Not all seniors, especially those who are new to Medicare, are aware of the coverage gaps which exist in Parts A and B of the federal Medicare program. What you need to know is that without covering these gaps, you could end up paying thousands in out-of-pocket medical bills if you don’t protect yourself with a Medicare supplement insurance policy. There are several different types, but one of the more well-known policies is known as Medicare Advantage (or Medicare Part C). This is a private health insurance policy which, unlike most other supplements, replaces your Medicare benefits.
Federal Regulations for Medicare Advantage
Because a Medicare Advantage policy means you will no longer be receiving federal Medicare, the government has strict regulations in place to protect consumers from receiving inferior coverage. Your Advantage plan, by law, must provide coverage which is as good or better than what Medicare Parts A & B have to offer. Usually, the coverage is better. These plans are designed not just to replace Medicare, but to protect you from Medicare coverage gaps as well.
Medicare Advantage Enrollment In Indiana
There are over three hundred thousand Indiana residents right now who are enrolled in a Medicare Advantage program. This number represents 26% of seniors in Indiana who are currently receiving Medicare benefits. As to what the other seniors are doing, it’s suffice to say that the remaining 74% are sticking with Original Medicare, receiving coverage through an employer health insurance plan, or have augmented Medicare Parts A and B with Medigap insurance.
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
Have you ever smoked? Are you a 65 year old senior who just enrolled in Medicare for the first time? Are you female, or male? The answers to these questions will play an important factor in how much you end up paying for a Medicare Advantage policy. For your reference, the chart below displays estimated rates for seniors in your area.
Most Popular Medicare Advantage Plans in Indiana
We have a very simple ratings plan to avoid any and all confusion. We use the popular five star system to rate Medicare Advantage plans from best to worst. The more stars the plan has, the more likely you are to get the best possible care for an affordable price. If you have special needs such as chronic condition management, then you’ll definitely want to go with a company who ranks high in customer service as well as value.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Your provider network will determine when, where, and how you get your medical care. Networks with more restrictions, like HMOs, have fewer doctors and hospitals for you to choose from. PPOs and PFFS networks, on the other hand, include a wider variety of doctors and facilities. Also, keep in mind that your insurance company can change the rules and restrictions on your provider network at any time. You should always be prepared for unexpected changes.
Where you generally need to get your care and services from for:
- HMO Plans: If you’re going to accept an HMO plan, prepare yourself for the fact that you may not get as much choice as other networks. It’s difficult to get your medical costs covered if you seek care from a physician outside of your network. This goes for hospitals and outpatient centers, too. The only exception is when you need emergency care and cannot get to a network provider. Point of service (POS) HMO plans have a few exceptions if the out-of-network care you seek is absolutely necessary.
- PPO Plans: A PPO plan is also known as a Preferred Provider Organization plan. These networks have preferred providers which they would like you to use, but they will still cover some of your medical costs if you go out of network. Just understand that you may have to pay a little bit more or your claims may pay out a little bit less than if you had stayed in network. The monthly premiums are usually more expensive than an HMO plan, too.
- PFFS Plans: Your third option is a Private Fee-For-Service plan (PFFS). It works very similarly to Original Medicare, but there are some exceptions. The odds are good that if it is a Medicare-approved doctor or facility, they will agree to work with your insurance and you won’t incur too many out-of-pocket costs. However, they can reject you if they don’t agree to the payment terms of your plan.
- Special Needs Plans: A Special Needs Plan may also be available if you qualify. Unfortunately, they are equally restrictive compared to HMO plans. At the same time, you can still go outside of your approved network in the event of an emergency. A Special Needs Plan also has exceptions for emergency dialysis in patients who have ESRD and cannot get to a network provider in time. Regardless of whether you have ESRD or some other type of special medical need, it’s a good idea to try your best to stay in network and get care from the specialists who have been specifically chosen for you.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans: The vast majority of Medicare plans which adhere to HMO networks may limit the different doctors, hospitals, and other facilities you can get medical care from. Of course, there are exceptions if you need emergency care and you are far from a network provider. There are also some Point-of-Service plans which make further exceptions for non-emergency specialty care.
- PPO Plans: Medicare Advantage PPO plans are also very similar to PPO Plans offered by Medicare Parts A and B. You have a much wider variety of choice, but you will likely have to pay higher monthly premiums. On top of that, any out-of-network health care you receive may cost a bit more out-of-pocket for you.
- PFFS Plans: The PFFS plans are also eerily similar with Medicare Advantage as they are to plain Medicare. You have to come to an agreement with the doctor or facility you want to get care from before they will agree to treat you. If they refuse the payment terms of your insurance, then you will have to get care from someone or from somewhere else.
- Special Needs Plans: Yes, Medicare Advantage plans may have special needs plans options available for you. But understand that you may have a more restrictive Network than you would with a different policy. It’s also important to understand that the specialists in your limited network have been chosen because of their expertise and not just for the price agreements they made with your insurance provider – so you should try to stick with them when and where you can.
For your convenience, Medicare.gov has an easy and efficient database you can search to see if your preferred doctor(s) and facilities are included in your plan.
Drug, Vision and Dental Coverage
Traditional Medicare only concerns itself with basic health services, such as hospital visits and outpatient care. Only in recent years has the option for prescription drug coverage (offered by Medicare Part D) become available. Very few Medicare supplements, with the exception of Medicare Advantage, offer ancillary benefits such as vision or dental coverage. You can mix and match vision, dental, and prescription drugs all together on the same Advantage policy if you wish. But keep in mind that the more benefits you have, the more expensive the policy will be.
- Vision Coverage – There aren’t any laws or regulations which require your Medicare Advantage plan to sell you vision coverage. Unlike Medicare, however, you may have the option to purchase it depending on where you live and the company you buy your policy from. It’s up to your provider to determine the network of care providers you have access to and how much you have to pay to access that care.
- Dental Coverage – Dental coverage is another option which a regular Medicare policy won’t offer, but that you may be able to get from Medicare Advantage. But you won’t be able to visit just any dentist. The odds that you will be limited to a specific network of dentists and dental surgeons is highly likely. You should consult with the details of your plan in order to figure out who those are and when you can see them.
Enrollment Options & Best Time To Enroll
Unlike Traditional Medicare or certain Medicare supplement policies, Medicare Advantage providers Can take greater liberties when it comes to refusing to provide coverage for poor health or pre-existing conditions (such as End Stage Renal Disease) if you apply outside of the open enrollment window. New Medicare recipients in relatively good health are the best candidates for receiving coverage. Contact your state department of insurance and/or your local insurance agent for more details on getting coverage with pre-existing conditions. You can also visit our Medicare Advantage Enrollment Page for more info.
- Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
- Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.
What Medicare Advantage Plan Is Best For Me?
If you do decide to go with a Medicare Advantage plan, finding the right one can be a challenge. The goal is to find the most financially stable provider you can who will offer you an affordable monthly premium and the best possible care management. It’s hard to anticipate what sort of care management you will need because anticipating your future medical needs is a challenge for everyone. But the best providers are the ones who will make that challenge as simple as possible.
As if making the decision weren’t hard enough, Medicare enrollment periods are much shorter than other enrollment periods. You have to act quickly if you want to get a good plan and have time to evaluate it or switch to one that works better for you. But we can help you spend less time searching and more time getting the care you need by comparison shopping now.