Medicare Advantage Plans in Indiana
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: February 17, 2021
Medicare Advantage plans in Indiana give seniors a variety of options. Those interested in extending coverage beyond what's offered with Original Medicare Parts A and B might want to consider Medicare Advantage, otherwise known as Medicare Part C. In addition to covering hospital and medical costs, Medicare Advantage plans typically encompass vision, dental, prescription drugs, and hearing resources. Medicare-approved private insurance companies manage the plans rather than the federal government, and costs vary according to the selected policy.
- 1 In 2019, there were 89 Medicare Advantage plans available in Indiana.
- 2 28% of the total Medicare population in Indiana is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $10,176 per beneficiary in Indiana, which is 1% higher than the national average.
- 4 Available Medicare Advantage plans range from 11 to 32 across Indiana’s 92 counties.
Indiana seniors interested in Medicare Advantage plans have the option of comparing cost and coverage before deciding on the policy that best meets their specific needs. As with Original Medicare, each of Medicare Advantage’s plans is governed by the agency’s rules, providing members with the same protections. While the availability of plans varies depending on the carrier and the enrollee’s geographic location, selections include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service options, and Special Needs Plans.
Medicare Advantage Plans in Indiana
Types of Medicare Advantage Plans
Indiana’s Medicare Advantage program provides a number of HMO and PPO options as well as PFFS and SNP selections available through private insurance companies. Each is required to follow specific guidelines pertaining to eligibility and enrollment. Indiana’s State Health Insurance Assistance Program (SHIP) offers seniors free and impartial assistance with understanding and navigating the Medicare system. Unaffiliated with any insurance company, the volunteers help beneficiaries choose the healthcare plan that best meets their needs.
Health Maintenance Organizations (HMO)
An HMO plan provides the enrollee with a network of healthcare professionals, including doctors and hospitals. The insured is required to choose a primary care physician who is the point of contact for all medical needs as well as referrals to specialists. In order to receive plan coverage, the insured must seek care within the network. The plan participant may be responsible for paying for the entire cost of medical services received outside of the network except in emergency or other critical situations. HMOs are among the most affordable plans, offering low and no deductible options. They are, however, the most restrictive.
Preferred Provider Organizations (PPO)
PPO plans generally offer more flexibility than HMOs; however, they are also more expensive. PPOs provide a more extensive network of preferred providers, and they typically cover a portion of out-of-network healthcare costs. Because providers within the network offer lower rates to plan members, using an approved doctor or facility equates to lower copay and coinsurance rates. PPO plan members do not need to choose a primary care physician or obtain a referral to see a specialist.
Private Fee-For-Service (PFFS)
Those insured through PFFS plans are afforded the most flexibility with their options of healthcare providers. PFFS coverage could opt for a partial or full network of providers, or it might choose to forgo a network altogether. However, the plan’s arranged, individuals receive full coverage with their Medicare-approved provider of choice, so long as the plan’s terms are followed. PFFS plans typically have higher premiums because they pay the healthcare providers on a fee-for-service basis, which determines how much the plan and its members pay for each service.
Special Needs Plans (SNP)
SNPs offer benefits tailored to the senior’s specific needs. These plans are restricted to certain members, such as those eligible to receive both Medicaid and Medicare, individuals living in nursing homes, or seniors who suffer from chronic diseases or disabling conditions. SNPs are designated for coverage of a specific situation and utilize a provider network. Members are required to receive care within the stipulated network. While the benefits of SNPs are designed to cover its members’ unique situations, their premiums are typically higher than other health insurance options. They are also limited by city or county geographic areas, so locating qualified providers may prove difficult.
Enrollment & Eligibility for Medicare Advantage Plans in Indiana
Seniors who meet the following eligibility requirements may enroll in one of Indiana’s Medicare Advantage plans:
- Those who are eligible for Medicare Parts A and B
- Individuals who are at least 65 years of age. Younger persons may also enroll if they have a qualifying disability
- American citizens or permanent residents with at least five consecutive years of residency can apply
- Live within the specified service area
- Those who are not enrolled in a Medigap plan
If Indiana seniors receive Social Security or Railroad Retirement benefits, they are automatically enrolled in Medicare Parts A and B when they turn 65. They have the option of enrolling in Medicare Advantage or changing plans during the open enrollment period.
It’s important to adhere to Medicare’s enrollment periods to ensure access to the most beneficial Medicare Advantage programs for specific needs and avoid penalties.
- Initial enrollment begins three months before the individual’s 65th birthday and ends three months after.
- During the annual election periods, from October 15th to December 7th each year, current Medicare recipients may switch to Medicare Advantage for the first time, and Medicare Advantage members can opt to change their current plans.
- The open enrollment period occurs annually between January 1st and March 31st and allows current Medicare Advantage beneficiaries to change plans or return to Original Medicare.
- General enrollment options run from April 1st to June 30th each year and include only those who had Medicare Part A and completed their initial enrollment in Part B during the open enrollment period, and who opt to change plans to Medicare Advantage.
Prescription Drug Coverage
Indiana’s Medicare Advantage prescription drug coverage plans are operated by insurance and other private companies approved by Medicare. The member’s Medicare Advantage plan determines the specific type of drug coverage. Medicare Advantage plans that include drug coverage are referred to as MA-PDs.
Members of HMO or PPO plans that don’t have drug coverage cannot purchase a separate Medicare Part D prescription plan. Those who opt to enroll in Part D coverage are automatically dropped from Medicare Advantage and re-enrolled in Original Medicare.
PFFS plans may include prescription drug coverage. They also permit members to enroll in separate Medicare Part D plans. SNPs must include prescription drug coverage with their plans.
Medicare Advantage Resources in Indiana
Although Indiana’s Medicare Advantage program offers beneficiaries a varied selection of coverage choices, trying to determine which is the best fit for individual needs can be a daunting task, especially for new enrollees. To help members navigate the Medicare process, Indiana provides a number of free counseling resources for qualified individuals. Seniors may find support from the following agencies:
State Health Insurance Assistance Program (SHIP)
As mentioned above, SHIP is a volunteer-based assistance program that provides seniors with free and unbiased assistance with choosing the Medicare or other insurance programs that provide the necessary coverage. The counselors attend an intensive four-day training course and are IDOI certified.
SHIP’s counselors are not affiliated with any insurance company. Their purpose is to educate seniors about the various Medicare options available and advise them on choosing the most beneficial program.
Counselors help seniors organize their records and assess their needs to be better equipped to choose the right policy. They inform individuals of their rights. SHIP advisors also help policyholders understand their prescriptions, so they are better equipped to make decisions about supplemental policies.
Contact Information: Website | 800-457-8283
Founded in 1974, Central Indiana Council on Aging, or CICOA, connects older adults and those with disabilities in Central Indiana with quality home and institutional caregivers and facilities. The center’s resources also include unbiased assistance with determining which Medicare programs best serve individual needs. Its counselors are certified through SHIP and equipped to answer all Medicare-related questions. Residents in Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby counties are eligible for assistance. Seniors can complete an online request form for options counseling, and a representative will contact them.
Contact Information: Website | 800-432-2422
Northwest Indiana Community Action (NWICA)
NWICA serves seniors and individuals with disabilities in Lake, Porter, Jasper, Newton, Pulaski, and Starke counties. Its resource center offers assistance with completing Medicare paperwork and access to finding the necessary information. Its team provides information and referral services as well as options counseling and long-term case management for local residents.
Contact Information: Website | 800-826-7871
- Sources [-]
https://www.in.gov/ship/2766.htm Last accessed April 2021
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https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan# Last accessed April 2021
https://www.medicare.gov/Pubs/pdf/11135-prescription-drug-coverage-with-ma-mcp.pdf Last accessed April 2021
https://www.in.gov/ship/2508.htm Last accessed April 2021
https://cicoa.org/resource-center/state-health-insurance-assistance-programs/ Last accessed April 2021
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Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.