- In 2019, there were 89 Medicare Advantage Plans available in Indiana.
- Twenty-eight percent of the total Medicare population in Indiana is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,176 per beneficiary in Indiana, which is 1% higher than the national average.
- Available Medicare Advantage Plans range from 11 to 32 across Indiana’s 92 counties.
Medicare Advantage Plans in Indiana come in a number of configurations. Since these products are offered by private insurance companies, benefits can vary significantly between plans and providers, but all insurers must meet certain federal requirements. Like other forms of health insurance, Medicare Advantage Plans have varying copays, premiums, and networks. These details can affect your out-of-pocket costs and determine which medical providers you must visit to receive the best rates.
Medicare Advantage Plans in Indiana
Types of Medicare Advantage Plans
Seniors can choose from a number of Indiana Medicare Advantage programs, depending on their medical needs, budget, and personal preferences. Understanding all of the possibilities and weighing your options is important when it comes to premiums, out-of-pocket costs, and your ability to choose an in- or out-of-network provider or see a specialist without a referral.
Health Maintenance Organizations (HMO)
Many Medicare Advantage Plans in Indiana give enrollees access to a health maintenance organization. This type of managed care system requires beneficiaries to use contracted in-network providers for most non-emergency services. HMOs often focus on preventive care and may have lower premiums and copays. Referrals are required if you need to see a specialist.
Preferred Provider Organizations (PPO)
Preferred provider organizations, or PPOs, are increasingly popular because these plans allow beneficiaries to see in- and out-of-network professionals, although it’s cheaper to stay in-network. With this option, you don’t have to select a primary care physician in most cases, and referrals aren’t required for specialists. These plans offer greater flexibility, although premiums may be slightly higher.
Private Fee-For-Service Plans (PFFS)
Private fee-for-service plans require medical providers to accept a pre-negotiated rate. Most services are provided by in-network professionals who have agreed to these terms. Out-of-network providers can choose whether or not to honor your coverage, as long as it’s not an emergency. Generally, you can purchase a Part D prescription drug supplement for your PFFS plan if this coverage isn’t included.
Dual Special Needs Plans (D-SNPs)
In Indiana, D-SNPs are available to dual Medicare and Medicaid beneficiaries who have certain qualifying medical conditions or personal needs. These plans include preventive and emergency medical care, case management services, and supplemental benefits.
Enrollment and eligibility for Medicare Advantage Plans in Indiana
- You must be aged 65 or older or have kidney failure or a disability that qualifies you for Original Medicare Parts A and B.
- You can enroll in a Medicare Advantage Plan if you’re eligible for Medicare Part A and B and live in a qualifying geographic area where the insurer operates.
- Medicare Part C is not compatible with Medigap insurance in most cases, and enrolling in a Part D Plan may cancel your Medicare Advantage Plan coverage.
- Initial enrollment in Medicare is handled by the Sociality Security Administration, and Part C plans are available through private insurers who receive a monthly stipend from the government for each enrollee.
- You can sign up for Original Medicare or select a Medicare Advantage Plan during the initial enrollment period, which runs for seven months, including the three months before your 65th birthday, your birth month, and the three months following your birthday.
- The annual Medicare Advantage Plan enrollment period runs from January 1 through March 31. During this time, you can change Medicare Advantage Plans or return to Original Medicare.
- If you already have Original Medicare, you can’t sign up for a Medicare Advantage Plan for the next year until open enrollment, which begins on October 15 and closes on December 7.
- A five-star special enrollment period runs from December 8 to November 30. During this time, you can switch from your current plan to a Medicare Advantage Plan that has a five-star quality rating.
Prescription drug coverage
Medicare Advantage Plans in Indiana typically include prescription drug benefits, so there’s no need to purchase a separate Part D prescription drug plan. This option is typically used by individuals who have traditional Medicare Parts A and B. Some Medicare Advantage Plans that don’t include prescription drug coverage are compatible with Part D, but it varies on a case-by-case basis. Check with the provider before changing coverage. Otherwise, your Part C benefits may be canceled, and you’ll revert back to Original Medicare.
Medicare Advantage Resources in Indiana
If you have questions about Medicare or need help choosing plans, understanding benefits, or appealing a denial, several state agencies can help. The Department of Insurance sponsors the State Health Insurance Assistance Program. Insurance counseling is available through Area Agencies on Aging, local councils on aging, and various community groups that are staffed by full-time counselors and trained volunteers. Indiana has a Senior Medicare Patrol that’s dedicated to reducing billing errors and combating health care fraud. To learn more about Medicare Advantage Plans in your area, reach out to these local agencies.
Indiana Area Agencies on Aging
Indiana is home to 16 Area Agencies on Aging that serve seniors and caregivers in designated counties. These government-sponsored service centers connect residents to information about Medicare, Medicaid, and long-term care insurance. Staff members can provide information about income-based Extra Help benefits that can lower your premiums or copays. It offers healthy aging programs, chronic disease management courses, and referrals to other local service providers.
Contact Information: Website | 800-986-3505
Indiana Senior Medicare Patrol
The Indiana Association of Area Agencies on Aging operates the state’s Senior Medicare Patrol, which helps beneficiaries detect and correct billing errors and inaccurate or unnecessary charges. It provides a variety of resources to protect seniors from fraud, financial abuse, identity theft, and other forms of exploitation. SMP resources are available online and through your local Area Agency on Aging.
Contact Information: Website | 317-205-9201
Indiana Family and Social Service Administration-Division of Aging
The Division of Aging sponsors a wide variety of programs for older adults and family caregivers. It provides long-term care benefits through Medicaid, supports the Program of All-Inclusive Care for the Elderly, and manages the state’s network of Aging and Disability Resource Centers, which are a one-stop shop for information about health insurance, in-home care, prescription drug benefits, and senior services.
Contact Information: Website | 800-457-8283
The Indiana State Health Insurance Assistance Program is a free counseling service available to current and prospective Medicare enrollees statewide. Specially trained counselors provide information and impartial advice to help you compare available plans. Services are provided through a statewide hotline and dozens of local senior centers, aging councils, and community partners.
Contact Information: Website| 800-452-4800
Learn More From Our Sources
- Medicare.gov | Joining a Health or Drug Plan | Last accessed June 2021
- Medicare.gov | Medicare Advantage Open Enrollment | Last accessed June 2021
- Medicare.gov | Five-star Special Enrollment | Last accessed June 2021
- Medicare.gov | What’s Medicare Supplement Insurance (Medigap)? | Last accessed June 2021
- Indiana.gov | Dual Special Needs Plans | Last accessed June 2021
- Indiana.gov | Indiana SHIP | Last accessed June 2021
- Indiana.gov | Area Agencies on Aging | Last accessed June 2021
- Indiana Family and Social Service Administration | Division of Aging Indiana Family and Social Service Administration | Last accessed June 2021
- Indiana Association of Area Agencies on Aging | Indiana Senior Medicare Patrol | Last accessed June 2021