Medicare in Indiana

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.

Options for Medicare Coverage in Indiana

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. 

Original Medicare (Parts A & B)

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:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

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):

• Health Maintenance Organizations have low out-of-pocket costs but the strictest rules.
• Preferred Provider Organizations have higher monthly costs but greater flexibility.
• Private Fee-For-Service Plans allow policyholders to go to any provider agreeing to the plan’s payment terms.

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: 

• Don’t mind being limited to in-network providers 
• Want more control over annual health care spending 
• Want benefits beyond what’s available in Original Medicare 

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 Prescription Drug Coverage (Part D)

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:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

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:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Indiana

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.