Learn about changes to Marketplace plans and where to find help.
By MARY CLAIRE MOLLOY, Mirror Indy
You may have heard about changes coming to certain types of health insurance next year. Or your family is preparing to choose coverage during open enrollment, which generally starts in the fall. Use the guide below to find out more about your options and ways to get help.
Check your eligibility
There are several ways to receive government-based health insurance.
Medicaid covers low-income families and children, older adults, people with disabilities and people who are pregnant. Use this guide to see if you qualify in Indiana based on your income, family size and conditions. If you are applying or have questions, call the Division of Family Resources in your county for help.
Medicare is generally for adults 65 and older. Some people may be eligible earlier if they have certain disabilities or diseases. Medicare.gov outlines different paths to coverage.
The Healthy Indiana Plan covers low-income adults ages 19 to 64 who are not eligible for Medicaid or Medicare. Enter your household size and income into this calculator tool to determine if you are eligible.
The Health Insurance Marketplace, or Obamacare, can cover people who are self-employed or work for a company that does not offer health insurance. Check your income and household size to see if you qualify for government subsidies to help pay for a plan.
However, note that some of these subsidies will expire in 2026 unless Congress acts — and health insurance companies in Indiana are raising their premiums by about 20%, too. That’s why if you’re enrolling in a new Marketplace plan or staying on the same one, it’s important to learn more about these changes.
Talk to experts
“This is the time to talk to people about your situation and what can be done,” said Susan Jo Thomas, the executive director of Covering Kids and Families. “You can look for programs that match your family’s needs.”
Covering Kids and Families is a statewide organization that helps people enroll in and stay on health insurance. You can make an appointment with one of their free navigators, who will share coverage options and guide you through the application process.
You can find more navigators in Marion County through a state portal. Many are connected to hospital systems and doctor’s offices.
“Talk to a physician you trust,” Thomas said. “The folks that do billing for medical centers and doctors know so much.”
Another option is to meet with a broker — a health insurance professional who can help evaluate your needs and compare different plans. Matthew Kubal, an Indianapolis broker, recommends verifying a person’s license before working with them.
“Nobody should ever charge you for help finding a health insurance plan,” Kubal said. “A good assistor should be asking about your doctors, prescriptions, expected medical needs and household income. If not, run.”
Prep for open enrollment
Kubal asks his clients to take several steps before picking a plan. These include gathering information about:
- the doctors and hospitals you regularly use
- the prescriptions you need covered
- your projected household size and income for next year
That way, you can better compare options.
To have Marketplace coverage in January 2026, you must participate in the open enrollment period between Nov. 1 and Dec. 15.
If you have a qualifying life event, such as losing other health insurance coverage, getting married, having a child or moving, you may also be eligible for a special enrollment period on the Marketplace.
If you recently turned 65, you have several months to apply for Medicare. For current Medicare members, open enrollment to make changes to your plan runs from Oct. 15 to Dec. 7.
You can apply for Medicaid and the Healthy Indiana Plan at any time.
Options if you’re uninsured
With expiring subsidies and spiking premiums, many people may be priced out of Marketplace plans this year. There are also Medicaid cuts and new work requirements that will take effect over time through the “One Big Beautiful Bill.”
If you or a loved one are underinsured or uninsured, there are still ways to get health care. You can find a Federally Qualified Health Center and other locations that offer sliding scale fees for primary care services, including preventative screenings, dental services and mental health care.
If you are experiencing a medical emergency, go to the emergency room. Under federal law, hospitals must provide treatment regardless of your ability to pay. If you are hit with a bill you can’t afford, look into the hospital’s financial assistance program.
Mirror Indy, a nonprofit newsroom, is funded through grants and donations from individuals, foundations and organizations.
Mirror Indy reporter Mary Claire Molloy covers health. Reach her at 317-721-7648 or email maryclaire.molloy@mirrorindy.org. Follow her on X @mcmolloy7.
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