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Indiana Health Insurance Marketplace

With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make healthcare insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.

The following guide offers a glimpse at the various types of ACA-compliant health insurance in Indiana, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.

Health and healthcare in Indiana

Indiana ranked 41st in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include high immunization coverage among adolescents, a low incidence of infectious diseases, and a small disparity in health status by educational attainment. According to the rankings, Indiana’s biggest health challenges include a high prevalence of smoking, high levels of air pollution and low immunization coverage among children.

The U.S. Department of Health and Human Services reported that 132,423 individuals in Indiana selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Indiana enrolled in a marketplace plan increased to 219,185 during the open enrollment period.3

Indiana individual and family health insurance

When the first open-enrollment period began Oct. 1, 2013, Indiana opted to participate in the federal Health Insurance Marketplace. The state’s residents may use Indiana’s federally facilitated exchange to shop for individual and family coverage. Those who buy health insurance through the exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.

However, the Obamacare exchanges are not the only place Indiana residents can purchase qualified health insurance plans. Indiana residents may also shop the private marketplace and find ACA-compliant coverage on websites such as Find out if you qualify for a premium tax credit using’s tax credit subsidy calculator. If you do, visit Indiana’s Health Insurance Marketplace to shop and apply for health insurance.

Indiana’s health insurance exchange:
Indiana department of insurance:

Indiana small group health insurance plans

Small business owners with 50 or fewer employees may purchase group health insurance plans through Indiana’s federally facilitated Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for the Small Business Healthcare Tax Credit.

Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Indiana’s federally facilitated exchange.

Indiana state COBRA variations for small groups

The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit

In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.

Indiana is among the few states that do not have a mini-COBRA or small group continuation law.

Indiana high-risk pools

It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.4

The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.

Indiana Medicaid

Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to

Indiana did not expand its Medicaid program in 2014.6 As a result, there is a coverage gap that includes Indianans who are not eligible for Medicaid under the state’s current qualification criteria but earn too little to receive premium tax credits when shopping the health insurance exchange—those earning 100 to 400 percent of the federal poverty level qualify for marketplace subsidies.

The information below is specific to Indiana’s Medicaid program:

Medicaid expansion No
Governing agency Centers for Medicare & Medicaid
Administrator Indiana Family & Social Services Administration
Where to apply
Additional application options
Phone number 317-713-9627 / 800-457-4584
More information
Open-enrollment period Year-round in all states
Eligibility7 Indiana’s Medicaid programs have different eligibility criteria related to income and family size, age, resources and assets, and medical needs

Indiana CHIP

The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.

In the state of Indiana, CHIP is part of Hoosier Healthwise, Indiana’s health insurance program for low-income individuals and families. The information below is specific to this program:

Program name Hoosier Healthwise
Where to apply
Additional application options
Phone number 317-713-9627 / 800-457-4584
Eligibility8 Low-income children under age 19 living in Indiana, pregnant women, and low-income parents and caretakers of children younger than age 18

1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.”

2 Kaiser Family Foundation

3 Kaiser Family Foundation

4 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014.

5 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” N.D.

6 Centers for Medicare & Medicaid Services. “Indiana.” N.D.

7 Indiana Family & Social Services Administration. “Am I Eligible?”

Indiana Family & Social Services Administration. “Hoosier Healthwise.”–benefits/medicaid-programs/hoosier-healthwise.aspx.