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Medicare Plans in Indiana – Coverage and Benefits

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.

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.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

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
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

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.

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:

[chart category=”supplement” name=”planTypes” state=”IN” zipcode=”46227″]

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”.

[chart category=”advantage” name=”topHMOPlans” zipcode=”36101″ state=”AL”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”36101″ state=”AL”]

Comparing Medigap to Medicare Advantage in Indiana

There are many fine differences between either form of supplemental coverage. For some people, a Medigap policy might be the perfect solution for their specific needs. For others, it’s possible that Medicare Advantage might give them just enough coverage to get by. It’s important to know the differences between the two, as outlined below:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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.

[chart category=”general” name=”usefulContacts”]

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.

 

 

 

 

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