Medicare Advantage in Indiana

Approximately 16.9% of Indiana’s population of around 6.8 million is aged 65+. Older adults are among the main participants in the federally run Medicare health insurance program and the privately operated Medicare Advantage initiative. Although similar, there are distinct differences between the two plans. Medicare provides pay-per-service inpatient and outpatient care through Parts A and B, respectively. It also offers prescription drug benefits via Part D. Medicare Advantage, sometimes known as Medicare Part C, provides a combined package of benefits payable by monthly premiums.

Medicare Advantage Plans must include all the same provisions as Parts A and B of Original Medicare, save for hospice care. Although not a requirement, many insurance companies also include some prescription medication coverage. Plans also typically include diverse services on top of those covered by regular Medicare, such as dental and vision care, routine medical transportation and senior nutrition programs. Part C providers are regulated by the Centers for Medicare and Medicaid Services.

Medicare Advantage participants benefit from an annual limit on personal charges, whereas yearly service fees are uncapped under Original Medicaid. Part C providers can also decide their fee schedule for deductibles and copays. Individuals enrolled in a group plan, such as through an employer or union, may have zero monthly premiums.

Across the country, 51% of qualifying Medicare beneficiaries opt for Medicare Advantage coverage. Opting into Part C is a little less common in Indiana, with 47% of approximately 1.3 million eligible candidates enrolled for Medicare Advantage in 2023. Compared to the previous year, eligible beneficiaries are up 2.46%, and the percentage growth of those enrolled for Part C is 11.05%. In 2022, 44% of Indiana’s Medicare-eligible individuals signed up for private coverage, suggesting that Medicare Advantage is gradually gaining popularity in the state.

This guide unveils the Medicare Advantage landscape in Indiana, providing valuable insights into top plans, eligibility criteria and coverage specifics for state residents. Whether seeking comprehensive coverage or knowledge, this resource empowers individuals to make informed health care decisions. 

The Top 10 Medicare Advantage Plans in Indiana

Many insurers offer private Medicare Advantage Plans in Indiana. The table shows the state’s 13 top Part C providers, ordered by the total number of enrollees. The enrollee number is a combination of people signed up for all plans from each provider. The cost range takes into account pricing variations across different policies. Figures are correct as of July 2023, and more information is available at Medicare.gov.

How Medicare Advantage Plans Work in Indiana

Prior to selecting an Advantage plan, it’s a good idea for seniors to familiarize themselves with how the Medicare Advantage program works and how to qualify. Insurance companies offer different types of plans, including the familiar health maintenance organization (HMO) and preferred provider organization (PPO) plans that most people already have experience with. Each health plan has its own rules regarding eligibility, which doctors plan members may see, how to get a referral to a specialist, which medications are covered and the need to establish primary care. Below is a review of the four most common types of Advantage plans. 

What Medicare Advantage Plans Cover in Indiana

Aside from hospice care (which remains covered by Medicare Part A), Advantage plans are legally required to cover everything offered by Medicare Parts A and B. This includes preventative care, emergency room visits, inpatient care, outpatient procedures, diagnostic testing and medical equipment and supplies. Medicare Advantage plans often include prescription drug plans, coverage for dental, vision and hearing care, and discounts on wellness programs, such as meal services and gym memberships. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Indiana

Before seniors can apply for Medicare Advantage, they need to already be enrolled in Original Medicare (Parts A and B) and live in the service area for the plan they’ve selected. They must meet all other Medicare enrollment requirements and the eligibility requirements for the Advantage plan they’ve chosen. Medicare is only provided to seniors over the age of 65 and adults with qualifying disabilities. It’s also only accessible to U.S. citizens and legal residents. 

Medicare has an initial enrollment period and annual enrollment periods that allow seniors to make changes to their plans. It’s important for seniors to know when they can enroll and how to avoid late enrollment penalties. The list below reviews enrollment periods and timing.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Indiana

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources