Anyone living in Indiana age 65 or older is eligible and encouraged to enroll in the federal Medicare program. This program is designed to help hard-working, retirement-age individuals manage their health care and costs during their golden years. The program starts off with two basic forms of coverage: Medicare Part A, which takes care of mostly hospital-related expenses, and Medicare Part B, which deals with doctor visits and various outpatient services. Parts A and B may also be referred to as “Traditional” or “Original” Medicare.
Coverage and Benefits
The base costs for Traditional Medicare are meant to be kept as low as possible, since most beneficiaries are expected to be living on a fixed income. Part B will require both a monthly premium and a yearly deductible. Those costs can be found here. Part A may be free for individuals with an extended work history (10 years/40 quarters or more). If you have worked less than that, you may need to pay fees in order to receive Part A benefits.
Every single senior who applies for Medicare will automatically get Part A and Part B benefits as soon as they are accepted. Unlike private insurance companies, the application process for Medicare rarely rejects an applicant. Once you are accepted, your first choice is whether or not to accept Part B benefits; refusing Part A benefits means you won’t have access to Medicare at all. Medicare Part B benefits may be optional for seniors who only want hospital, hospice, and end of care coverage.
The optional nature of original Medicare benefits gets a little more complicated when you look at Parts C and D. If you want Medicare Part D prescription drug coverage, you have to accept and pay for Medicare Part B as well as Part A benefits. Part B is no longer optional in this scenario. Likewise, if you go with a Part C private health insurance plan, Medicare Parts A & B are a package deal. You cannot alter your policy in a way that takes away these benefits – you can only add optional coverage to it.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Indiana Medicare Coverage Statistics
As of right now, there are more than one million (1,048,499) residents living in Indiana who are enrolled in some sort of Medicare program. 230,669 of them have opted out of government Medicare in exchange for Medicare Part C (a.k.a. Medicare Advantage – more on that later). A larger number of beneficiaries – 292,142, to be exact – prefer Medigap supplements. These two groups make up 22% and 28% of all Medicare beneficiaries in Indiana. The remaining 50% are either relying on a supplement from some other source, such as an employment benefit, or aren’t supplementing their Medicare at all.
To meet your Medicare supplement needs, you must first enroll in the program or currently be receiving benefits. Enrolling in Medicare is easy – just click the link to learn how.
Should All Indiana Residents Purchase Supplemental Insurance?
Really, it all depends on a number of factors. Some of the biggest ones are your age, relative level of health, and your available budget. Purchasing supplemental insurance while you are still closer to 65 and in comparably good health might get you lock in lower rates for years to come. And it will help protect you from the “gaps” in Medicare coverage, which can lead to some of the following out-of-pocket expenses:
|Medicare Part A Costs||Medicare Part B Costs|
Postponing the purchase of a supplemental policy now to save money in the short term could end up costing you more in the future. For these reasons, and also for the peace of mind, many retired citizens choose to supplement their Medicare benefits.
It’s important to understand that despite living in Indiana, healthcare costs are only going to rise in the near future. This can become very problematic for retirees, especially as they age. Dwindling savings and limited Social Security income can make it difficult to pay for health care costs. This is especially true if you don’t do anything to protect yourself from the gaps in Medicare coverage.
Luckily, there are supplemental health insurance options to protect against these gaps. For most seniors, this extra coverage is highly affordable and will pay for itself many times over in the long run. Some of these supplement plans are very simple and straightforward, making it easier for their customers to enjoy their golden years without the stress of expensive claims for their medical care.
The most expensive coverage gaps can be found in Medicare Part A. Benefits that cover extended hospital stays dwindle after a few days. If you need to spend weeks or months in a hospital, you can end up paying tens of thousands of dollars for your care. Similarly, Part B coinsurance and copay as can get out of hand if you don’t have a supplement insurance policy to help you share the costs.
So what supplements options are available for people over the age of 65? There are two main competitors: Medicare Part C (Medicare Advantage), and Medicare supplement insurance (Medigap). Although both aim to achieve similar goals, there are some stark differences between the two that seniors need to know about before they make such a serious decision.
Indiana Medigap Supplement Insurance
Medigap supplement insurance – which is designed to protect against the “gaps” in Traditional Medicare coverage – is available in all 50 states, which includes Indiana. These 10 government-approved plans are named alphabetically: A, B, C, D, F, G, K, L, M, and N. Each one of those ten plans offers identical benefits, no matter where you live in the country. The only difference is how much they cost, and which provider will underwrite them for you.
Here’s a breakdown of each plan’s benefits:
Medicare Advantage Options in Indiana
Although Medicare Advantage (MA) is technically a form of supplemental insurance, it acts more like a replacement of Traditional Medicare in practice. This is because MA policies are not offered by the federal government. Rather, a private insurance company promises to provide “equal or greater” coverage and benefits than Traditional Medicare as is required by law. In fact, many companies do fulfill the “greater” part of that promise with additional coverage options like prescription drugs or vision. But these extra benefits will cost extra, too.
MA plans offer access to fairly restricted networks. These limited PPO and HMO networks of doctors and physicians do help keep costs low, but switching to a Medicare Advantage plan might make it difficult or impossible for you to keep seeing the same doctor. However, if the price is right and you feel like you may get comparable care from a new physician, you have to sit down and consider what is best for you, your health, and your budget.
Note: in this context, PPO stands for “Preferred Provider Organization” and HMO is short for “Health Maintenance Organization”.
Comparing Medigap to Medicare Advantage in Indiana
Medigap plans are your first option when it comes to filling your Medicare coverage gaps. You can enroll in one as soon as you enroll in Medicare, and they usually cost only a small monthly premium to keep your coverage. Smaller plans may only cover extended hospital stays and blood transfusions, but comprehensive ones like Plan F can cover everything including original Medicare deductibles, coinsurance, co-pays, and even foreign travel medical care. Total costs largely depend on your needs.
Next up is Medicare Advantage. Although it has the name “Medicare” in it, it’s not actually a true Medicare plan. It is a private health insurance policy designed to mimic your Medicare Part A and B benefits. but with Medicare Advantage, you have the option to purchase additional coverages such as dental or vision. you can also add prescription drug coverage. These optional coverages are not available with a Medigap supplement insurance policy. Just keep in mind that adding these options to your Part C plan may significantly increase your costs.
For most seniors, Medicare Advantage can be a little unpredictable – especially as time goes on. Younger retirees who are in good health and don’t need many other coverage options get the most bang for their buck with Medicare Advantage. Seniors on a tighter fixed income who require more medical care can see their health care costs rise exponentially with Medicare Part C. While Medigap policies don’t necessarily have as many options as Medicare Part C, they still provide a lot of value and cost savings for millions of senior citizens.
For more information on the difference between Medicare Advantage and Medigap, we compassionately encourage you to contact one of our customer service Representatives. They can help you find out which policy is best for you, and they can even help you find fast, free quotes today. For your convenience, we’ve also included a list of frequently asked questions which helped clarify some of the differences between these two types of insurance.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||The government pays for most or all of your premium based on estimated costs in your area. Whatever the government doesn’t pay for, you do.||Your low monthly premium covers most or all of your expenses, especially if you have a very comprehensive plan.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||Depending on where you live and what your health care needs are, your premium could be almost $0 – or it could be much, much higher.||Regardless of your location or health care needs, the vast majority of your Medigap costs only require a low monthly premium.|
|What will the plan cover?||Medicare Advantage covers the same benefits you would get from Medicare Parts A & B. Additional coverage, such as prescription drugs, will cost more.||Medigap policies supplement the gaps in Medicare coverage, such as extended hospital stays, hospice care, and may cover expensive coinsurance/copay costs associated with Part B. There is no prescription drug coverage.|
|Is it easy to budget my health care expenses?||Your out-of-pocket expenses will rise with the more care you receive, making it harder to budget unless you stay healthy.||If your Medigap plan covers all of the Part A gaps and most of the Part B gaps, it becomes much easier to budget for.|
|Is my plan guaranteed? Or can it be cancelled?||You will not receive the guarantees from Medicare Advantage that you would get from original Medicare. They can cancel or raise your rates at any time at their discretion.||Medigap policies are guaranteed to stay active unless you fail to pay your premiums or the company goes under.|
|Do I have to clear a pre-approval or pre-certification process?||Yes, there is a separate and more rigorous approval process compared to that of Medicare||Qualifying for Medicare automatically makes you qualified for a Medigap supplement insurance policy|
|Am I limited to specific doctors or hospitals?||Not only are you limited to a select network of doctors and facilities, but they can be quite restrictive and certain areas.||Medigap insurance is accepted everywhere that Medicare is accepted.|
|What type of plan is best for me?||Seniors who are young, as healthy as possible, who are living in urban areas with many health care choices, and who want many additional coverage options could see a financial advantage with Medicare Advantage.||If you are older, if you need lots of expensive Medical Care, if you live in an area without many doctor/facility choices, and if you need to stick to a budget, there are many advantages to purchasing Medigap insurance.|
Medicare Resources in Indiana
We hope that this article has been informative enough to get you started towards supplementing your Medicare benefits in an efficient and cost-effective manner. However, it is unlikely that we can answer all of your questions on this one page. The experts at the offices below, however, most likely can. Feel free to reach out to them, or any other Medicare insurance experts, and discuss any concerns you may have.
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.