Medicare in Indiana

Original Medicare is a federally-run program that does not vary from one state to another. So general Medicare eligibility in Indiana and Medicare enrollment in Indiana work the same way they do in every other state. For residents who aren’t yet receiving Social Security retirement benefits and thus aren’t automatically enrolled when they turn 65, the Medicare application in Indiana is done via the Social Security Administration, as is the case throughout the United States.

Available options for private Medicare coverage, including Medicare Advantage plans, Medigap plans, and Medicare Part D plans, do vary from state to state.

Medicare Advantage is available as a private alternative to Original Medicare. Medicare Advantage includes all of the benefits of Original Medicare (hospital and outpatient/physician coverage), although the out-of-pocket healthcare costs can be very different, as Medicare Advantage plans can set their own coinsurance, copays, and deductible levels (within parameters set by CMS).

Most Medicare Advantage plans also include Part D coverage for prescription drugs, as well as extra programs like dental and vision coverage. But Medicare Advantage plans tend to have localized healthcare provider networks, as opposed to Original Medicare’s nationwide access to healthcare providers. There are pros and cons to either option.

Twenty-eight percent of Medicare beneficiaries in Indiana were enrolled in Medicare Advantage plans as of 2018, compared with an average of 34% nationwide. As of mid-2023, there were 631,801 Indiana Medicare beneficiaries enrolled in private Medicare plans (as opposed to Original Medicare; that figure does not include people who had private coverage to supplement Original Medicare), which amounted to about 47% of the state’s Medicare population.

That’s in keeping with the national trend of increasing enrollment in Medicare Advantage plans over the last several years; Medicare Advantage accounted for about 48% of all Medicare beneficiaries nationwide as of 2023 (and more than half of all eligible beneficiaries, if we only include people who are enrolled in Medicare Part A and Part B, as opposed to just one or the other; you can only enroll in Medicare Advantage if you have both parts of Medicare).

Medicare Advantage plan availability varies from one country to another. For 2023, Indiana residents can choose from among at least 37 Medicare Advantage plans, and up to 67 plans, depending on where they live (these numbers are a dramatic increase from 2020, when plan availability ranged from 11 to 30 plans, depending on the county).

Medicare’s annual election period (October 15 to December 7 each year) gives Medicare beneficiaries the opportunity to switch between Medicare Advantage and Original Medicare (and add or drop a Medicare Part D prescription plan). There is also a Medicare Advantage Open Enrollment Period (January 1 to March 31), during which a person who already has a Medicare Advantage plan can pick a different Advantage plan or switch to Original Medicare.

More than half of Original Medicare beneficiaries receive supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) are designed to pay some or all of the out-of-pocket costs (deductibles and coinsurance) that Medicare beneficiaries would otherwise have to pay themselves. Original Medicare does not limit out-of-pocket costs, so most enrollees use some form of supplemental coverage; Medigap plans are what’s available for people who don’t have access to an employer-sponsored plan (including retiree plans) or Medicaid.

Although Medigap plans are sold by private insurers, the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer is selling the plan. So plan comparisons are much easier for Medigap policies than for other types of health insurance; consumers can base their decision on premiums and less tangible things like customer service, since the benefits themselves are uniform.

You can compare Medigap plans on Medicare.gov’s plan finder, or using Indiana’s plan comparison tool. According to an AHIP analysis, 387,689 people in the state had Medigap coverage as of 2021.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and about 14% of Indiana’s Medicare beneficiaries are under age 65. But federal rules do not guarantee access to Medigap plans for people who are under 65. However, the majority of the states have rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. Since mid-2020, Indiana has been among them, thanks to legislation that the state enacted in 2019 (S.B.392).

The bill passed with strong support in both chambers of Indiana’s legislature, and was signed into law in May 2019. As of July 2020, it requires Medigap insurers to offer at least one Medigap plan (Plan A) to Medicare beneficiaries who are under 65 and eligible for Medicare due to a disability. The legislation requires Medigap insurers to grant Medicare beneficiaries a six-month open enrollment period that begins when they’re enrolled in Part B (or determined eligible for retroactive Part B coverage), regardless of age. And for Indiana residents who were under 65 and already enrolled in Medicare due to a disability, a one-time six-month enrollment window ran from July through December 2020.

Prior to mid-2020, Medigap insurers in Indiana were not required to offer coverage to beneficiaries under the age of 65—and none of them voluntarily chose to do so.

Indiana joined several other states that require Medigap insurers to offer at least one plan on a guaranteed-issue basis to disabled Medicare beneficiaries. But unlike some of those states, Indiana’s legislation does not limit premiums for these enrollees, so rates for people under 65 can be much higher than the rates for a person who is 65. As an example, premiums for Plan A for a 65-year-old non-smoking woman in Indianapolis range from about $91 to $322/month in 2023. But if she’s 64 instead, the premiums for the available plans range from about $210 – $1,027/month.

Medicare beneficiaries under age 65 also have the option to enroll in Medicare Advantage plans, as those plans are guaranteed issue for all Medicare beneficiaries within their service area, regardless of age.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those regulations don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can look back at your medical history in determining whether to accept your application, and at what premium.

Original Medicare does not cover outpatient prescription drugs. Some Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer), and these plans often include prescription coverage. But Medicare enrollees without drug coverage through an employer-sponsored plan need to obtain Medicare Part D prescription coverage (note that people who are dually eligible for both Medicare and Medicaid also get their drug coverage through Part D, rather than the Medicaid program). Part D coverage can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan that includes Part D prescription drug coverage.

In Indiana, there are 24 stand-alone Part D plans for sale for 2023, with premiums as low as $4.80/month.

As of mid-2023, there were 1,097,487 Indiana Medicare beneficiaries who had Part D prescription coverage. About 46% had coverage under stand-alone Part D plans, while about 54% had Part D prescription coverage as part of their Medicare Advantage plans.

Medicare Part D enrollment is available when a beneficiary first becomes eligible for Medicare. And the annual Medicare election period each fall (October 15 to December 7) allows beneficiaries the opportunity to switch to a different Medicare Part D plan or enroll for the first time if they didn’t do so when they were first eligible, although a late enrollment penalty can be assessed if they didn’t have creditable coverage prior to enrolling.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Indiana includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Do you have questions about Medicare eligibility or need help enrolling in Medicare in Indiana?

• The Indiana Department of Insurance (IDOI) website is good resource for eligibility, enrollment, and other general Medicare information.
• The Indiana State Health Insurance Assistance Program offers free assistance for Medicare beneficiaries. Call their central office at 1-800-452-4800 or find a local office.
• The Medicare Rights Center has a comprehensive national website and a helpful call center that can provide a variety of assistance with Medicare-related questions.
• Programs of All-Inclusive Care for the Elderly (PACE): A Medicare and Medicaid program that helps seniors receive the care they need in their homes and local communities, without having to move into a nursing home.