You can still get a nationwide PPO in Indiana, even though the marketplace sells none. Here is how owners in counties with thin marketplace choice are finding better coverage for their families.
Hi, I'm Sam Jaber. I'm a broker in Tampa licensed in 36 states, and Indiana business owners, whether you run a machine shop in Jeffersonville, a salon in New Albany or a landscaping crew in Kokomo, can work with me by phone.
This page focuses on one Indiana situation: the owner whose county has very little marketplace choice. Statewide, Indiana counties have between 2 and 5 marketplace insurers, and in places like Clark, Floyd and Harrison counties, across the river from Louisville, there are only 2. When a family's doctors don't fit either insurer's network, the marketplace can leave an owner with no good answer.
Statewide, HealthCare.gov lists 80 medical plans for Indiana this year, and not one is a PPO. In a two-insurer county the real number of distinct networks you can choose from is small.
You can still get a nationwide PPO in Indiana, and I'll set it up for the family. Each family member answers health questions, the price follows from the answers, and the network includes doctors and hospitals nationwide. For an owner in southern Indiana whose family sees specialists in Louisville, that reach can be the whole point.
Indiana's marketplace plans each rest on one insurer's provider network, and outside it an HMO or EPO usually pays only when it's an emergency. In a county with two insurers, you're effectively choosing between two networks. If your pediatrician belongs to one and your spouse's specialist to the other, no single marketplace plan covers both.
Here's how to test your county:
If that last list is empty, a marketplace plan can work well. If it isn't, a nationwide PPO is worth pricing.
Insurer counts run from 2 to 5 across Indiana, so plenty of rural counties have a short list too, and even a county with more insurers can leave a family stuck if its doctors all belong to one system. The same test applies everywhere: list the doctors, check every network, and see who's left out. It's worth repeating each fall, because the plans an insurer sells in your county, and the networks behind them, can change from one year to the next.
This is where owners most often move to the private side. The insurer reviews each person's health and accepts, declines, or accepts with a stated condition excluded. A healthy household often pays less than the marketplace's full price and keeps every doctor in network, including across the river.
Next step: Send me your county and the family's doctors, and I'll show you both marketplace networks next to a nationwide PPO quote.
That person belongs on the marketplace even at full price, since its plans must accept everyone without pricing in their health. Choose the network that includes their specialists; if neither does, we'll look at how to keep their care as intact as possible.
Next step: Give me the doctors and medicines that person relies on, and I'll run them past both insurers' directories.
In a year when the company can barely pay you, the Healthy Indiana Plan may enter the picture; its adult limit, per KFF, is 138% of the federal poverty level. If you hire someone who isn't an owner or relative, SHOP may become available for a group plan, which can come with different network options.
Next step: If your year or your payroll is changing, call me and we'll re-run the options before you renew.
Straight answers, no sales pitch.
Between 2 and 5, depending on the county. Clark, Floyd and Harrison counties have 2.
No marketplace PPO exists in Indiana this year. For a healthy household, a private nationwide PPO is the way to get one, and I can arrange it.
A group plan via SHOP requires at least one employee from outside the owners and their relatives.
If household income stays at or below HIP's limit, 138% of the federal poverty level according to KFF, it might.
Name your county, list the family's ages, and give me a rough figure for company profit. You'll see the full set of marketplace choices in that county beside a private PPO.
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