Indiana Health Insurance: Healthcare.gov and HIP 2.0 Guide

Indiana's health insurance landscape is defined by two key facts: Indiana uses Healthcare.gov (the federal ACA marketplace — not a state-based exchange) and HIP 2.0 (Healthy Indiana Plan) — Indiana's distinctively structured Medicaid expansion that uses POWER accounts and a HIP Plus/Basic distinction unlike any other state in this series. Indiana's low income tax (3.05% flat) and its large group employer market (Eli Lilly, Elevance Health, Indiana University Health) create specific group health advisory needs. And Indiana's no-individual-mandate position means there's no state tax penalty for being uninsured — though IDOI's strong consumer protection framework still creates specific insurance advisory obligations.

Healthcare.gov — Indiana's ACA Marketplace

Indiana does NOT have a state-based ACA exchange. Indiana residents purchase marketplace coverage through Healthcare.gov — the federal marketplace. This distinguishes Indiana from Maryland (Maryland Health Connection), NJ (Get Covered NJ), MN (MNsure), and CO (Connect for Health CO).

Indiana on Healthcare.gov:

Open Enrollment Period: November 1 through January 15 (federal calendar)

Special Enrollment Periods: standard qualifying life events (job loss, marriage, birth, age 26)

Federal APTC (premium tax credits) for income-eligible enrollees

Indiana does not offer additional state-funded premium subsidies (unlike Maryland's state Premium Assistance program)

Enrollment figures follow national trends — Indiana participates in the federal marketplace without state-level enrollment enhancement programs

Advisory for Healthcare.gov in Indiana: Indiana producers helping marketplace clients navigate Healthcare.gov use the standard federal portal. Unlike MNsure (which requires annual broker certification) or Maryland Health Connection (which requires specific MHC platform knowledge), Healthcare.gov producers follow the standard federal certification process. Indiana producers must complete the federal Marketplace Agent Broker Training annually to assist clients with marketplace enrollment.

HIP 2.0 — Indiana's Distinctive Medicaid Expansion

Indiana expanded Medicaid under the ACA through HIP 2.0 (Healthy Indiana Plan 2.0) — a distinctive, IDOI-approved approach to Medicaid expansion that emphasizes personal responsibility:

Who qualifies: Adults up to 138% FPL (same threshold as standard Medicaid expansion)

POWER Accounts (Personal Wellness and Responsibility Accounts): Indiana's most distinctive Medicaid feature — a health savings-like account funded by:

Employer contributions (if employer sponsors)

Member contributions (sliding-scale based on income)

State contributions

Two coverage tiers based on POWER account participation:

HIP Plus (for POWER account contributors):

More comprehensive benefits

Dental and vision included

No copays for preventive care

Member pays sliding-scale premiums based on income

For members below 100% FPL: state covers contributions; no member payment required

HIP Basic (for non-contributors):

More limited benefits (no dental or vision)

Copays for many services

Lockout penalty: Members who earn above 100% FPL and fail to make POWER account contributions may be "locked out" of HIP for 6 months

Lockout provision is a specifically Indiana enforcement mechanism with no equivalent in standard Medicaid expansion states

HIP Link: A separate HIP component that assists members who have access to employer-sponsored insurance — helps fund premiums for employer plans, allowing members to maintain commercial coverage rather than shifting fully to HIP. HIP Link is specifically Indiana.

Why HIP 2.0 matters for producers:

Producers advising clients at or below 138% FPL need to understand HIP Plus/Basic eligibility to accurately represent coverage options

The POWER account contribution requirement creates an advisory conversation about whether clients should contribute to access HIP Plus benefits

Correctly routing clients between HIP 2.0 and marketplace coverage is an ethics and advisory obligation

Indiana Medicaid — Additional Context

Indiana's Medicaid program (beyond HIP 2.0) covers:

Children under 19 through CHIP and regular Medicaid at higher income thresholds

Seniors and individuals with disabilities through standard Medicaid tracks

Long-term care through Medicaid (subject to spend-down and LTC Partnership program)

No Indiana Individual Mandate

Indiana does NOT have a state individual health insurance mandate or tax penalty for being uninsured. This is consistent with most non-coastal states and distinguishes Indiana from NJ (which reinstated a state mandate in 2019).

Indiana Group Health Market

Indiana's large employer base — Eli Lilly (pharmaceutical), Elevance Health (health insurance), Salesforce (technology), Cummins (manufacturing), Indiana University Health (healthcare) — creates an active group health insurance advisory market.

Elevance Health group health context: Elevance Health (formerly Anthem) is a Fortune 500 health insurer headquartered in Indianapolis. Elevance Health is both a major Indiana employer AND a major health insurance carrier operating in Indiana's individual, group, and Medicaid markets. Producers advising on Indiana group health coverage may be recommending Elevance products to employer clients — an interesting intersection in Indiana's largest city.

Small group market (1-50 employees): Indiana's small employer market has standard ACA requirements:

Guaranteed issue for eligible small employers

Community rating

Essential health benefits required

ACA-compliant plan designs

Self-insured employers: Many Indiana large employers self-insure health benefits (exempt from state insurance regulation under ERISA). Producers serving self-insured employers understand that state insurance mandates don't apply to self-funded plans — relevant for Lilly, Elevance, Salesforce, and other large Indiana employers.

5 Frequently Asked Questions

• What is HIP Plus and why is it better than HIP Basic? HIP Plus is available to Medicaid-eligible Indiana adults who contribute to their POWER account (required for income above 100% FPL; optional but encouraged for income below 100% FPL with state covering contributions). HIP Plus includes dental and vision coverage, lower cost-sharing, and no lockout risk. HIP Basic is for non-contributors — more limited benefits, copays, and the lockout provision that can result in 6-month coverage gaps for non-payment above 100% FPL.
• What is the HIP lockout provision and why is it important for advisory? The HIP lockout provision applies to HIP Basic members above 100% FPL who fail to make required POWER account contributions. These members can be locked out of HIP coverage for up to 6 months — creating a coverage gap. For producers advising clients at risk of HIP lockout, understanding the contribution requirement and helping clients plan for continued coverage during lockout periods is a genuine advisory service.
• Does Indiana have annual broker certification for Healthcare.gov? Yes — producers who assist Indiana clients with marketplace enrollment through Healthcare.gov must complete the federal Marketplace Agent Broker Training annually (before each open enrollment period). This is a federal CMS requirement, not an Indiana-specific requirement, but it applies to all Indiana producers who assist with marketplace enrollment.
• How does Elevance Health's dual role as employer and insurer affect Indiana advisory? Elevance Health is both a major Indiana employer (employees with group health benefits, 401(k) plans, and individual supplemental insurance needs) and a major health insurance carrier in Indiana's markets. Producers who build relationships with Elevance Health employees advise clients who have deep health insurance knowledge — the "sophisticated client" dynamic requires genuine advisory value rather than generic product pitching. Producers who also advise Indiana employer groups on carriers may be recommending or evaluating Elevance products for group health accounts.
• Does Indiana have state health insurance mandated benefits beyond ACA? Yes — Indiana has state-mandated health insurance benefits that apply to fully-insured Indiana policies. Verify current Indiana mandates at in.gov/idoi — the specific mandated benefits, mental health parity requirements, and other Indiana-specific requirements affect fully-insured individual and small group plan designs. Self-insured ERISA plans are exempt from state mandates.

Serve Indiana Health Insurance Clients With Expert Knowledge

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