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home : most recent : statewide implications July 19, 2018

11/1/2017 6:23:00 PM
Nov. 1 is first day for 2018 health care marketplace with enrollment closing Dec. 15
At a glance
The Federal Poverty Level is a measure of income issued every year by the Department of Health and Human Services and used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance.

The 2017 federal poverty-level income numbers below are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program. 2016 numbers are slightly lower, and are used to calculate savings on Marketplace insurance plans for 2017.

$12,060 for individuals
$16,240 for a family of 2
$20,420 for a family of 3
$24,600 for a family of 4
$28,780 for a family of 5
$32,960 for a family of 6
$37,140 for a family of 7
$41,320 for a family of 8

This information was obtained from the website.


Jefferson County
Navigators are available to meet with area residents and answer questions about the Affordable Care Act Marketplace at King’s Daughters’ Hospital by appointment. Contact ClaimAid navigators at (812) 801-0744 or (812) 801-0744 to set up an appointment.

Switzerland County
Navigators are available by phone and email to answer questions about the Affordable Care Act Marketplace. Contact Affiliated Service Providers of Indiana Inc. – or ASPIN – at (317) 471-0000 and by email at or ClaimAid Consulting Corporation at (317) 777-7535 and


King’s Daughters’ Health will be contracting with CareSource, which is available through the Affordable Care Act Marketplace throughout the Courierarea. Although not yet listed when searching providers, spokesman Dave Ommen said the hospital organization expects to be ready to accept the insurance Jan. 1, 2018.

Scott Memorial Hospital in Scottsburg, Kentuckiana Medical Center in Clarksville, Clark Memorial Hospital in Jeffersonville, St. Vincent Jennings Hospital in North Vernon and Dearborn County Hospital in Lawrenceburg are some of the Indiana hospitals already listed as providers on CareSource’s website at

CareSource’s website also lists 430 specialists, 26 primary care physicians and four clinics including LifeSpring Inc. and Cornerstone of Indiana locations as in-network providers within 25 miles of Madison.

The Madison Courier so far has been unable to obtain information about Carroll County Memorial Hospital’s acceptance of insurance through the Affordable Care Act Marketplace. We will continue to try to obtain that information.


• The federal marketplace English-language website:
• The federal marketplace Spanish-language website:
• The federal call center for consumer questions, available 24/7: 1-800-318-2596
• The Kaiser Family Foundation’s FAQ on ACA
• A new campaign to get people signed up for ACA:


The Small Business Health Options Program Marketplace helps businesses provide health coverage to their employees.

The SHOP Marketplace is generally open to employers with 1 to 50 full-time-equivalent employees. If you have fewer than 25 employees, you may qualify for a tax credit if you buy insurance through the SHOP Marketplace.

If you’re a sole proprietor or self-employed with no employees, you can get coverage through the Health Insurance Marketplace for Individuals and Families, but not through the SHOP Marketplace.

To access the SHOP Marketplace visit

Madison Courier

Phyllis McLaughlin and Renee Bruck, Madison Courier Staff Writers

Today is the first day of open enrollment for obtaining 2018 health care through the Affordable Care Act’s federal Marketplace.

Enrollment closes Dec. 15. This is the shortest open-enrollment period since the program was launched in 2014. Previously, enrollment was open through the end of January.

After Dec. 15, only those who qualify for a Special Enrollment Period will be able to get healthcare through the program.

Determining exactly how many people in this area are insured under the ACA has been difficult, but based on information The Madison Courier was able to obtain, it appears around 1,200 plans were purchased through the Marketplace for 2017 in Jefferson and Switzerland counties in Indiana and Trimble and Carroll counties in Kentucky.

Only two insurance providers remain in Indiana’s ACA Marketplace –- CareSource and Celtic Insurance. Only one — CareSource — will serve this area.

MDwise and Anthem participated in 2017 but have dropped out for 2018. Anthem said earlier this year that the change in their decision to stop ACA Marketplace offerings will not affect anyone who has employer-provided health insurance, Medicare Advantage, Medicare Supplement, Medicaid or those who enrolled in “grandfathered” plans that were purchased before March 2010.

CareSource will be the only Marketplace provider available for residents In Jefferson, Scott, Jennings, Ripley, Dearborn, Ohio and Switzerland counties in Indiana and in Trimble and Carroll counties in Kentucky.

The website, where enrollment takes place, says participants who purchased plans for 2017 who do not renew or change their existing plan by Dec. 15 could be automatically enrolled with CareSource in the same plan or in a plan closest to the one purchased last year.

To be safe, however, officials recommend participants log into their Marketplace accounts now to update the application with the expected 2018 income and household information and compare plans.

It is important to remember that the online portal will be shut down for 12 hours every Sunday for maintenance by the U.S. Department of Health and Human Services, which reduces the available time between now and Dec. 15 to sign up for or renew plans.

It is better to start the application process now, said J Hopkins, senior vice president of ClaimAid, which provides certified “navigators” to walk people through the application process.

The first step, Hopkins said, is to create an account on This will enable users to start the application process and, if necessary, log back in to edit any information before submitting the completed application for approval.

During the application process, a user will have to provide information about how many dependents will be on the plan and estimate income for 2018. After that, the user will choose from Bronze, Silver and Gold premium packages.

“The goal is to determine if someone qualifies for a Premium Tax Credit,” which is based on household income and establishes how much an enrollee will pay out of pocket, Hopkins said.

Tax credits or premium subsidies are available to households or individuals whose income is from 139 percent to 400 percent of the Federal Poverty Level.

Tax credits will be applied in advance each month. So, if an enrollee chooses a plan that costs $200 a month and qualifies for a tax credit of $150 a month, the enrollee will pay $50 premiums out of pocket each month. All of that information must be included on the enrollee’s federal tax return for the 2018 fiscal year for the credits to be applied, Hopkins said.

After an application is completed, the enrollee still has time to decide whether to participate in the Marketplace plan, Hopkins said. Once they have coverage, premium and tax-credit information, the enrollee can look at other options that may be available to compare programs, such as private insurers or the state’s Healthy Indiana Plan.

The plan will go into effect Jan. 1 when the enrollee pays the first month’s premium, Hopkins said.

Copyright 2018, The Madison Courier

Editor, John C. DePrez Jr.; Executive Editor, Carol Rogers; Publishers: IBRC and IAR

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