Frequently Asked Questions

What is the Health Insurance Marketplace?

MDwise Marketplace is part of the Health Insurance Marketplace created under the Affordable Care Act. Open enrollment for 2017 coverage is now closed. You can still enroll for 2017 coverage for the remainder of the year if you have a qualifying life event. MDwise Marketplace is not offering plans in 2018, but you can check healthcare.gov during open enrollment for other coverage options.
 

Who is MDwise?

MDwise is a nonprofit health insurance company with more than 20 years of experience taking care of Hoosiers. With our large network of doctors, specialists and hospitals throughout the Indiana, we can help you make wise choices about your health and the health of your family. MDwise is accredited by a national organization that measures the quality of health care. It is called the National Committee for Quality Assurance (NCQA). MDwise takes pride in providing Indiana families with quality and affordable health coverage for the whole family.


Why Choose MDwise?

  • MDwise has Indiana’s top ranked doctors and hospitals in-network and close to home. Our network includes Eskenazi Health, Franciscan Alliance, Indiana University Health, Parkview Health, St. Joseph Health System and St. Vincent Health. This means our members have access to an extensive network of doctors and hospitals.
  • MDwise knows your community and how to help you. We offer quality service that results in high member satisfaction.


What Free Services are Included with MDwise Marketplace Plans?

MDwise Marketplace members get FREE preventive care. You won’t have to pay a copay or coinsurance for these services. They are grouped into three categories:


Who Qualifies for MDwise Marketplace?

You could qualify for MDwise Marketplace if you meet all of the following requirements:
  • You are a U.S. citizen or national. Or you are a non-citizen who is lawfully present in the United States for the entire period for which enrollment is sought.
  • You are between the ages of 0–64.
  • You aren't currently incarcerated.
  • You live in Indiana.


Can I Apply for MDwise Marketplace If I Have Health Coverage Through My Employer?

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs on premiums or out-of-pocket costs in the Marketplace, regardless of your income and family size, unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums. Employer coverage is considered unaffordable if the employee’s total premium cost for the year, for self-only coverage, is greater than 9.5 percent of the annual household income.


Do I Qualify for a Lower Monthly Premium or Out-of-Pocket Costs?

You can qualify for a lower monthly premium or out-of-pocket costs for services if your total household income is below 400 percent of the federal poverty line (FPL). Click our income guidelines page to see how it works based on family size and income level.


What Are the 10 Essential Health Benefits?

All MDwise Marketplace products include 10 essential health benefits. They are required under the Affordable Care Act. It includes:
  1. Ambulatory patient services (care you get without being admitted to a hospital, like at a clinic or doctor’s office)
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care (care given to women during pregnancy and care after baby is born)
  5. Mental health and substance use disorder services, including behavioral health treatment (care for mental health and substance abuse)
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management (includes routine physicals and immunizations/shots)
  10. Pediatric services (services covered for children, includes vision care)


How Do I Find a Doctor Close to Home?

When you sign up for MDwise Marketplace, you will choose a doctor (also called a primary medical provider, or PMP). The doctor you choose will be part of a hospital delivery system. He/she will work with you to keep you and your family healthy. MDwise Marketplace provides access to the top doctors and hospitals in Indiana. Find a doctor in the wide MDwise network that is close to home.
 

What Health Coverage Options Do I Have?

MDwise offers three categories of Marketplace insurance, called metal levels. The right plan for you and your family depends on your health and financial situation.

Bronze offers the lowest monthly premium, with the highest cost sharing structure. This means you will have higher out-of-pocket costs, including copays, coinsurance and deductibles. While you will pay less for your insurance each month, it will cost more when you go to the doctor to get care. You may prefer this plan if you are healthy and don’t anticipate many doctor visits or prescriptions.

Silver offers the second lowest premium and has smaller out-of-pocket costs than bronze. If you qualify for subsidies, this plan will have lower out-of-pocket costs than Bronze. If you qualify for subsidies, you must choose a Silver plan to get the savings. If you qualify for these savings, you’ll get the out-of-pocket savings benefits of a Gold plan for a Silver plan price. You can choose any category of plan, but you’ll only get the out-of-pocket savings if you enroll in a Silver plan.

Gold has the highest monthly premium but a smaller out-of-pocket maximum. You will pay more for your insurance each month but will pay less out-of-pocket costs. This could be the best choice if you think you will need a lot of medical care and regular prescriptions.


How Do I Know What Prescription Drugs Are Covered?

A searchable list of drugs and participating pharmacies is available by selecting the links below:


When Can I Apply?

Open enrollment lasts from November 1 to January 31 every year. You can enroll in MDwise Marketplace outside of this time frame if you have a qualifying life event
 

How Can I Apply?

MDwise is here to help you understand the Health Insurance Marketplace.

  • We can help you apply over the phone. Call MDwise Marketplace customer service at 855.417.5615.
  • Complete this form and someone will contact you to help you apply for coverage.


How Do I Pay My Premium?

If you have a monthly premium, MDwise provides several payment options. Learn more about how to pay your premium.
 

What if I Don't Have Health Insurance?

If you can afford health insurance but do not have coverage, you may have to pay a fee. This will be taken from your tax refund amount at the end of the year. In addition to paying a fee, if you need to go to the doctor or hospital you will also have to pay the entire cost of all your medical care. You won’t be protected from medical bills that could be very expensive.


What Other Programs and Services Does MDwise Offer?

MDwise offers many extra programs and services to help you and your family stay healthy. Below are some of the programs we offer to our members.