Medicare is a federal health insurance program available to people age 65 or older, as well as to those under 65 years old who have certain chronic health conditions or disabilities.
Medicare plans in Indiana have four parts:
- Part A, which is hospital inpatient care
- Part B, which is outpatient care
- Part C, also known as Medicare Advantage
- Part D, which is prescription drug coverage
When you turn 65 years old, you may sign up for original Medicare (Part A and Part B).
Medicare Part A
Most people qualify to get Part A coverage without a monthly premium. If you don’t qualify, you can purchase coverage.
Part A coverage includes:
- coverage when you’re admitted to a hospital for short-term care
- limited coverage for short-term skilled nursing facility care
- some part-time home healthcare services
Medicare Part B
Part B coverage includes:
- doctors’ visits
- preventive screenings and checkups
- imaging and laboratory tests
- durable medical equipment
- outpatient treatments and services
After signing up for original Medicare, you can decide whether you want a Medicare Advantage (Part C) plan or a Medigap plan, as well as prescription drug coverage.
Part C (Medicare Advantage)
Private insurance carriers offer Medicare Advantage plans in Indiana that bundle the benefits of original Medicare with prescription drug coverage and other services, such as dental or vision care. Specific coverage varies by plan and carrier.
Another benefit of Advantage plans is the annual out-of-pocket spending limit. Once you reach the yearly limit set by the plan, your plan pays the rest of your Medicare-approved costs for covered care for the year.
Original Medicare, on the other hand, does not have an annual limit. With parts A and B, you pay
- a deductible each time you’re admitted to the hospital
- an annual deductible for Part B
- a percentage of medical costs after paying the Part B deductible
Medicare Part D
Part D plans cover prescription drugs and vaccines. This type of coverage is required, but you have a few options:
- purchase a Part D policy with original Medicare
- sign up for a Medicare Advantage plan that includes Part D coverage
- get equivalent coverage from another plan, such as an employer-sponsored plan
If you don’t have prescription drug coverage and don’t sign up for it during initial enrollment, you’ll pay a lifetime late enrollment penalty.
Medigap can help pay out-of-pocket expenses. There are 10 Medigap “plans” that offer coverage: A, B, C, D, F, G, K, L, M, and N.
Each plan has slightly different coverage, and not all plans are sold in every area. Consider your individual needs when reviewing Medigap plans, and use the Medicare plan finder tool to see which plans are sold in your ZIP code.
Depending on the plan you choose, Medigap covers some or all of these Medicare costs:
Medigap is available for use only with original Medicare. It can’t be combined with Medicare Advantage (Part C) plans. You may not enroll in both Medicare Advantage and Medigap.
In Indiana, Medicare Advantage plans fall under seven categories:
- Health Maintenance Organization (HMO) plans. In an HMO, you select a primary care provider (PCP) from the plan’s network of doctors. That person coordinates your care, including referrals for specialists. HMOs include hospitals and facilities within the network as well.
- HMO with point of service (POS) plans. HMO with POS plans cover care outside their network. They generally include higher out-of-pocket costs for out-of-network care, but some of that cost is covered.
- Preferred Provider Organization (PPO) plans. PPO plans have a network of care providers and hospitals and don’t require you to get a PCP referral to see a specialist. Care outside the network may cost more or may not be covered at all.
- Provider-sponsored managed care plans (PSO). In these plans, providers take on the financial risks of care, so you choose a PCP from the plan and agree to use the plan’s providers.
- Medicare savings accounts (MSAs). An MSA involves a high-deductible insurance plan with a savings account for qualified medical expenses. Medicare pays your premiums and deposits a certain amount into your account each year. You can seek care from any doctor.
- Private Fee-for-Service (PFFS) plans. These are private insurance plans that set reimbursement rates directly with providers. You can choose any doctor or facility that will accept your PFFS plan; however, not all providers will.
- Religious Fraternal Benefits Society plans. These plans are HMOs, HMOs with POS, PPOs, or PSOs created by a religious or fraternal organization. Enrollment may be limited to people within that organization.
Special Needs Plans (SNPs) are also available if you need more coordinated care. These plans offer additional coverage and assistance.
You can get an SNP if you:
- are eligible for both Medicaid and Medicare
- have one or more chronic or disabling conditions
- live in a long-term care facility
These insurance carriers offer Medicare Advantage plans in Indiana:
- Anthem Blue Cross and Blue Shield
- Anthem HealthKeepers
- Indiana University Health Plans
- Lasso Healthcare
- Zing Health
Different plans are available in each Indiana county, so your options depend on where you live and your ZIP code. Not all plans are available in every area.
To be eligible for Medicare Indiana plans, you must:
- be 65 years old or over
- be a U.S. citizen or a legal resident for 5 years or more
You may qualify before you’re 65 years old if you:
- received Social Security Disability Insurance (SSDI) or Railroad Retirement Benefits (RRB) for 24 months
- have end stage renal disease (ESRD) or a kidney transplant
- have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
Some people are automatically enrolled in Medicare, but most need to sign up during the correct enrollment period.
Initial enrollment period
Starting 3 months before the month of your 65th birthday, you can enroll in Medicare. Your benefits will begin the first day of your birth month.
If you miss this early signup period, you can still enroll during the month of your birthday and for 3 months after, but coverage will be delayed.
During the initial enrollment period, you can enroll in parts A, B, C, and D.
General enrollment: January 1 to March 31
If you missed your initial enrollment period, you can enroll at the beginning of each year, but your coverage won’t start until July 1. Late enrollment may also mean you’ll pay a penalty whenever you do sign up.
After general enrollment, you can sign up for Medicare Advantage from April 1 through June 30.
Medicare Advantage open enrollment: January 1 to March 31
If you’re already enrolled in a Medicare Advantage plan, you can change plans or switch back to original Medicare during this period.
Medicare open enrollment: October 1 to December 31
Also called the annual enrollment period, this is a time when you may:
- switch from original Medicare to Medicare Advantage
- switch from Medicare Advantage to original Medicare
- switch from one Medicare Advantage plan to another
- switch from one Medicare Part D (prescription drug) plan to another
Special enrollment period
You can enroll in Medicare without waiting for open enrollment by qualifying for a special enrollment period. This will typically occur if you lose coverage under an employer-sponsored plan, move out of your plan’s coverage area, or your plan is no longer available for some reason.
It’s important to evaluate your healthcare needs and read each plan carefully so you can choose the one that offers the best coverage for your needs. Carefully consider:
- whether you need original Medicare or Medicare Advantage
- if your preferred doctors are in the Medicare Advantage plan’s network
- what the premium, deductible, copay, coinsurance, and out-of-pocket costs are for each plan
To avoid the late enrollment penalty, sign up for all parts of Medicare (A, B, and D) or make sure you have other coverage, like an employer-sponsored plan, when you turn age 65.
If you need more information or help understanding your Medicare options in Indiana, these resources are available:
- Indiana Department of Insurance, 800-457-8283, which offers a Medicare overview, helpful links for Medicare, and help paying for Medicare
- Indiana State Health Insurance Program (SHIP), 800-452-4800, where volunteers answer questions and help you with Medicare enrollment
- Medicare.gov, 800-633-4227
Here are tips to help you enroll in Medicare:
- Collect any records or information about your prescriptions and medical conditions.
- Ask your doctor which insurance or Medicare plans they accept or participate in.
- Determine when your enrollment period is and mark your calendar.
- Sign up for Part A and Part B, then decide if you would like a Medicare Advantage plan.
- Pick a plan with the coverage you need and providers you like.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.
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