Indiana Health Coverage Options for Individuals in 2026

If you’re buying your own health coverage in Indiana, your main options are an ACA Marketplace plan through HealthCare.gov, the Healthy Indiana Plan if your income qualifies, a health sharing ministry, Direct Primary Care, short-term insurance, or a fixed indemnity plan, and Indiana stands out in two ways: it expanded Medicaid in 2015 through a distinctive consumer-responsibility model unlike any other state, and its ACA benchmark premiums remain among the lowest in the country despite a 27% average increase in 2026.

Indiana’s individual market sits at an interesting intersection in 2026. Its Medicaid expansion program, HIP 2.0, uses a Health Savings Account-style POWER Account mechanism that reflects a longstanding state philosophy of personal responsibility in healthcare financing, a philosophy that also makes Indiana unusually receptive to health sharing ministries and Direct Primary Care as coverage alternatives. At the same time, the state’s low benchmark premiums mean that even after 2026’s rate increases, unsubsidized ACA coverage in Indiana can be more affordable than in neighboring states. This guide walks through every coverage option available to Hoosiers buying their own insurance in 2026, what each one costs, and how Indiana’s specific Medicaid structure and regulatory environment shape those choices.

How does Indiana’s ACA Marketplace work?

Indiana uses the federally facilitated exchange at HealthCare.gov for ACA Marketplace enrollment. The state chose not to build its own exchange and has used the federal platform since 2014. According to the Indiana state government’s Open Enrollment Fact Sheet, five carriers offered individual Marketplace coverage in Indiana for 2026: Anthem Insurance Companies, CareSource Indiana, Cigna Health and Life Insurance Company, Coordinated Care Corporation, and UnitedHealthcare. Cigna expanded from eight counties in 2025 to fifteen counties for 2026, improving competition in parts of the state that previously had fewer options.

KFF’s 2026 enrollment analysis found that Indiana Marketplace plan selections declined 16% in 2026, tied for the third-steepest drop of any state alongside Delaware and Arizona, and behind only North Carolina (22%) and Ohio (20%). The enrollment decline reflects a combination of premium increases and the expiration of enhanced subsidies that had made Indiana Marketplace plans particularly affordable since 2021. Indiana’s benchmark (second-lowest-cost Silver) premium remains among the lowest in the country by most national analyses, according to the KFF benchmark premium monitoring table, which has consistently placed Indiana in the bottom five states nationally on this measure. Even after 2026’s increases, Hoosiers generally pay less for ACA coverage than residents of most other HealthCare.gov states.

Open enrollment for 2027 coverage runs from November 1 through December 15, 2026, under federal rules that shortened the enrollment window starting with the 2027 plan year.

How much did ACA premiums increase in Indiana for 2026?

The Indiana Department of Insurance approved an average rate increase of approximately 27% for individual ACA Marketplace plans in 2026, according to WFFT’s analysis of Indiana premium changes, which reviewed IDOI filings directly. The Peterson-KFF Health System Tracker, which reviewed Indiana insurer actuarial memoranda as part of its national 19-state analysis, noted that Coordinated Care Corporation’s filing cited assumptions that the ACA statewide average premium would decrease by 9% due to risk transfer estimates, illustrating the complex actuarial dynamics at work when subsidies expire and enrollment mix shifts.

A worked example from WFFT illustrates the stakes for Indiana households at the subsidy cliff. A hypothetical Allen County couple ages 58 and 57 with combined household income of $85,000 paid approximately $602 a month for a benchmark Silver plan in 2025 thanks to enhanced premium tax credits. For 2026, the same couple, whose income falls above 400% of the federal poverty level and therefore receives no premium tax credit under current law, faces a benchmark Silver premium approaching $1,974 a month, an increase of roughly $1,372 a month or more than $16,000 a year. This specific example reflects Indiana’s combination of a 27% rate increase and the elimination of the subsidy that had previously capped this couple’s costs.

What is the Healthy Indiana Plan, and who qualifies?

Indiana’s Medicaid program for adults is called the Healthy Indiana Plan, or HIP, and it represents one of the most distinctive Medicaid expansion structures in the country. According to KFF’s analysis of Indiana’s Medicaid expansion, Indiana received federal approval in January 2015 for HIP 2.0, a Section 1115 demonstration waiver that covers adults ages 19 through 64 earning up to 138% of the federal poverty level, approximately $1,836 a month for a single individual under the updated 2026 income limits, according to CheckMedicaid’s 2026 Indiana eligibility guide.

What makes HIP 2.0 structurally unique is its POWER Account system. Rather than operating like traditional Medicaid, HIP requires most adult members to contribute to a Personal Wellness and Responsibility account, a health savings account-style fund that covers copays and certain out-of-pocket costs, according to healthinsurance.org’s Indiana Medicaid guide. Contributions equal approximately 2% of household income, as little as $1 a month for the lowest-income members. Members who make their POWER Account contributions receive the HIP Plus benefit package, which includes dental and vision coverage and eliminates copays. Members who miss contributions and have income at or below 100% FPL are moved to HIP Basic, which carries copays and excludes dental and vision. Members above 100% FPL who miss contributions face disenrollment.

This consumer-responsibility structure is one reason Indiana has historically had among the most engaged Medicaid expansion populations in the country in terms of active participation. The POWER Account model also reflects the same philosophical framework that makes Direct Primary Care and health sharing ministries particularly well-aligned with Indiana’s broader approach to healthcare financing.

What are HIP work requirements, and when do they take effect?

Indiana is implementing work requirements for HIP beginning January 1, 2027, making it one of the first states to do so under the federal One Big Beautiful Bill Act of 2025, which mandated work requirements for Medicaid expansion populations nationally. According to the Indiana Capital Chronicle’s reporting on the FSSA’s implementation plans, able-bodied adults ages 19 through 64 on HIP will be required to demonstrate 80 hours a month of qualifying activities, including employment, education, apprenticeships, or volunteer work, or to earn at least $580 a month, to remain eligible.

New applicants starting January 1, 2027 must prove they met the requirement for three consecutive prior months before qualifying. FSSA Secretary Mitch Roob stated that work requirements are not expected to produce cost savings, since the HIP expansion population is funded primarily by the federal government with a 10% state share covered through hospital assessment fees. Exemptions apply for children, disabled adults, the blind, and seniors 65 and older. Hoosiers currently enrolled in HIP should monitor their mailbox for compliance notifications as the January 2027 implementation date approaches.

Who qualifies for ACA subsidies in Indiana, and where is the subsidy cliff?

Premium tax credits are available to Hoosiers with household income between 100% and 400% of the federal poverty level. The lower boundary is the HIP Medicaid expansion threshold: anyone earning below 138% FPL qualifies for HIP rather than Marketplace subsidies. Above 138% FPL and up to approximately $62,600 for a single individual, ACA subsidies are available on a sliding scale through HealthCare.gov.

Cost-Sharing Reductions, which lower deductibles and out-of-pocket costs on Silver plans, are available for Marketplace enrollees between 100% and 250% FPL. Indiana does not have a state individual mandate, so there is no state tax penalty for going without coverage in 2026. For Hoosiers above 400% FPL, no subsidy is available, and the 27% average rate increase, combined with what WFFT illustrated as a potential $16,000-plus annual cost jump for a mid-income couple, makes this the income range where alternatives deserve the most serious consideration.

Is a health share a realistic option for Hoosiers?

Yes, and Indiana has a particularly strong cultural and legislative alignment with health sharing as a model. Indiana is one of the states that has enacted specific legislation favorable to health sharing organizations operating within its borders, reflecting a broader state philosophy that aligns well with the community-based, personal-responsibility structure of health sharing. The state’s POWER Account model under HIP reflects a similar philosophy applied to Medicaid: members who actively engage in their own healthcare financing receive better benefits.

For Hoosiers above the subsidy cliff who are paying full, unsubsidized price for ACA coverage, a health sharing ministry with a long operating history and transparent Member Guidelines offers a meaningful monthly cost difference. Reputable health sharing organizations operating in Indiana have consistently shared members’ eligible medical costs over multiple decades, often with more direct and personal member support than large insurers provide through outsourced call centers, a practical advantage that resonates particularly well in a state where direct accountability in healthcare is a stated value. Health shares are not insurance in Indiana or any other state, their obligation runs to written Member Guidelines rather than to a state-regulated insurance policy, pre-existing conditions are typically subject to waiting periods, and maternity care usually requires a waiting period before becoming eligible for sharing. Hoosiers considering a health share should request and read the complete Member Guidelines before enrolling.

Is Direct Primary Care available in Indiana, and how does it fit as part of a coverage strategy?

Yes, and Indiana has one of the more favorable legal frameworks for Direct Primary Care of any of the states covered in this guide. Indiana enacted dedicated DPC legislation that explicitly defines direct primary care agreements as not being insurance and not subject to state insurance regulation, consistent with DPC Frontier’s tracking of state DPC laws nationally. DPC practices operate across Indiana, with strong concentrations in Indianapolis, Fort Wayne, South Bend, Evansville, and several smaller markets.

DPC membership in Indiana typically runs $60 to $120 a month for an adult, providing unlimited primary care visits, direct physician access, and often discounted labs and generic medications at near-wholesale cost. Starting January 1, 2026, DPC membership fees became HSA-reimbursable up to $150 a month for an individual under a provision of the federal reconciliation law, according to KFF’s summary of the 2025 budget reconciliation law, making the DPC-plus-high-deductible-plan combination more tax-efficient than before. This change is particularly meaningful in Indiana, where the HSA concept is already embedded in the HIP POWER Account model, and where many self-employed and gig economy Hoosiers are already familiar with HSA mechanics.

DPC does not cover hospitalization, emergency care, or specialist visits, so it functions as a primary care layer within a broader coverage strategy. The DPC-plus-health-share combination is particularly popular among Hoosiers above the subsidy cliff who want lower monthly costs without sacrificing primary care access.

What about short-term health insurance and fixed indemnity plans in Indiana?

Both are available in Indiana and are classified as non-ACA-compliant products. Short-term health plans are medically underwritten, can deny coverage based on health history, and are not required to cover the ACA’s ten essential health benefits. Fixed indemnity plans pay predetermined cash amounts per covered event and are typically sold as supplemental coverage rather than a replacement for comprehensive insurance.

Indiana does not have a state individual mandate, so there is no state penalty for choosing either of these non-ACA options over comprehensive coverage. For Hoosiers who have left the Marketplace due to 2026’s premium increases, these products represent some of the available alternatives, though the same trade-offs apply in Indiana as elsewhere: neither provides guaranteed issue, neither covers pre-existing conditions the way ACA plans are required to, and neither provides the same legal payment guarantee as a regulated insurance policy.

Which option makes sense at each income level in Indiana?

For Hoosiers earning below approximately $22,000 as a single adult (138% FPL), HIP 2.0 provides comprehensive Medicaid coverage with small POWER Account contributions, eliminating any need to use the Marketplace and closing the coverage gap that still affects non-expansion states. HIP Plus, available to members who make their POWER Account contributions, includes dental and vision coverage alongside standard medical benefits. Applications are available through FSSABenefits.in.gov or by calling 1-800-403-0864.

For Hoosiers between 138% and 400% FPL, an ACA Marketplace plan through HealthCare.gov is the strongest financial option for most people, particularly since Indiana’s benchmark premiums remain among the lowest in the country even after 2026’s increases, and since Cost-Sharing Reductions on Silver plans below 250% FPL provide significant additional out-of-pocket savings.

For Hoosiers above 400% FPL, Indiana’s combination of low benchmark premiums and strong health sharing and DPC cultures makes the alternatives particularly worth comparing. The specific $16,000-plus annual cost jump illustrated by WFFT’s Allen County example applies only to households near or above 400% FPL who previously relied on enhanced subsidies. For this group, a health sharing ministry, DPC-plus-Catastrophic combination, or Farm Bureau-style alternative (where available) can lower monthly costs substantially, with the trade-offs in each case being a non-insurance or non-ACA-compliant structure rather than guaranteed coverage.

Frequently Asked Questions

Do Indiana residents use HealthCare.gov or a different website for ACA enrollment? Indiana residents enroll through HealthCare.gov, the federally facilitated Marketplace. Indiana chose not to build its own state exchange. Five carriers offered plans in Indiana for 2026, including Cigna, which expanded from 8 to 15 Indiana counties for the year. Licensed agents, Navigators, and online enrollment partners are available at no additional cost to assist Indiana residents.

What makes Indiana’s HIP 2.0 Medicaid program different from regular Medicaid? HIP 2.0 uses a Personal Wellness and Responsibility (POWER) Account system in which most adult members make small monthly contributions to a health savings account-style fund in order to receive full benefits under HIP Plus, including dental, vision, and no copays. Members who miss contributions are moved to HIP Basic, which carries copays and excludes dental and vision. This consumer-responsibility model is unique to Indiana among all Medicaid expansion programs and reflects the same philosophy that underlies the state’s receptiveness to health sharing and Direct Primary Care.

When do Indiana’s HIP work requirements start, and who is affected? Work requirements for HIP take effect January 1, 2027, requiring able-bodied adults ages 19 through 64 to demonstrate 80 hours a month of qualifying work, education, or volunteer activity, or to earn at least $580 a month. New applicants starting January 2027 must prove they met the requirement for three consecutive prior months. Exemptions apply for children, disabled adults, the blind, and seniors 65 and older. Current HIP members should watch for official FSSA notifications as the implementation date approaches.

Can I be denied ACA coverage in Indiana for a pre-existing condition? No. Every ACA-compliant plan sold through HealthCare.gov in Indiana must accept all applicants regardless of health history and cover pre-existing conditions from day one with no additional charge. This protection does not extend to health sharing ministries, short-term plans, or fixed indemnity products, all of which can exclude or limit coverage based on health history.

Is Indiana a good state for Direct Primary Care? Yes. Indiana has enacted dedicated DPC legislation that explicitly classifies direct primary care agreements as not being insurance and exempts them from Indiana Department of Insurance regulation. DPC practices operate across the state, and the DPC-plus-high-deductible-plan and DPC-plus-health-share combinations are particularly popular among self-employed Hoosiers. Starting January 2026, DPC fees are also HSA-reimbursable, a change that meshes naturally with Indiana’s existing POWER Account HSA culture.

Is there a penalty for going uninsured in Indiana? No. Indiana does not have a state individual mandate, and the federal mandate penalty has been $0 since 2019. There is no state or federal tax penalty for going without coverage in 2026. Hoosiers below 138% FPL should check HIP eligibility first, since coverage at low or no cost may be available regardless of the mandate status.

This article is for general informational purposes only and is not insurance, legal, or financial advice. Figures referenced here come from publicly available sources including KFF.org, the Peterson-KFF Health System Tracker, the Indiana Department of Insurance, the Indiana Family and Social Services Administration, the Indiana Capital Chronicle, WFFT, healthinsurance.org, and CMS.gov, current as of 2026. Always confirm current HIP eligibility, ACA enrollment options, and plan availability directly at HealthCare.gov, FSSABenefits.in.gov, or with a licensed Indiana insurance agent before making a coverage decision.

By the Modern Healthcare Works team