Medicare is a federal program that provides health insurance coverage to seniors who are 65 years old and over, as well as to people with disabilities, even if they do not reach the age threshold. It consists of four coverage options — or parts — each of which charges its own monthly premium and helps pay for a portion of different medical services. Medicare Part A primarily covers inpatient hospital stays, services at skilled nursing and psychiatric facilities, hospice care and some home health care services. This option is free of charge for seniors, including those with eligible spouses, who have contributed through payroll to Medicare for a sufficient amount of time, typically 10 years.
Part B focuses on outpatient medical services and preventive care, and pays for doctor visits, diagnostic tests, medically necessary equipment and emergency ambulance transportation. Beneficiaries pay a mandatory premium each month, which is determined on a sliding scale. Part C, also known as Medicare Advantage, is offered through a private health insurance plan that combines Part A and Part B benefits with additional coverage, such as dental, vision and hearing. Part D is a separate plan that pays for prescription drug costs.
In Indiana, around 1.3 million citizens are covered by Medicare, which is nearly 1 in 5 of the state’s 6.8 million residents. As of 2023, 632,000 of those beneficiaries are enrolled in Medicare Advantage; this amounts to 47% of those eligible, which exceeds the 44% of the previous year. The percentage of beneficiaries enrolled in a Medicare plan increased by 8%, higher than the U.S. average of 7%. In addition, the state pays $11,118 per beneficiary, which is just below the national average of $11,910.
This guide explains in detail the coverage options available to Medicare beneficiaries in Indiana to help them make an informed decision that fits their needs and budgets. It also highlights top Medicare Advantage Plans in the state and provides a brief overview of some agencies and programs that help seniors understand and manage their coverage.
Original Medicare offers the same basic coverage for everyone, and for many seniors, it’s enough to cover the medical services they receive. For those who have more extensive needs, want to tailor their coverage or are seeking more robust coverage, private Medicare options are available.
Medicare Part A is free for most beneficiaries if they or their spouse paid enough Medicare taxes while working. Individuals who don’t qualify for premium-free coverage pay a monthly fee of either $278 or $506, depending on how much Medicare taxes they have paid.
Part B, however, comes with an income-based premium that starts at $164.90 per month, if the recipient’s annual income doesn’t exceed $97,000. After beneficiaries pay an annual deductible — $1,600 for services covered by Part A and $226 for Part B, as of 2023 — Original Medicare pays a portion of the costs.
Who Should Consider Original Medicare
Original Medicare may be a good option for those who:
Neither Part A nor Part B covers all health care expenses, and beneficiaries may need to consider supplemental insurance, such as Medicare Advantage, to fill gaps in coverage. There are four main types of Medicare Advantage Plans plus a Medical Savings Account (MSA):
Special Needs Plans are tailored for those with conditions such as diabetes or who are dually eligible for Medicare and Medicaid.
Who Should Consider Medicare Advantage
Seniors who should consider enrolling in a Medicare Advantage plan are those who:
The Top 10 Medicare Advantage Plans in Indiana
One of the biggest benefits of Medicare Advantage is that it enables seniors to enroll in coverage that best fits their needs and budget. The following table makes it easy to compare the top plans available to Hoosier seniors by highlighting monthly premiums across plans, quality ratings, plan type and the number of enrollees. To learn more about Medicare Advantage, visit the Medicare Advantage Plans in Indiana page.
|Medicare Star Rating
|Monthly Cost Range
|$0 – $132
|$0 – $81
|$0 – $21
|Blue Cross Blue Shield of Michigan
|$0 – $29
|Anthem Blue Cross and Blue Shield
|$0 – $54
|Indiana University Health Plans
|$0 – $98
|$0 – $187
|Wellcare by Allwell
|$0 – $12
Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later. Most Advantage plans include Part D coverage.
Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.
Who Should Consider Medicare Prescription Drug Coverage
Seniors who may benefit from prescription drug coverage include those who:
While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.
For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
Hoosier seniors can get help with finding the right Medicare policy for their budgets and coverage preferences through several state departments and programs. Through the following resources, seniors can learn about Medicare’s coverage, enrollment windows and how to find Medicare-registered health care providers. Seniors can also get information on resolving problems such as denied claims, canceled policies and Medicare fraud and waste.
The Indiana State Health Insurance Assistance Program provides free, unbiased Medicare counseling for beneficiaries. Seniors can call the program’s helpline to get answers to questions regarding Original Medicare coverage, how to avoid late enrollment penalties and what Medicare Advantage and Medigap plans are available in their ZIP code. SHIP advisors can also help seniors determine what to do if a claim is denied or their policy is canceled without just cause.
There are 16 Area Agencies on Aging throughout Indiana, each of which serves specific geographic regions. These agencies have health insurance Medicare advisors on staff to provide free information and assistance with Medicare. Advisors aren’t affiliated with any insurance companies and aren’t licensed to sell policies, but they can help seniors determine when enrollment periods are open and find the right coverage for their needs. All services are free and confidential.
Indiana Legal Services, Inc., is a statewide nonprofit organization staffed with licensed legal professionals who provide free civil legal services to those aged 60 and over. Through its regional offices, the organization offers assistance to Medicare beneficiaries, helping them enroll in a plan and understand their coverage. The organization can also help them dispute denied claims.
Senior Medicare Patrol is a volunteer-driven program that seniors can contact to learn how to protect themselves from Medicare fraud, waste and common scams. The program publishes information on how to recognize a scam or identify wasteful spending. It has trained volunteers who can help seniors review their medical bills and dispute charges for goods or services they didn’t receive, as well as file complaints with the Department of Insurance for unfair claims handling. SMP also organizes community events in which attendees can learn about Medicare fraud, errors and waste in a group setting.
The Social Security Administration publishes current information on how to sign up for Medicare in person, online or at local SSA offices. It outlines how beneficiaries can manage their Medicare benefits and obtain Medicare cards. It also has an online tool seniors can use to determine whether they qualify for assistance programs to help them pay for health costs not covered by Medicare, including monthly premiums, deductibles and copayments or coinsurance.