with incomes under the 200 percent federal poverty level. This changes means that current HIP members earning between $11,490 and $22,980 will need to seek alternate insurance options as of January 1, 2014, likely through the new federally-facilitated Indiana Health Insurance Marketplace.
MEDICAL MUTUAL PULLS OUT OF INDIANA
Meanwhile, Medical Mutual of Ohio recently announced that they are pulling out of the Indiana, Georgia, and South Carolina health insurance markets to focus on their “core market” of Ohio. In a July 19, 2013, interview with Shameca Kelly of the Savannah, Georgia, NBC-affiliate WSAV, Medical Mutual spokesman Ed Byers said, “Under new regulations, which are vast and quite complex, it is in our best interest to focus on our core market of Ohio where we are headquartered and have been doing business successfully for nearly 80 years.”
For more information about the emerging provisions of the PPACA, review the “Health Reform Implementation Timeline” developed and maintained by The Henry J. Kaiser Family Foundation: http://kff.org/interactive/implementation-timeline/.
For more information about Indiana’s individual health insurance market, review this report from the Indiana Department of Insurance: http://www.in.gov/idoi/files/Individual_Insurance_Market_Report.pdf.
Or to learn more about the new Health Insurance Marketplaces, CMS has developed the following resources:
- 10 Things Providers Need to Know: http://marketplace.cms.gov/getofficialresources/publications-and-articles/10-things-providers-need-to-know.pdf
- 10 Things Patients Need to Know: http://marketplace.cms.gov/getofficialresources/publications-and-articles/10-things-to-tell-your-patients.pdf
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