Hoosiers looking for health insurance on the Obamacare marketplace will have another big option next year.
Indianapolis-based Anthem Inc., which quit the program three years ago after racking up huge losses, is jumping back in under a partnership with three hospital systems covering 45 of Indiana’s 92 counties.
Anthem will offer plans in partnership with Indiana University Health in 38 counties stretching from Pulaski County in the north to Orange County in the south, including all of central Indiana.
It will also partner with Union Hospital to offer plans in four counties in the Terre Haute region, and with Methodist Hospital of Gary to offer plans in three counties in northwest Indiana.
People who sign up for the plans will have to get their care from those hospital systems under so-called “narrow networks” in an effort to manage care and keep an eye on costs.
Three other carriers will also offer insurance plans on the marketplace: CareSource Indiana, MHS/Ambetter and US Health and Life Insurance Co.
It’s a key moment for the Affordable Care Act marketplace, to see if other major insurers will follow Anthem back into the program.
Anthem quit the exchange after 2017, saying the individual market was deteriorating and shrinking, making planning and price difficult. The company lost $374 million on its individual health plans on the marketplace in 2016.
But Anthem is now saying that the American Rescue Plan, signed into law on March 11, makes major improvements in access and affordability by increasing eligibility for financial assistance.
“The American Rescue Plan really drummed up a lot of interest in the ACA Marketplace and made the rates a lot more affordable, and increased the subsidies to a lot of people,” Joe Gilbert, vice president of Anthem’s individual and small group sales told IBJ.
Other big insurers, including UnitedHealth Group and Aetna, also jumped out of the marketplace in recent years.
“We’ve seen some the other big carriers go back into other states, like Aetna and UnitedHealthcare,” Gilbert said. “We’re the first big one to go into Indiana.”
Indiana University Health Plans, the insurance arm of IU Health, quit the exchange after 2016, citing “heightened financial uncertainty.” But now IU Health will re-enter the exchange as the provider partner to Anthem.
People who buy an Anthem plan in central Indiana will be required to use IU Health’s doctors and hospitals, which are highly ranked by US News and other ranking organizations.
“The hallmark of this plan is close collaboration between the member’s doctors and health insurer,” IU Health said in an emailed statement.
It added that the two organizations would “work jointly on medical management” of consumers to proactively manage their health.
Enrollment begins Nov. 1 and runs through Dec. 15 for coverage that begins Jan. 1. Enrollment closes Jan. 15 for coverage that begins Feb. 1.
The average monthly premium, before subsidies, for a plan in Indiana is $553 for Anthem, $533 for US Health, $520 for CareSource and $616 for MHS/Ambetter, according to information posted on the Indiana Department of Insurance website.
The new law will lower premiums for most people who currently have a health plan through the marketplace, and expand access to financial assistance for more consumers. Premiums will decrease, on average, by $50 per person per month, or by $85 per policy per month.
Anthem said four out of five enrollees will be able to find a plan for $10 or less a month after premium tax credits, and more than half will be able to find a so-called silver plan (which features low deductibles, copayments, and coinsurance) for $10 or less.
To qualify for a subsidy, your household income must be below 138% of the federal poverty level of $26,500 to qualify. To qualify for a premium tax credit, your household income must be between 100% and 400% of the federal poverty level.
Last year, about 130,000 Hoosiers bought health insurance through the exchange.