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Best Medicare Advantage Plans in Indiana 2020

When you are first eligible for Medicare, you have the option to receive your Medicare Part A and Part B benefits through Original Medicare or one of the best Medicare Advantage plans in Indiana for 2020. The federal government administers Original Medicare through The Centers for Medicare and Medicaid Services (CMS). Independent Medicare-approved insurance companies administer Medicare Advantage plans in Indiana.

A Medicare beneficiary who chooses Original Medicare can buy a Medicare Supplement policy to help pay out-of-pocket health care costs such as copayments, deductibles, and coinsurance. Beneficiaries opting for a Medicare Advantage plan in Indiana cannot buy additional health insurance through a Medicare Supplement policy.

Whether you choose Original Medicare or a Medicare Advantage plan (MA) in Indiana for 2020, you must stay enrolled in Medicare Part A and Part B and pay your Medicare Part B premiums.

Monthly premiums for Medicare Advantage plans range from $0 premium and higher. Rates vary due to several factors:

  • Insurance company
  • Location
  • Cost-sharing amounts
  • Benefits
  • Type of Advantage plan
  • Whether the plan includes Medicare Part D

Best Medicare Advantage Plans in Indiana: When Can You Enroll?

A Medicare Advantage plan is often referred to as Medicare Part C. Medicare Advantage enrollment occurs during set periods:

  • Medicare Initial Coverage Election Period ICEP. The ICEP is the same as your Medicare enrollment period. It covers a seven-month window that starts three months before you turn 65, the month you turn 65 and the three months after you turn 65. During your ICEP, except for end-stage renal disease ESRD, an insurance company cannot deny you coverage due to health, age, or pre-existing conditions.
  • Medicare Annual Election Period AEP. Oct. 15 to Dec. 7. Your AEP is when you can change policies and switch from Medicare Part C to Medicare Part A and Part B or vice versa. You can also change, join, or drop Part D plans. During your AEP, except for ESRD, an insurance company cannot refuse to cover you due to health, age, or pre-existing conditions.
  • Medicare Advantage Disenrollment Period MADP. Before 2019, beneficiaries could disenroll from a Medicare Advantage plan between Jan. 1 and Feb. 14. The  Open Enrollment Period replaces the MADP.
  • Medicare Advantage Open Enrollment Period  MA OEP. Jan. 1 to Mar. 31. During open enrollment, you can change to another Medicare Part C policy in Indiana or disenroll from a Medicare Advantage plan and return to Original Medicare and a Medicare prescription drug plan.
  • Medicare Special Election Periods SEP. SEPs are for individuals who experience life events such as moving, becoming dual-eligible for Medicare Part A and Part B and Medicaid, or losing group or employer coverage. If you lose employer or group insurance, your SEP ends 63 days after the insurance ends. The time frame for other SEPs varies. If you have an unusual situation, one of our agents can explain your options.

Remember, you must stay enrolled in Medicare Part A and Part B to qualify for a Medicare Advantage plan in Indiana.

Best Types of Medicare Advantage Plans in Indiana for 2020

There are several types of Medicare Advantage plans a beneficiary can choose from in Indiana, although not every kind is offered in all Indiana counties. Most of the options require cost-sharing. Here’s a brief look at the health plans Indiana offers:

HMO Medicare Advantage Plans in Indiana

Health Maintenance Organization HMO plans are managed care plans that are the most restrictive in terms of health care providers:

  • Have a doctor and hospital provider network
  • Does not cover out-of-network services except emergencies
  • Primary care physician (PCP) coordinates care
  • Usually, cover prescription drugs

PPO Medicare Advantage Plans in Indiana

Preferred Provider Organization PPO plans also fall under managed care:

  • Have in-network providers
  • Provide coverage for out-of-network services but at lower rates
  • No PCP or referral
  • Usually, cover prescription drugs

Private Fee-for-Service Medicare Advantage PFFS Plans in Indiana

Private fee-for-service plans are private health insurance, not managed care:

  • No primary doctor required
  • Can see any provider as long as the provider accepts the fee schedule
  • The plan decides fee schedule and medical necessity
  • Might cover prescription drugs

Special Needs Plans in Indiana

Medicare limits Special Needs Plans SNPs to individuals who fit one of the following categories:

  • Have chronic health conditions such as ESRD or heart failure
  • Live in institutional conditions such as a nursing facility
  • Dual-eligible for Medicare Part A and Medicare Part B and Medicaid

Characteristics of SNPs:

  • Have provider network
  • Typically require primary care doctor
  • Referrals required
  • Must include prescription drug coverage

Medicare Medical Savings Accounts MSA in Indiana

MSA health insurance policies combine a high deductible with a savings account. Medicare pays the premiums and deposits money into your MSA. Indiana beneficiaries can use money from the MSA to pay healthcare costs:

  • $3,000 deductible
  • $2,000 savings account
  • No doctor or hospital networks
  • No limit on what providers can charge

Enrollment Figures for Indiana Medicare Advantage Plans

Indiana has a population of more  than 6.7 million; about 36% live in the five largest counties:

  • Marion
  • Lake
  • Allen
  • Hamilton
  • St. Joseph

About 15% of Indiana residents are age 65 or older. Some statistics from CMS:

  • Seniors who have Medicare coverage: 1,245,842
  • Beneficiaries who have Medicare Advantage: 32%
  • Individuals in Indiana who have Medicare Advantage Prescription Drug plan: 34%
  • Beneficiaries who get a low-income subsidy through the Extra Help program: 25%

In any case, almost 90 percent of residents chose their Medicare Part C plans in Indiana from only three insurance companies. To find the best Medicare Advantage plan, it might help to look at these major Indiana Medicare insurance companies:

  • Humana: Humana ranks right behind UHC for popularity. Humana has about 33 percent of the Indiana market.
  • Health Alliance: This smaller insurer has some highly rated HMOs in certain Indiana counties.
  • Indiana Blue Cross: The Indiana Blue Cross affiliate is a popular choice with a little more than one-fifth of the statewide market.

You may want to pay attention to news about updated quality ratings for  Medicare Advantage Plans in Indiana for 2020. The highest rating that Medicare assigns is a 5-star rating. However, there didn’t appear to be any providers with a 5-star rating in Indiana at this time. Most MA members enroll in plans that have a score of at least 4 stars.

Do Medicare Advantage Plans in Indiana for 2020 Cover Prescription Drugs?

Most of the Medicare Advantage plans in Indiana include prescription drug coverage. These are known as Medicare Advantage Prescription Drug (MAPD) plans. Each MAPD has a list of drugs (formulary) that it covers.

Each formulary is divided into prescription drug tiers. Tiers range from the lowest cost (generic drugs) to the highest price (specialty drugs). Your copay and coinsurance amounts depend on how the MAPD categorizes your drug.

Your deductible, drug tiers, copayments, and pharmacy restrictions vary between MAPD plans. Formularies differ, too. When evaluating the best Medicare Advantage prescription drug plans, examine the policies carefully to see how they compare in these areas.

Network Restrictions for Medicare Advantage plan in Indiana

HMOs and PPOs use provider networks. They differ in how they treat in-network vs. out-of-network services:

  • Within coverage area. PPOs will pay for services if you go outside the network, although the payment will be less than if you stay in-network. HMOs require you to receive care in-network — except in cases of emergencies — and might deny payment if you go outside the network. If your PCP authorizes a referral to an out-of-network health care provider, the HMO will pay.
  • Traveling. PPOs and HMOs are required to cover emergency care when you’re traveling outside of the service area.

With Medicare Advantage plans, you must live within the service area of the plan. Moving out of state requires you to switch to a plan in your new location; this triggers an SEP.

Added Benefits of Medicare Supplement Plan in Indiana for 2020

Each insurance company selling Medicare Advantage plans in Indiana can choose whether to offer additional benefits over and above the basic Medicare Part A and Part B benefits. Extra benefits might include:

  • Routine vision and dental
  • Hearing
  • Wellness programs such as SILVER SNEAKERS
  • Starting in 2020, insurance companies that provide Medicare Advantage plans in “state” will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
  • The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insurers that offer Medicare Advantage plans in “state”.

To find the best Medicare Advantage plan in Indiana, carefully compare plan options, rates, and benefits. If you would like one of our insurance agents to help you compare plans, feel free to give us a call.

For a beneficiary new to Indiana Medicare, Medicare coverage and the various insurance plans can become confusing. Our agents can also provide information on Medicare Supplement insurance (Medigap) and stand-alone Medicare Part D prescription drug coverage so that you can get the best coverage available.

Indiana Medicare Resources

Extra Help Program

Indiana Department on Aging and Elder Services