Medicare Advantage Plans in Indiana

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans also provide extra benefits such as vision, dental, hearing, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first be enrolled in Original Medicare (Parts A and B). Most individuals qualify for Medicare enrollment at age 65, though those with disabilities, ALS, or ESRD may qualify earlier.

Enrollment is only permitted during the following windows:

• Initial Enrollment: 3 months before and after your 65th birthday month
• General Enrollment: Jan 1 – Mar 31 (if enrolling in Medicare Part B during this time)
• Special Enrollment Periods: Triggered by life changes like moving, losing employer coverage, or health-related eligibility for SNPs

What Types of Medicare Advantage Plans Are Available in Indiana?

Indiana offers a broad selection of MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists
• Preferred Provider Organizations (PPOs): Allow out-of-network access at higher costs; typically no referral needed
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider that agrees to the plan’s terms; some plans have networks
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic illnesses like cancer, diabetes, or ESRD
  • I-SNPs: For people needing nursing-level care in institutions or at home
  • Dual Eligible Special Needs Plans (D-SNPs): For those who qualify for both Medicare and Medicaid
• Medical Savings Accounts (MSAs): Pair a high-deductible MA plan with an insurer-funded savings account

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, if your MA plan does not include drug coverage:

• MSAs and some PFFS plans allow enrollment in a standalone Part D plan
• HMOs and PPOs without drug coverage do not allow purchase of a separate drug plan
• Delaying drug coverage may result in a late enrollment penalty if you don’t have creditable coverage

How Do You Choose a Medicare Advantage Plan?

Before enrolling, understand Medicare Advantage costs. Consider:

• Premiums: Many Indiana plans offer $0 premiums, but you still pay your Medicare Part B premium
• Deductibles, Coinsurance & Copays: Know what you’ll owe for visits, procedures, and medications
• Out-of-Pocket Maximums: Each plan caps your total annual spending on covered services
• Extra Benefits: Look for plans that include dental, vision, hearing, telehealth, gym memberships, and transportation

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: 3 months before and after your 65th birthday
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA plan
• General Enrollment (Jan 1–Mar 31): Enroll in MA if you start Medicare Part B during this period
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare
• Special Enrollment Periods: May apply if you:
  • Move out of your current plan’s service area
  • Lose employer or union coverage
  • Qualify for Medicaid
  • Have a new chronic condition qualifying you for a C-SNP

What If You Want to Change Your Medicare Advantage Plan?

You can change your plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

What Are Medicare Resources in Indiana?

Indiana residents can access several support services:

• Indiana State Health Insurance Assistance Program (SHIP): Offers free Medicare counseling. Call 1-800-452-4800
• Indiana SMP Program: Helps beneficiaries prevent fraud
• Indiana Department of Insurance: File insurance-related complaints
• Indiana Medicaid: Assists low-income individuals with healthcare. Apply online or call 1-800-403-0864

Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, are standardized policies that help cover deductibles, copayments, and coinsurance from Original Medicare.

• Must be enrolled in Medicare Parts A and B
• Best time to enroll is during your six-month Medigap Open Enrollment Period
• Plans don’t include prescription drugs—buy a separate Part D plan
• There are 10 standardized Medigap plans. Medicare Supplement Plan G was the most enrolled in 2023
• Plan F is no longer available to those newly eligible after 2020
• Medigap offers predictable costs and nationwide access to Medicare providers

Learn more about Medicare Supplement plans in Indiana.

Next Steps

If a Medicare Advantage plan in Indiana is right for you, compare available options in your ZIP code. Review plan benefits, provider networks, prescription drug coverage, and out-of-pocket costs—then be ready to enroll during the next eligible enrollment period.