Answering your insurance coverage questions

We know that insurance regulations can quickly become confusing and stressful in the face of a diagnosis. Below are some frequently asked questions concerning insurance coverage. If you are a patient or family member in Indiana with questions concerning these or other insurance issues, please call 317.871.0000 and ask to speak with an IHTC Insurance Coordinator.

WHO IS QUALIFIED FOR MEDICAID?
WHAT IS GATEWAY TO WORK?
ARE YOU CELEBRATING YOUR 19th BIRTHDAY SOON?
HOW LONG CAN I BE ON MY PARENTS' INSURANCE PLAN?
what are the THREE IMPORTANT FACTS ABOUT MEDICARE?

Who is Qualified for Medicaid?

Medicaid eligibility is determined by several factors and can be complicated. There are several different Medicaid programs, each with slightly different eligibility requirements. While different Medicaid programs have different eligibility criteria, the four main things used to determine eligibility are:

  • Income and Family Size: Household income includes earned income (such as wages from a job) and unearned income (such as Social Security Disability payments). Income limits are based on the number of people in your family. Your income is the amount before taxes, not take-home pay.
  • Age: Eligibility can be based on age. Certain programs are designed for people in specific age groups.
  • Resources and Assets: Certain things you own may be taken into consideration when determining eligibility. Different programs count different resources and assets. Resources and assets are not counted for certain groups, such as children, pregnant women, and former foster children up to age 26.
  • Medical Needs: Specific medical needs may determine your eligibility, or they may also determine which program can best serve your needs. Some programs are designed to meet specific medical needs.

How long will it take someone to get coverage?

Depending on the program applicants apply for, it may take approximately 45-90 days from the date the application is submitted to find out eligibility.

How long does someone keep his or her benefits?

Eligibility for any Indiana Health Coverage Program will typically need to be renewed each year. If eligibility cannot be renewed through the automated process, recipients will be contacted by mail when it is time for enrollment renewal. It is important for recipients to respond to all mail they receive regarding coverage. If enrollment occurs on time, there will be no break in program services. If recipients do not re-enroll, there may be a break in coverage or even lost coverage.

For more information on Medicaid or other health insurance options, please contact an IHTC Insurance Coordinator at 317-871-0000.

What is Gateway to Work?

Gateway to Work is a part of the Healthy Indiana Plan (HIP). It connects HIP members with ways to look for work, train for jobs, finish school and volunteer. The Gateway to Work program begins July 1, 2019, and HIP members might be required to do Gateway to Work activities to keep their HIP benefits. The Indiana Family Social and Services Administration (FSSA) will assign members a Gateway to Work status. The status will be Reporting, Reporting Met or Exempt.

If a member’s Gateway to Work status is “Reporting,” they need to meet a required number of activity hours each month and report them. There are many things the member can do to meet the requirement. Activity hours must be reported using the Member reporting tool or by calling their health plan (Anthem, CareSource, MDwise, or MHS). The health plans can answer questions or connect members with new activities.

At the end of the year, FSSA will look at all the hours members reported and determine if they met their required hours each month. HIP members will need to meet the required monthly hours 8 out of 12 months of the year to keep their HIP benefits. Members can contact their health plan at any time for questions about Gateway to Work.

Gateway to Work Member Status

 Any HIP member can do the Gateway to Work program but some HIP members are required to do it. Based on the information members have reported to FSSA, a Gateway to Work status has been assigned. Every HIP member has one of the following status assignments for Gateway to Work:

  • Exempt – “Exempt" means they meet an exemption for Gateway to Work. Exempt members are not required to participate during months they are exempt, but can if they want to.
  • Reporting Met – “Reporting Met" means a member does not meet an exemption, but has reported at least 20 hours per week of employment to the Division of Family Resources (DFR). They do not need to do anything new for Gateway to Work unless they report a change of employment to DFR.
  • Reporting – “Reporting" means they are required to do Gateway to Work. Reporting members will have to work, attend classes or volunteer and report those activities each month through the member reporting tool. They can also call their health plan (Anthem, CareSource, MDwise, or MHS) to report their hours.

A HIP member’s Gateway to Work status may change during the year if they have a change in work or school status, or if the member starts or stops meeting an exemption.

Schedule of Timeframe for Monthly Required Hours

Gateway to Work’s required activity hours will increase on a set schedule. This is designed to give HIP members time to learn about the program, contact their health plan, find Gateway to Work partners and activities, and set up their member reporting tool account. After July 1, 2020, the required activity hours reach 80 hours per month.

If a member’s Gateway to Work status is “Reporting,” they will need to do qualifying activities for a certain number of hours each month. Hours do not carry over from month to month. The number will start at zero in January 2019 and increase as shown below:

Date                                                           Required Hours Per Month
Jan 1, 2019 - Jun 30, 2019          0 hours
Jul 1, 2019 - Sep 30, 2019           20 hours
Oct 1, 2019 - Dec 31, 2019           40 hours
Jan 1, 2020 - Jun 30, 2019        60 hours
Jul 1, 2020 - Ongoing                  80 hours

For example, in July 2019, if a member does 5 hours of activities each week, they will meet the 20 hour requirement for the month. When the requirement goes up in October 2019, if they do 10 hours of activities each week, they will meet the 40 hour requirement for the month.

For more information on Gateway to Work or other health insurance options, please contact an IHTC Insurance Coordinator at 317-871-0000.

Are You Celebrating Your 19th Birthday Soon?

Turning 19 years old and aging off Hoosier Healthwise (HHW) Medicaid does not mean there are no other options for you. While your HHW may end as your turn 19 years old, the Healthy Indiana Plan (HIP) provides coverage for adults ages 19-64. Learn about eligibility criteria

If by chance you are over income for HIP Medicaid, coverage may be available to you through the health insurance marketplace. Apply for a marketplace policy

If you are employed and your employer offers insurance, employer coverage could also be an option for you.

If you need assistance in determining the best insurance option for you, please contact an IHTC Insurance Coordinator at 317-871-0000.

How Long Can I Be on My Parents’ Insurance Plan?

A dependent may remain covered under their parents’ insurance coverage until they turn 26 years old.

For adults who are turning 26 years old and who will soon no longer be eligible for coverage through their parents’ employer coverage, there are options for you:

  • If you or your spouse are employed and that employer offers insurance, talk to your Human Resources representative to determine your benefits. Because you are no longer eligible for coverage under your parents’ plan, you may be eligible for special enrollment, but it must be done within 30 days.
  • If you are not employed, you may consider a Medicaid plan with the state of Indiana. Learn more about Indiana Medicaid 
  • Another option may be applying for a policy through the Health Insurance Marketplace. Explore this option

If you need assistance in determining the best insurance option for you, please contact an IHTC Insurance Coordinator at 317-871-0000.

DO YOU KNOW THE THREE IMPORTANT FACTS ABOUT MEDICARE?

FACT #1: There is a cost associated with Medicare.
Part A-Hospital services is free for most individuals who have worked 40 quarters (10 years) in their lifetime. Part B-Outpatient services has a monthly premium cost. The standard 2019 premium is $135.50. Part D-Prescription drug coverage also has a monthly charge. In 2018 the average drug plan cost was about $35.00 per month. In addition to the monthly cost there are deductibles, copays, and coinsurance associate with the plans.

FACT #2: Knowing when you should enroll is important. Beneficiaries have a seven month window to enroll. Three months prior to the month of their 65th birthday, their birth month and three months after their birthday. If you begin taking Social Security at 62 years of age you will automatically be enrolled in Medicare at age 65. Some individuals continue to work past age 65. They can delay Medicare Part A (no cost) and delay enrollment in Part B and Part D and continue to participate in their employer coverage.

FACT #3: Medicare beneficiaries have options to fill the gaps in coverage with Traditional Medicare.

  • Option #1: This option includes Medicare Supplements also called Medigap plans. These are insurance plans managed by private insurance companies that are purchased to fill in the gaps in coverage in Medicare. The Medigap policy has a monthly premium but beneficiaries would have very little out of pocket cost. They would pay Medicare deductibles, copays and coinsurance. If purchasing a Medigap policy, a beneficiary will also need to purchase a Part D Prescription Drug plan to help reduce the cost of their medications. While the Part D plans can provide some free and reduced cost medications it too has deductibles, copays and out of pocket costs for the beneficiary.
  • Option #2: This other option is a Medicare Replacement Plan. These plans bundle your Part A, Part B, and Part D into one plan administered by an insurance company rather than Medicare. Medicare Replacement Plans offer low monthly premium however operate more like commercial insurance. They have deductibles, copays and out of pocket costs. Some Medicare Replacement Plans also offer additional benefits not included in Traditional Medicare such as dental, vision, and fitness plans.

Learn how our Patient Insurance Coordinators can help you

Contact Us

If you are in Indiana, call
317.871.0000 or 877.CLOTTER (877.256.8837)