As a Medicare beneficiary in Indiana, you may have the option of an alternative way of obtaining the benefits of Original Medicare Part A and Part B, which is Medicare Advantage (Part C). Private insurance companies contract with Medicare to offer Medicare Advantage plans. If you opt to receive your Medicare coverage from a Medicare Advantage plan, you can enroll in a plan that is available where you live in Indiana.
How Medicare Advantage works in Indiana
Medicare Advantage plans must provide at least the same medical and hospitalization benefits available under Original Medicare, Part A and Part B, with the exception of hospice care, which continues to be covered by Part A. In addition, many Medicare Advantage plans offer extra benefits not available from Original Medicare, such as routine vision, hearing and dental coverage; many also offer prescription drug coverage.
To be eligible to enroll in a Medicare Advantage plan in Indiana, or in any state, you must already be enrolled in or be eligible to enroll in Original Medicare, Part A and Part B. You also need to live in the service area of the Medicare Advantage plan you select. In most cases, if you have end-stage renal disease (kidney failure) your coverage is through Original Medicare, and you may not be able to enroll in a Medicare Advantage plan.
There are several election periods during which you may enroll in a Medicare Advantage plan.
Your Initial Coverage Election Period (ICEP) is when you’re first eligible to enroll. In most cases, this time period occurs at the same time as your Medicare Initial Enrollment Period (IEP), which begins three months before you turn 65, includes your birthday month, and ends three months after your birth month.
If you missed your ICEP, you can sign up for a Medicare Advantage plan in Indiana, or switch to a different Medicare Advantage plan, during the Fall Open Enrollment period, which runs from October 15 to December 7 each year. Your new coverage goes into effect on January 1 of the following year. You may be able to make other changes to your Medicare coverage at this time, including but not necessarily limited to, adding or dropping prescription drug coverage. For example, you might change from a Medicare Advantage plan that does not include Part D prescription drug coverage to one that does, or you might enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage. You cannot sign up for a stand-alone Medicare Part D Prescription Drug Plan, however, if your Medicare Advantage plan includes prescription drug coverage—a plan type called a Medicare Advantage Prescription Drug plan.
If you decide to leave your Medicare Advantage plan and return to Original Medicare, Part A and Part B, you can do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31. You can then add a stand-alone Medicare Part D Prescription Drug Plan during that period (if you dropped your Medicare Advantage plan).
In certain situations, you may be allowed to switch Medicare Advantage plans during a Special Election Period. Those circumstances include, among others: losing your current coverage; moving to a new address where your existing Medicare Advantage plan isn’t available; qualifying for other coverage; or experiencing changes in your current plan that affect your health benefits. The timing of Special Election Periods is not standardized like the enrollment periods discussed above; instead, a Special Election Period occurs when your circumstances change, usually when you have a life-changing event or a change in your health coverage that could jeopardize your receiving Medicare benefits to which you are entitled if you had to wait until one of these annual enrollment periods.
Types of Medicare Advantage plans in Indiana
If you are interested in receiving your Medicare benefits through Medicare Advantage, you may find that you have a number of choices in Medicare Advantage plans available in Indiana. Listed below is a summary of the various types of Medicare Advantage plans that may be available where you live.
- Health Maintenance Organization (HMO): An HMO plan requires you to visit doctors, health-care providers, and hospitals included in your plan’s network, except in emergency situations or when approved by the plan, to receive coverage. You may also need to get a referral from your primary care doctor to receive coverage for certain health services.
- HMO Point-of-Service: An HMO-POS plan is a more flexible option than an HMO, allowing you to go out of network for most health services, but generally at a higher out-of-pocket cost.
- Preferred Provider Organization (PPO)*: A PPO plan offers great flexibility, allowing you to choose doctors, health care providers, and hospitals outside of your plan’s network, but usually at a higher out-of-pocket cost for covered services than you would pay if you used a provider in the plan’s network. Usually you are not required to select a primary care physician to coordinate your care, and your plan does not require referrals.
- A Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan that usually reserves the right to decide how much it will pay for covered services you receive from your doctor, other health-care providers and hospitals. A PFFS plan also determines your share of each expense. A PFFS plan does not include prescription drug coverage. Therefore, if you enroll in a PFFS plan and desire Part D prescription drug coverage, you will need to enroll in a stand-alone Medicare Part D Prescription Drug Plan.
- A Medicare Medical Savings Account (MSA) plan is a Medicare Advantage plan that combines a high deductible with a savings account. You can use the savings account to pay for your health care expenses with pre-tax dollars. A Medicare Medical Savings Account does not include Part D prescription drug coverage. If you desire prescription drug coverage, you would need to enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Medicare Medical Savings Account.
- Medicare Special Needs Plans (SNPs) limit enrollment to people with certain health needs and offer coverage and programs tailored to suit those specific needs. There are Medicare Special Needs Plans for beneficiaries with specific chronic diseases; people living in nursing homes; and those who are eligible for both Medicare and Medicaid.
- As mentioned earlier, many Medicare Advantage plans, including most of the plan types described above, combine health and prescription drug coverage. Such plans are also referred to as Medicare Advantage Prescription Drug plans, which afford you the opportunity to receive your Medicare health and prescription drug coverage from a single plan.
Comparing Medicare Advantage plans available in Indiana
As a Medicare beneficiary in Indiana, you may find it useful to compare all the Medicare Advantage plans available in your area.
The availability and costs of Medicare Advantage plans generally depend on your county of residence, the insurance company offering the Medicare Advantage plan, and the plan’s specific benefit details. You may find that some Medicare Advantage plans in Indiana offer premiums as low as $0. Keep in mind, however that you continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose.
Some further considerations to keep in mind when selecting a Medicare Advantage plan:
- What kinds of extra benefits are you interested in? Some Medicare Advantage plans may offer additional coverage beyond what is included in Original Medicare, Part A and Part B, so compare the plans available in your area to see which ones may include benefits that would be valuable to you.
- Do you need prescription drug coverage? If so, make sure the plan you choose is a Medicare Advantage Prescription Drug plan. Also, check the plan’s formulary, or list of covered drugs, to see if your medications are included in the formulary. Note, a plan’s formulary may change at any time. You will receive notice from your plan when necessary.
- Does the Medicare Advantage plan have a network of participating providers? If so, check to see if your doctors, your other health-care professionals, and your preferred hospitals participate. Your out-of-pocket expenses for care may be higher if your providers do not participate in the plan’s network.
With all these options available in Indiana, you can see why it may be a good idea to review and compare each plan so you can find one that offers the benefits and costs suited to your individual needs.
If you need additional information about Medicare in Indiana, view the following resources:
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.