Indiana Health Insurance Exchange The Unofficial Health Exchange Resource Site
As the Federal Facilitated Marketplace evolves, we are starting to see the processes put into place to resolve issues. Here you can find the appeal request form. You can request an appeal if you think there was a mistake about you or your family members’ eligibility.
Here are some of the reasons you may want to file an appeal:
- A denial of eligibility for purchasing health coverage, including eligibility to purchase a catastrophic health plan through the
- A denial of eligibility for tax credits or cost-sharing reductions to help pay for coverage through the marketplace.
- The amount of tax credits or cost-sharing reductions you were determined eligible to receive through the marketplace.
- A denial of eligibility for a marketplace enrollment period.
- A denial of eligibility for an exemption from the individual responsibility requirement.
The main issue we see for filing an appeal would be the denial of coverage for Indiana Medicaid, Hoosier Healthwise and Health Indiana Plan (HIP). We have had a lot of Hoosiers get very frustrated with the subsidy application for multiple of reasons, the big one being that they are being told they or their dependents are eligible for one of these programs. These programs are based on income, so if your household income is under the 250% of Federal Poverty Level (FPL) then your children could qualify for Hoosier Healthwise.
There have been a lot of situations where the children would not qualify for such programs but would have to reapply for Hoosier Healthwise. Since it takes 45 -90 days to get a determination form Hoosier Healthwise this has been frustrating to many parents.
Another big issue concerns adults that have low income but that do not qualify for Medicaid. On the exchange, these people are being told they are not eligible for subsidy assistance. This has been very frustrating for a lot of people in Indiana.
Now, we have an appeal process for the marketplace set up. How long this process could take we don’t know yet. You will see in the PDF that we have to mail the appeal letter in. We hope that the marketplace comes up with a solution to email, fax or upload the document directly.
We do think that the processes for the exchange will continue to get faster and easier. As always, if you are frustrated, please contact us so that we can find solutions for you!
The press is reporting that four million people have signed up for health insurance through the marketplace.
In March, the CBO is going to release the exact numbers and we hope it will give a break down of enrollment by state. In Indiana, we have had enrollment numbers around 50,000 policies. 40,000 of those policies have enrolled with Anthem. It will be very interesting to see a detailed report on enrollment numbers.
What is the breakdown of the four million? Is that four million policies or four million belly buttons? What percentage of the four million went onto Medicaid? As you might know, Indiana did not expand our Medicaid. There are still many Hoosiers being steered to Hoosier Healthwise and HIP. There has been a large amount of dependent children that have been deemed eligible for those programs by the marketplace.
It would be interesting see how much the federal government is spending on subsidies. We have written millions of dollars in subsides through our agency alone. We are projecting that subsidies amounts are going to be way over what was originally projected. It is very common now to see an $8,000 per year subsidy for a couple. It will also be interesting to see what the average age is for a marketplace policy holder. Most of our exchange sales have come form Hoosiers in their 50′s while younger people have been reluctant to pay any premium.
We feel the exchange process is now streamlined. There are still problems but we are able to solve a lot of those problems for our clients. If you still need health insurance, you have about one more month to sign up before you get penalized, so contact us today!
Some Anthem plan designs have specific copays for inpatient and outpatient procedures.
If you have an outpatient procedure you could see an additional $500 copay. This could be a shock to a lot of people who purchased plans from the marketplace without local broker representation. If you elected a plan from a non-insurance professional you need to look at your master contract. The contract will have a summary of benefits that will give you a snapshot on what benefits you have.
Network access has been an issue. On the exchange, Anthem is using the Pathway X network and Community Hospital as the main treatment hospital. One should be very aware of where they can get care. There has also been some confusion with the other exchange carriers networks. It seems that our medical community in Indiana has not really stayed on top of what networks they are accepting. You may have elected a plan that gives you access to IU, but the doctors are not accepting that plan. Some in the physician community are considering exchange plans to be Medicaid. This has created some real confusion with many policyholders.
Prescription drug benefits have also been a huge issue. Anthem has a very strong drug formulary. This has created some very positive experiences for Anthem exchange policy holders. We have seen a lot of brand name drugs fall into the 2nd tier drug copay with Anthem and it has been a huge benefit for Anthem members. You may have a script that is $209 dollars a month, but now you can get it for $40 or less.
Anthem has also developed a member portal that has made the process a little bit easier. MyAnthem.com members are now able to go in and see billing statements, policy numbers and even print temp cards. This development has been a big help for Anthem members on the exchange.
The marketplace plans also have the options for Pediatric dental coverage. This has been a topic that has received very little attention. If you have a child under 19 on the exchange plan with pediatric dental coverage, you could have unlimited dental coverage in the network. This is a huge benefit! When thinking about this coverage, you may want to go with a company like Anthem that has experience and paying these type of claims. The dental network is also key in this situation.
The exchange plans really have not had a blueprint. We are now seeing that blueprint of coverage. We are also seeing which exchange companies have the capabilities of being able to service the members of the exchange.
When considering an exchange plan, you should consider using a broker like Nefouse & Associates. We are able to give you the most information on the health policies and how it impacts you and your family. Right now our average subsidy is around $5,000 a year. With this type of financial assistance, electing a narrow network is easier. If you have any questions, don’t hesitate to contact us!
On the healthcare.gov site, the “Life Change” tab has gone live. The “Life Change” tab is very important because this is where you would report life changes. Such changes could impact your subsidy amount or cost sharing reductions.
If there are discrepancies with the data in the marketplace and the carrier, you will have to contact both to make corrections. We are starting to see the marketplace guiding members to the carriers. Unfortunately, wait times are very long and may stay this way for awhile. This is why we urge people to use a local broker to help expedite these types of issues.
If you need to add a dependent to an existing plan, because of a birth or an adoption, you will have to contact the carrier. If you contact the marketplace they will refer you on to the carrier. When the carrier adds the dependent, they are not calculating the additional premium with subsidies or cost sharing. As we understand it right now, the carrier will contact the marketplace and give them the new information. The carrier will follow the marketplace rules for assigning a start date for the dependent.
The big issue for Indiana is that we have had many people that do not qualify for subsidies inside the exchange and informed that they could apply for Medicaid type coverage. We are starting to see letters of declination for some of these Hoosiers. We are still waiting on clarification on how to apply for the subsidies inside the marketplace after a letter of declination has been given.
Changes NOT Affecting Eligibility
You can contact the carrier directly to make the following changes and/or corrections to certain data that does not affect eligibility for coverage in a QHP or eligibility for APTC/CSRs:
- Name spelling corrections
- E-mail address changes
- Phone number changes
- Address changes within the same zip code and county
- Spelling corrections to street name or city name
- Contact method preference changes
- Authorized representative changes
Authorized representation: One should really consider who is representing them with the insurance industry. We are projecting that there will be a lot of claims issue in the future. If you have a local broker or agent, you have someone to represent you with the carrier. This does not cost you anything and really is the best deal. If you or someone you know needs a local broker, let them know about us!
It seems that most medical practices have not been informed on how to file claims under the new plans through the marketplace.
What if you are in the Emergency Room with your loved one and the front desk does not know how to file a claim on the exchange plan?
For Anthem Policies, have them call 1-855-886-6152. This is the Anthem enrollment number. Stress to the medical provider to use the prompt for providers, otherwise they will be on hold for a long time. This will give the medical facility the ability to file medical claims with your ID number or social security number and birthdate.
What if you are trying to fill a prescription and the pharmacy is unable to file a claim?
Give the pharmacy this information: Indiana Bin 3858 PCNA4 ON Exchange WX2A Off the Exchange WL2A. The pharmacist should under stand the bin number and PCN Number.
If they are still having problems, they can call Express scripts help desk at 1-800‐662‐0210. If you have bought an Exchange policy without broker representation, you may want to contact me.
Hoosiers who purchased an Anthem individual health plan with a January 1 effective date now have until January 31 to submit payment for their first month’s premium. This extension applies to individual plans bought on or off the exchange. And coverage will still be effective on January 1, as long as the application was received by the December 2013 deadline.
Initial payments must be received (not postmarked) by January 31. If you haven’t already mailed payment, encourage them to make payment via the Payment Portal. For coverage starting
January 1, ongoing payment for coverage (beginning February 1) is due at the beginning of each month. And please remember that your must receive a payment letter from Anthem with a payment ID before they can make their initial payment
If payment are received after January 31, on-exchange clients must go back to the exchange and request a new effective date. Anthem cannot automatically change the effective date for them. Payment deadline is February 10 for on-exchange clients seeking a February 1 effective date. On-exchange clients can make their initial payments on our payment portal. For off-exchange clients buying online, the initial payment is a built-in feature of the online application process.
For existing clients transitioning to new plans or renewing, the payment deadline is January 31.
Due to many questions about health care reform, such as this one, Anthem service centers are experiencing a high volume of calls. To accommodate the volume, Anthem extended their member service hours from 7 a.m.to 7 p.m. and have added additional representatives to our call centers. Right now Anthem is the only exchange carrier with these level of resources.
Here is the link to Anthem to make payment on your exchange plan.
You will need the Anthem application control number. This would have been mailed out to you. (Snail Mail) You can also call 1-855-886-6152 to get that control number. Your hold time may be around 45 minutes so grab a cup of coffee before you call.
Let me know if you have any questions.
We have been having a lot of success in getting our clients signed up for subsidies through the federally facilitated marketplace.
What we have discovered is that there is new eligibility for Hoosier Healthwise that is having a big impact. If you have children that are under 18 years of age and your income is 208% of the Federal Poverty Level, then your children are eligible for Hoosier Healthwise.
While this is good news, there are two issues we are facing. The first is once the children are removed from the subsidy equation, the subsidy is much less. The second issue is that the application for Hoosier Healthwise can take up to 45 days to process.
This has been creating all kinds of problems. If you are eligible for Hoosier Healthwise then you will want to visit their online site and apply. That is the fastest way to get approval.
Below is the grid for guidance on the eligibility of the exchange.
We are hoping that the Anthem Online Portal will be up and running this week so that you can apply for subsidies. You can visit our website and click “apply now” to see that tab.
Over the years, health insurance has been a major obstacle for those who want to retire before the age of 65. Many people have not had the option of retiring early because of underwriting or the cost of health insurance policies.
With the new health care reform law, people now can retire early. Once underwriting is eliminated, a door opens up to many people to obtain a health policy. Then, with the Federal Facilitated Marketplace (exchange), people can qualify for subsidies. When you are in your late 50′s or early 60′s, these subsidies can be huge. The law states that if you qualify for subsidies then you will only pay a percentage of your household income towards health premiums.
We have had a real life situation where a couple was approved for a $1,600 per month subsidy, which leaves them with a $100 per month premium. The best part of it was when the gentlemen saw his estimated subsidy and said, “hell, I am going to retire early!” This was a great moment for us because I saw first-hand the positive impact of the law. This couple was lucky that all of their doctors were in the network.
While retiring early was not previously an option for many people due to health insurance restrictions, the door is now open for more people to consider. This is just another postive outcome of the Affordable Care Act.
Subsidies are tax credits available through state-based exchanges for middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare. Subsidies can mean that some low-income people will pay almost nothing for insurance, while higher-income people will pay the full market price.
We have had clients get approval through the healthcare.gov site and over the phone. The current administration vowed that the website would be fixed of glitches by November 30, although we are starting to see it work for some clients. It looks like there might be a bit of light at the end of tunnel.
Our subsidy estimates have been very close to what has been issued to our clients. This is also a bit of relief since the government subsidy calculator does not work. After you have an estimate of your subsidy and narrow down your health plan, you can move forward with the subsidy application.
The first step is to run plan designs with estimated subsidies. Then, we choose the health plan option that best fits your needs. I will send you a copy of the subsidy application to prepare you for the questions that will be asked.
Once your subsidy eligibility is determined, healthcare.gov will send that information to the insurance company for the plan you elect. This is call the 834 transaction. The last step is paying your portion of the premium to the carrier and then a policy number should be issued.
Have questions about the Affordable Care Act? Give us a call at (317) 803-4220 and let us find the best rate for you and your family.