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Indiana Health Insurance Exchange The Unofficial Health Exchange Resource Site


A Recent Announcement by UnitedHealthcare

Nov 20 2015

health_insuranceThere has been a recent announcement by UnitedHealthcare in which they may pull out of the exchange market in 2017, Has sent alarms going off!

Currently in Indiana, UnitedHealthcare (UHC) is the parent company to All Savers which offers plan through the market place. It is estimated that All Savers currently insure 28,000 Hoosiers. This plan has be very attractive because of the network access. The network is UnitedHealthcare choice  which is an  Exclusive Provider Organization (EPO). This is a hybrid between a PPO and HMO. It is a large network with no coverage out of network.

UHC, which is the parent company to All Savers and a dozen other exchange carriers, is stating that the exchange market has more risk than expected. They are losing money on the policies that are being bought through the exchanges. It’s estimated that they cover 550,000 people on exchange plans.

That 550K is/was going to triple or quadruple because they doubled their enrollment footprint in the country. For 2016, their plans were going to be offered in states that have huge exchange enrollment numbers.

Florida and Texas combined have over 3 million in exchange membership. Just in those states alone, UHC was/is going to have 2 million more subscribers. With these huge increase in enrollments, UHC is not set up to manage the business nor the risk.

So now UHC is trying to slow the enrollments down and reduce their overall risk exposure.

How does this Impact Indiana?

Essentially UHC could pull out of the exchange market. Leaving a huge void for enrolled members and medical providers.
Current All Saver subscribers have enjoyed being able to access medical services from multiple medical groups.
That is going to change with or without All Savers in the market place.

For 2016, if you are eligible for a tax credit, do you want to take the chance of going with a company that might pull out of the market mid-year?


1st Week of Open enrollment

Nov 06 2015

openenrollmentThis has been another shaky 1st week of open enrollment.

A day before open enrollment began, there were changes from both CMS and the Insurance industry.
These changes had huge impacts on subsidy estimates and even premiums.

The insurance industry was offline for most of this week. They had their IT departments trying to resolve the issues as quickly as they could.
This create a huge barrier for even reviewing plans especially plans that showed cost sharing reductions.

We are still experiencing problems with tax credit estimations. We are seeing some problems with dependent children being eligible for coverage.
Example, you could be a household of 3, with an income of $35,000. The entire family should be eligible for the marketplace plan with tax credits and cost sharing reductions.
The estimators are stating the child is eligible for Children’s Health Insurance Plan (CHIP), but the child is not eligible under the requirements.

$35,000= $2,916 a month

Here are the eligibility requirements taken form www.indianamedicaid.com

Income level for a family of 3

HIP 2.0  =  $2,338

Hoosier Health wise = $2,646

This can lead to frustration with enrollments.

Please contact us with questions.



IU Health Plans

Oct 26 2015

Here at Nefouse & Associates we are excited about the new plans available from IU.

The IU Health Plans are going to be a true HMO. The main providers are IU Medical group but they have enlarged the network with many regional hospitals.
These plans are going to be very competitively priced. The premiums are going to be the lowest in many counties through out Indiana.
Under the Affordable Care Act, it was predicted that large medical groups were going to get into the health insurance industry. We have already seen other plans that are owned by medical groups offer plans in Indiana.  Those plans have encountered obstacles, that have been difficult to over come. Most of that has been infrastructure for managing an insurance company.
We think IU Health plans have prepared for such issues. We will know within 6 months after open enrollment.
With tax credits, eventually the HMO network will be the only option on the exchange.
In other states, HMO plans are the only options on the exchange.
For 2016, IU Health Plans are going to be very competitively priced,  If price is your top issue then you have to look at these plans.
Please contact us for information.

Health Carriers and Additional Benefits

Oct 21 2015

With most of the health insurance companies, they have additional benefits and programs available to their insured members. These programs come along with the premiums and are even available for members that bought policies on the exchange.

Members Portal

This may be the best resource an insured has through the insurance company. The members portal has options from printing temp cards, reviewing claims, researching procedures, wellness programs and even the cost of a procedure.  Now we are seeing the member’s portal available through smart phone apps.  The apps can tell you about network access, how much you have paid towards your deductible and RX options.  If you have the technology, take advantage of these programs. The insurance industry has spent $1 million developing these members’ tools. The truth is most of these programs are coming from the group platform, where employers would pay for them.

One big change with the Affordable Care Act (ACA), is durable medical equipment.  With plans being offered on the exchange, they have limited networks which will lead to limited medical equipment providers. Now you can log into a participating medical equipment provider, input your insurance and doctor info, and then order the equipment. The provider will confirm with your doctor and then it’s applied to the health insurance plan.  A good example is automatic breast pumps. These are free under the ACA, but you have to jump online to order them.  Other interesting things are baby formula for allergies. Did you know that you can order that formula online and it will go towards the health plan?

When shopping this year for your health insurance plan, ask what programs come along with the plan!


2016 Health Insurance Tele Medicine

Oct 13 2015

This year, 2 companies are going to offer tele medicine through their health plans. Anthem and UnitedHealthcare, this is a huge step in the next generation of general medical treatment.  Not everyone will want to use the technology but the ones that do, may have a very pleasant experience.  No waiting to see the doctor or paying high costs at the med check.  These medical professionals will even have the ability to prescribe basic medications.

Just think, jumping on your smart phone and getting treated for the flu in a matter of minutes.

We have been slow to adopt tele medicine at the state level but now it is here. I do think utilizing these types of programs will eventually become main stream.



Open Enrollment

Oct 02 2015

openNovember 1st is the start of this year’s open enrollment for health insurance.

This year enrollments should go smoother for a multiple of reasons.

We now have multiple platforms where you apply for tax credits and enroll in health plans. These platforms are being offered by web based brokers (WBE) like us. (Nefouse & Associates) Essentially these enrollment tools are a side door to healthcare.gov. Instead of an hour enrollment process these platform will take about 10 minutes.  This is a huge plus!

From a carrier selection standpoint, there are options for every situation.

Anthem will be a solid option for those that want a positive experience. Anthem is now in their 3rd year of offering exchange plans. They have developed an internal process to give the members higher level of customer service. They also have development online tools that will help educate consumers on medical conditions.

United Health Care/ All Savers is the option for those that want the broadest network access. They offer an EPO network that includes the majority of medical providers in Indiana and the surrounding states. Their technology is getting better from a billing standpoint and member portals.

Ambetter is the lowest priced option on the exchange. The network is very limited to 28 counties in Indiana. If you live in one of those counties and priced is your main concern, then they could be an option.

IU Health plan is making a push this year for membership. They are going to be competitively priced with access to IU medical providers.

It’s important to research network access before making a decision on a health insurance company.  Not only should you look at the network, but look at the physicians that are accepting new patients.




Humana and Assurant Both Call it Quits in Indiana

Sep 09 2015

exitHumana just withdrew their health insurance rate increase from the Indiana department of Insurance. This means they are not going to offer a plan in Indiana for 2016. They did not offer a plan on the exchange, but was one of the 3 companies to offer a true PPO product for Indiana. The other two were UnitedHealthcare and Assurant. Assurant did offer a PPO plan on the marketplace.

Assurant has exited the individual market for the entire United States.  The lose in the Individual market, was so severe they made the decision to close down.  Now Humana is making a calculation to remove all off the exchange plans in most of the country. This has to do with income loses.

Humana & Assurant offered traditional health plans in a guaranteed issue market.  Why would they not attract high utilizers? For an Insurance company to be successful in the individual market, they cannot offer traditional plans. You can either have access to medical providers or a rich drug plan, you can’t have both and stay in business.

This is really just the beginning of less competition in the Individual market. There will only be a couple of carrier left after 2017.


2016 Health Insurance Rates Approved for Indiana

Aug 28 2015

196199598We posted back in May that all of the individual health insurance companies in Indiana, submitted their plans and rates for 2016.  Those plans and rates have been approved for both the individual and small group markets. This includes on and off the exchange.

All Savers owned by UHC, was approved for a 6.5% rate increase on the exchange.

  • All Savers currently has the most comprehensive network access.

Anthem was approved an avg. 3,8% rate increase on both on and off the exchange.

  • St. Vincent’s in central Indiana is now a part of the Pathway X network.

CareSource was approved for a -5.05% decrease. They had originally asked for a 22% decrease.

  • If they received the 22% decrease, it would have had a negative impact on tax credits.

Celtic was approved for a -7.44% decrease, but their plans have a large variation in premium.

  • Some may receive a 16% decrease, while other are looking at a 23% rate increase.

Humana had asked for a 19% increase, whi was withdrawn.

  • Humana is an off the exchange carrier with a great PPO plan but higher premiums.

IU Health plans was approved for a -16.5 decrease.

  • IU health plans was launched last year and did not pick up a large amount of membership. This year for Hoosiers that receive all their care from IU, it may be an option.
  • Mdwise was approved for a -19% decrease.  Mdwise and IU Health Plans have the same ownership so essentially these two companies are competing with themselves.

Physician Health Plans (PHP) was approved for a 13.50% rate increase. They asked for a 14.5%. PHP is small regional carrier out of Fort Wayne. We hope they have a good year.

Southeastern Indiana Health Organization (SIHO) requested a 6.7% rate increase, but was approved for 8.10%. SIHO is participating in just a few counties in Indiana.

Time Insurance has exited the Individual health insurance market completely.  They had huge loses in 2014 and 2015.

UnitedHealthcare was approved for a 6.7% rate increase. The platinum plan that they no longer market, will receive a 29% rate increase.

Health insurance rates for next year appear to be all over the board. But they really are not because with in these rate and decrease lies the truth. The plans and counties where the carriers had the highest amount of claims are getting high rate inceases. Some plan designs that have huge out of pocket cost up front, may get a 22% decrease. The plans that have rich 1st dollar benefits or low out of pockets, are going to see rates increase as high as 36%.

For Indiana, our premiums were already high comparted to other states that have a healthier population. We could see our rate increase level off in 2017. At that point, companies will have 3 years worth of claims data.  Then the carrier will decide if the individual market is sustainable.


Reinstating Health Insurance Exchange Policies

Jul 28 2015

healthinsuranceMany Hoosiers along with the rest of the country have experienced very frustrating situations with the marketplace.  One big frustration is when tax credits are taken away.  This is a result of some type of verification not being received or the marketplace losing documents that are sent to them. If the documents are not sufficient for verification, the marketplace will not notify the member. This has caused huge issues with keeping health insurance in place.

One option to resolve these issue is to go back to healthcare.gov and try to resolve the issue. Many times the issue can be resolved on the website. The newly established tax credit and plan selection is sent to the insurance company for policy issue.

Here is the problem! Each applicant for tax credit is issued a tax credit application ID number for the entire year.  When one goes back to fix problem, the information is sent back to the insurance company under the same application ID number.  This creates a big problem because now you are responsible for the back premium of that policy with no tax credit. 99% of the time that back premium is not affordable to people making under the 400% of federal poverty level.  This leads to the member not having health insurance because of cost.

This issue has been unforeseen by the marketplace, insurance companies and even knowledgeable brokers like myself.

The solution?

The marketplace has said verbally, that a member that is reinstating their tax credit, and is eligible for a Special Enrollment Period (SEP) “Should Choose a different Insurance company if they don’t want to pay back premium.”

So it does not matter if you are issued a new policy by the same insurance company, you will still have to pay back premium for the old policy. This can create a huge problem for people that have elected certain insurance companies because of network access.



Individual ACA Major Medical Compliant Plans

Jul 02 2015
Individual ACA Major Medical Compliant Plans 2016
All Savers Insurance Company $502.07 6.50%
Anthem Insurance Companies, Inc. $450.42 3.80%
CareSource Indiana Inc. $393.68 -5.05%
Celtic Insurance Company $378.25 -7.44%
IU Health Plans $400.84 -16.50%
MDwise Marketplace, Inc. $403.02 -19.00%
Physicians Health Plan of Northern Indiana, Inc. $458.66 14.50%
Southeastern Indiana Health Organization, Inc. $443.29 6.70%
Time Insurance Company $694.12 26.00%


Above are the Health insurance companies in the marketplace for Indiana. They have submitted their rates to the department of Insurance for 2016.

The rate submitted rate increase is an average for all of their plans. This average really does not tell the full story. This is because each carrier will rate Indiana counties differently.  There may be one county that receives a 27% decrease, while another county may receive a 22% rate increase.

The reason why the rating for each county is so important is because tax credits are based off the 2nd lowest Silver plan. Your current carrier may not have a rate increase on your plan, but the another carrier may reduce their premium. This would then reduce your tax credit if you are receiving one.

By now, everyone knows not all plans are equal.  The plan that is asking for a rate reduction may not have any specialist in the network. So then Hoosiers are faced with paying higher costs because they want a plan that has access.   That doesn’t seem fair!

Then we look at insurance companies that may be lowering their rates to boost membership, so they can bid on Indiana’s Medicaid contract. It doesn’t seem fair that Hoosiers have to pay more because a company is making a strategic move.

This is the new health insurance markets of the Affordable Care Act.

Right now we are estimating tax credits will go down by about 30% for Indiana.  The level of tax credit you are getting will dictate how much of the 30% reduction will impact you. The lower the income, the higher the impact.  Again, not really fair.

All in all, these rates still have to be approved by the state and The Department of Insurance does a good job on making sure the carriers are being honest and Indiana residents are getting taken care of!