Many Medicare Advantage plans in Indiana include coverage for prescription drugs.
Some Medicare Advantage plans in Indiana require you to see doctors in their network; other Part C plans allow for more choice and flexibility.
To get any Medicare Advantage plan in Indiana, you must first enroll in Medicare Part A and Medicare Part B ( Original Medicare ).
The Part B premium applies to every Part C plan.
From Evansville to La Porte, Medicare Advantage plans are available to eligible people living in Indiana. Whether you love the bustle of Indianapolis, or prefer the rural vibes of Big Turkey Lake, there’s a Part C plan that’s right for you. Read on to learn about the ins and outs of Medicare Advantage plans in The Hoosier state.
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If you’re new to Medicare, you probably have lots of questions about the types of coverage available, and which will be right for you.
One popular option for Medicare recipients in Indiana is a Medicare Advantage plan (Part C). Medicare Advantage plans are a private insurance alternative to Original Medicare (Part A and Part B). According to the Centers for Medicare & Medicaid (CMS), there are more than 100 Part C plans in Indiana.
With a Medicare Advantage plan, you get all the benefits and coverage of Original Medicare. You may also get additional coverage, such as Medicare Part D (prescription drugs) included with your plan.
Since Medicare Part C is private insurance, the costs and coverage associated with each plan vary. All Part C plans set a limit on your annual out-of-pocket costs for covered healthcare services. This can go a long way towards giving you the peace of mind that comes from knowing you won’t incur massive, unexpected bills.
In Indiana, you may choose from several different types of Medicare Advantage plans. Offerings vary based on your county and zip code.
Part C plans in Indiana include:
- Health Maintenance Organizations (HMOs): HMOs require you to use in-network providers.
- Preferred Provider Organizations (PPOs): PPO plans are flexible and provide some level of coverage for both in-network and out-of-network providers.
- Private Fee-for-Service plans (PFFSs): PFFS payment plans determine what they’ll pay to providers, and how much you’re required to pay for healthcare when you get it.
- Special Needs Plans (SNPs): If you have a chronic, long-term condition, you may be eligible for an SNP. These plans are structured to provide specialized care tailor-made for people with specific, severe diseases.
Any Part C plan you choose will cover at least as much as Original Medicare. This includes:
- Inpatient services such as hospitalizations, skilled nursing facility care, and hospice care
- Outpatient services such as annual checkups, specialist appointments, and preventive care, including most vaccines
Medicare Advantage plans in Indiana usually provide coverage for extras that aren’t included in Original Medicare. These vary from plan to plan, but may include:
- Prescription drugs (Medicare Part D)
- Wellness programs, including SilverSneakers gym memberships
- Over-the-counter medications
In 2022, the average monthly premium for Part C plans in Indiana is $14.86, down from $16.22 in 2021. There are also many Medicare Advantage plans with a $0 monthly premium.
The Part B monthly premium also applies to Part C plans purchased in Indiana. The standard Part B premium amount that most people pay is $170.10 per month (in 2022). If you collect Social Security or Railroad Retirement Board benefits, your Part B premium will be automatically deducted from the amount you receive monthly.
Other costs you may incur with your Part C plan include copays, coinsurance, and deductibles. A licensed GoHealth insurance agent will be happy to go over your options with you, so you know exactly what’s available in your area and what your out-of-pocket costs will be for each plan.
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Medicare is a Federal program that is only available to U.S. citizens and permanent legal residents who have lived in this country for at least five years.
In Indiana, you must be eligible for Original Medicare if you want to enroll in a Medicare Advantage plan.
The criteria for eligibility are age or disability. Most people who get Medicare in your state are 65 or older.
Many also have disabilities. Despite your age, if you have a disability, you’ll become eligible for Medicare Advantage after you’ve received Social Security or Railroad Retirement Board disability benefits for 24 months. If you have Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s disease), you are eligible for Medicare Advantage starting the first month you receive disability benefits.
If you have end-stage renal disease (ESRD), you are eligible for Medicare Advantage in Indiana. Eligibility usually begins on the first day of the fourth month you begin dialysis. Medicare coverage for people with ESRD starts on the day you become eligible, even if you sign up later. This is known as retroactive coverage.
In Indiana, there are several points at which you can get a Medicare Advantage plan:
- Initial Enrollment Period (IEP): You can sign up for Medicare Advantage during the seven-month period that starts three months before you turn 65 and ends three months afterward. You’ll need to sign up for Original Medicare first.
- Medicare Open Enrollment: You can join, switch, or drop a plan during the Medicare Open Enrollment Period, which starts on October 15 and ends on December 7 each year. This period is sometimes referred to as the Annual Enrollment Period (AEP).
- Medicare Advantage Open Enrollment: If you already have a Medicare Advantage plan but wish to switch to a different one, you can do so during the Medicare Advantage Open Enrollment Period. Medicare Advantage Open Enrollment starts on January 1 and ends on March 31 each year.
- Special Enrollment Period: Special enrollment periods are triggered by events that are specific to you. For example, you may have creditable coverage from an employer when you first become eligible for Medicare. If you were qualified to delay Medicare and didn’t sign up during your IEP, you can still get Part C within two months of losing your current coverage.
There are many Medicare Advantage plans offered throughout Indiana that include prescription drug coverage as a benefit. Some of these have feature no-cost annual deductibles for prescription drugs.
Several Indiana-based Medicare Advantage plans offer lower out-of-pocket insulin costs through the Part D Senior Savings Model. The goal of the Senior Savings Model is to offer Medicare beneficiaries with diabetes enhanced quality of care combined with less expensive prescription drug options.
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