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Medicare in Indiana

October 6, 2016

Medicare beneficiaries in Indiana have Medicare options beyond Original Medicare Part A and Part B. You can receive your coverage through Original Medicare (with or without a Medicare Supplement plan offered by a private insurer), or through an alternative means, by enrolling in a Medicare Advantage plan, offered by a Medicare-approved private insurance company. You can also enroll in a Medicare plan offered by a private insurance company contracted with Medicare to provide prescription drug coverage.

Original Medicare for Indiana beneficiaries

Original Medicare is the federal program that provides health coverage to American citizens and legal permanent residents as well as individuals under the age of 65 with certain disabilities. Original Medicare is administered by the federal government and works the same way in all states.

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance).

Part A coverage includes:

  • Inpatient hospital care
  • Skilled nursing facility (SNF) care
  • Long-term care hospitals
  • Hospice care
  • Limited home health care

Part B coverage includes:

  • Outpatient care, including doctor visits and preventive services
  • Medically necessary services
  • Mental health services
  • Participation in certain Medicare-approved clinical research studies
  • Durable medical equipment

If you live in Indiana and have Original Medicare, you receive benefits for covered services delivered by  any provider in the country that accepts Medicare assignment.

Keep in mind, however, that Original Medicare doesn’t cover certain services and items, including acupuncture, hearing aids, routine vision or dental benefits. It also doesn’t include prescription drug coverage,

To be eligible for Medicare, you must be at least 65 and either a U.S. citizen or a legal permanent resident of at least five continuous years. You may also be eligible for Medicare if you have a qualifying health condition, such as end-stage renal disease or Lou Gehrig’s disease or if you receive disability benefits for 25 continuous months from the Social Security Administration or the Railroad Retirement Board.

Many Medicare beneficiaries don’t have to pay a premium for Part A as long as they worked at least 10 years and paid Medicare taxes. However, Part B has  a premium. Keep in mind that if you don’t sign up for Part A and/or Part B when you’re first eligible, you may have to pay a late enrollment penalty when you sign up later.

Most people enroll (or are automatically enrolled) in Medicare Part A and/or Part B during their Initial Enrollment Period (IEP). This is the seven-month period that begins three months before you turn 65, includes the month you turn 65, and ends three months later.

If you don’t sign up during your Initial Enrollment Period, you can sign up during the next General Enrollment Period (GEP). This is the annual enrollment that takes place from January 1 to March 31 every year.

You may also sign up during a Special Enrollment Period (SEP) if you didn’t sign up for Part B because you had other health coverage. For example, you may have coverage through an employer (either your own or through your spouse), and perhaps you didn’t want to pay a separate premium for Part B when you didn’t need it yet. In this case, you can sign up for Part B as a Special Enrollment Period when your employer coverage ends. You won’t have to pay a late penalty if you qualify for a Special Enrollment Period.

Medicare beneficiaries in Indiana, like the rest of the country, can apply for Part A and/or Part B in the following ways:

  • By submitting an application online through the Social Security website.
  • By calling the Social Security Administration at 1-800-772-1213. TTY users can dial 1-800-325-0778. Phone lines are open Monday through Friday, from 7AM to 7PM.
  • By visiting a local Social Security office. To search for locations in Indiana, click here.

Medicare plan options in Indiana

Medicare beneficiaries in Indiana may have several options available, depending on where they live.

Medicare Part C

Medicare Advantage (Part C) is another way to receive your Part A and Part B benefits. If you enroll in a Medicare Advantage plan, you’re still in the Medicare program, and you’ll get the same benefits you’d have in Original Medicare (except hospice care, which continues to be covered under your Part A benefits). Many Medicare Advantage plans also include additional benefits, such as coverage for routine vision care, dental care, or hearing aids.

Often Medicare Advantage plans also provide prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans. If you enroll in a Medicare Advantage Prescription Drug plan, you receive your health and drug coverage from the same plan.

In Indiana, as in the rest of the country, you must have Medicare Part A and Part B to enroll in a Medicare Advantage plan. You’ll continue to pay your Part B premium, in addition to a premium for your plan (if applicable).

Medicare Part D

Medicare Part D is optional prescription drug coverage available through private insurers approved by Medicare. Some things to understand about Part D:

  • If you receive your Medicare benefits from a Medicare Advantage Prescription Drug plan, prescription drug coverage is included in your plan’s benefits.
  • If you don’t enroll in a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan  when you’re first eligible, you may have to pay a late enrollment penalty if you add this coverage later and you were without creditable prescription drug coverage (coverage at least as good as Medicare Part D) for 63 consecutive days or more.

Medicare Supplement (Medigap)

If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.

Indiana resources for Medicare beneficiaries

If you are an Indiana resident, you may find the following Medicare and state resources useful:

  • Indiana Department of Insurance: Find general information on Medicare, the Low-Income Subsidy Program, and Indiana’s State Health Insurance Assistance Program (SHIP).
  • HoosierRx: Get help with Part D costs through Indiana’s pharmaceutical assistance program.
  • Indiana Medicaid: Find information on applying for assistance with health costs, including eligibility requirements.

Learn more about how Medicare plans work in Indiana, including:

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