What You Need to Know
Medicare Advantage plans are an all-in-one alternative to Original Medicare.
Most MA plans include Medicare Part D benefits, which help to pay for prescription drugs.
The average monthly cost for an MA plan in Indiana is $16.07 for 2021. This is less than the national average of $21.
What Are Medicare Advantage Plans in Indiana?
Original Medicare consists of two parts: Medicare Part A, which is hospital insurance, and Medicare Part B, which is medical insurance. While Original Medicare provides a significant amount of healthcare coverage, it also has out-of-pocket costs.
One way to lower your costs is to purchase an Indiana Medicare Advantage (MA) plan, also known as Medicare Part C. MA plans are an all-in-one alternative to Original Medicare. They provide you Medicare benefits in one policy. Most plans also include Medicare Part D coverage for prescription drugs. Many plans have additional benefits too, such as vision, dental and hearing care.1
What Types of Medicare Advantage Plans Are Available?
You can choose among a variety of MA plans. One factor to consider is the plan’s provider network. A provider network is a group of doctors and other healthcare providers who have contracted with an insurance company and agreed to accept the insurance company’s payments.
Here are the types of MA plans available:
- Health maintenance organizations (HMOs): This plan type typically requires you to see providers that are part of the plan’s network. You usually need a referral to see a specialist.
- Preferred provider organizations (PPOs): PPO plans also have a network. You can visit providers outside the network, but you will pay more if you do. Typically, you don’t need a referral to see a specialist.
- Private fee-for-service (PFFS) plans: These plans may have a network, but if so, you can still go to providers outside it. Whether or not there’s a network, you can visit any provider who accepts the plan’s terms.
- Special needs plans (SNPs): This option is designed for people with specific healthcare needs. There are three types of SNPs:
- Chronic condition SNPs (C-SNPs): These are for Medicare members with conditions like diabetes, cancer, dementia and end-stage renal disease (ESRD).
- Institutional SNPs (I-SNPs): This option is for people on Medicare who need ongoing care in a nursing home or at home.
- Dual eligible SNPs (D-SNPs): This plan is for people who have Medicare and Medicaid.
- Medical savings account (MSA) plans: This type of plan pairs a high-deductible MA plan with a medical savings account. Your deductible is the amount you pay for covered healthcare services before your insurance plan starts paying. The plan deposits money into your MSA, and you use that money to pay for healthcare. If you run out of money in the account before meeting your deductible, you’re responsible for your Medicare-approved healthcare costs until you reach the deductible. After it is met, the plan pays for your care.2
Look for Additional Benefits
Many Medicare Advantage plans include prescription drug coverage and other “extra” benefits, such as vision, dental and hearing care.
What Are the Prescription Drug Options with a Medicare Advantage Plan?
Most MA plans include Medicare Part D coverage. This coverage helps to pay for prescription drugs.
If you join an HMO or PPO that doesn’t have Part D coverage, you cannot sign up for a separate Part D plan. If you join an MSA or certain PFFS plans, you can sign up for a separate Part D plan sold by a private insurance company.
If you don’t start Medicare Part D coverage when you’re first eligible, you may be required to pay a late enrollment penalty if you decide to join a plan at a later date.3
A Popular Option
About 33% of all Hoosiers who are eligible for Medicare are enrolled in a Medicare Advantage plan.
How Do You Choose a Medicare Advantage Plan?
To find the best Indiana MA plan, compare multiple plans to find the right one for you. Here are some factors to consider:
- Premiums: Many MA plans have a $0 premium, while others vary in price. Keep in mind that in most cases, you will continue to pay the Medicare Part B premium. Your MA plan is an additional cost.
- Other costs: MA plans have out-of-pocket costs, including:
- Deductibles: Some plans have separate deductibles for drug costs and for healthcare costs.
- Coinsurance: This is a percentage of a service that you are required to pay. For example, you might pay 20% of an emergency room visit.
- Copayments: These are a set dollar amount you pay for a service. You might pay a $10 copay for doctor visits.4
- Out-of-pocket maximum: This is the most you’ll pay out of pocket for Medicare-covered services.5
- Plan benefits: Many plans offer additional benefits such as:
- Vision care: This typically includes annual eye exams and coverage for glasses.
- Dental care: This helps cover basic dental care like cleanings, and it may also cover more advanced services like crowns and dentures.
- Hearing care: This typically covers hearing exams and helps to pay for hearing aids.
- Fitness memberships: This may include a membership at a local gym.6
Plan benefits vary by plan, so it’s essential to look at which benefits are offered and exactly what’s included in them.
When and How to Enroll in a Medicare Advantage Plan
You can only enroll in MA plans at the following specific times.
- Initial Enrollment Period: This period is tied to when you start Medicare Parts A and B. For most people, the period starts three months before your 65th birthday month and lasts for three months after you turn 65.
- General Enrollment Period: If you have Part A of Medicare and not Part B, you can sign up for Part B during this period, which lasts from January 1 – March 31. If you sign up for Part B, you can also enroll in an MA plan during this time. Your plan coverage may not start until July 1.
- Open Enrollment Period: This annual enrollment period (sometimes referred to as the Annual Election Period) lasts from October 15 – December 7, and you can enroll in an MA plan during this time. You can also switch MA plans or drop your MA plan and go back to Original Medicare. Your coverage starts on January 1.
- Medicare Advantage Open Enrollment Period: This period is from January 1 – March 31. If you have an MA plan, you can switch to another MA plan. You can also drop an MA plan and switch back to Original Medicare.7
- Special Enrollment Periods: You are also entitled to a special enrollment period in certain situations. These include:
- Changing your service area: If you move out of your current plan’s service area, you can enroll in a new plan.
- Losing coverage: If you lose employer or union coverage, you can enroll in an MA plan.
- Gaining coverage: If you gain coverage from an employer or union, you can disenroll from your plan.
- Plan changes: For example, if Medicare terminates its contract with your MA plan, you can enroll in a new one.
- Other special circumstances: Examples include changes to your health where you’d be better served by a chronic SNP or if you qualify for Medicaid and want to switch to a dual eligible SNP.8
To enroll in an MA plan, contact the plan or a licensed professional for help. You can also visit the Medicare Plan Finder and enter your Indiana ZIP code. You also have the option to enter your preferred doctors and medications to find plans that are a good fit for you.
What’s Medicare Advantage Enrollment in Indiana?
The Medicare Advantage penetration rate in Indiana is about 33%. This means that out of all the Hoosiers eligible for Medicare, 33% are enrolled in an MA plan.
How Much Does a Medicare Advantage Plan Cost in Indiana?
The average monthly cost for an MA plan in Indiana is $16.07 for 2021. This is less than the national average of $21.9
Let’s take a look at how much an MA plan would cost for someone living in Indianapolis. There are 35 plans available, and 20 of those plans have a $0 monthly premium. Of those that are left, 10 have monthly premiums of less than $50.
How Do You Change Your Medicare Advantage Plan?
You can change your MA plan during the Open Enrollment Period from October 15 – December 7 and during the Medicare Advantage Open Enrollment Period from January 1 – March 31.10
What Are Alternatives to Medicare Advantage Plans?
MA plans bundle coverage. One alternative to an MA plan is Original Medicare on its own. If you want coverage of Original Medicare’s out-of-pocket costs, you would need a Medicare Supplement plan. If you want prescription drug coverage, you’ll need a Medicare Part D plan. If you want help with out-of-pocket healthcare costs and drug coverage, you’ll need to purchase both a Medicare Supplement plan and a Part D plan.
In other words, you could have three different healthcare plans (Original Medicare, a Medicare Supplement plan and a Part D plan) instead of just one. Medicare-approved private companies sell Medicare Supplement plans (also known as Medigap policies) and Part D plans.11
Another option may be PACE, which stands for Program for All-Inclusive Care to the Elderly. This program is for Indiana residents who are age 55 or older and need nursing-home-level care but want to stay in their communities.
What Are Medicare Resources in Indiana?
Hoosiers on Medicare have access to several resources. These include:
- The Indiana State Health Insurance Assistance Program (SHIP): This program provides free counseling to people with Medicare to help them make informed decisions. Call 1-800-452-4800 for assistance.
- The Indiana Department of Insurance: This department can assist you if you have a complaint about your MA plan. File a complaint online here.
- Indiana Medicaid: This program provides low-cost and free healthcare to people with limited income and assets. Apply for assistance here.
Ready to sign up for an MA plan? Compare at least two to three plans to find the one that’s right for you. If you need assistance, don’t hesitate to contact SHIP.