Indiana Medicare Supplement Plans (Medigap)
Indiana residents who are currently enrolled in Original Medicare are eligible for what is called a Medigap Plan. Medigap Plans are supplemental insurance that work alongside Traditional Medicare to provide added coverage for the out of pocket (OOP) expenses not covered by straight Medicare.
These plans also include coverage of some deductibles, copayments and coinsurance. Private insurance companies offer Medigap insurance aka Medicare Supplement Plans in Indiana. Medigap is broken down into plans whereas Medicare is broken down into parts.
Here we will discuss the different insurance police and what their coverage includes to provide you with better understanding for insurance offered in Indiana.
- Medicare Part A: Is the first part of your Traditional Medicare benefits and includes your hospitalization coverage.
- Medicare Part B: is the second part of your Traditional Medicare benefits and includes your doctor’s visits and other outpatient medical expenses.
- Medicare Part C: is the third part, however, it’s not consider a, “true”, part of Traditional Medicare. This is oftentimes referred to as a Medicare Replacement Plan. These plans are offered through private insurance carriers and will take over for your Traditional Medicare Parts A and B benefits. This can also be called a Medicare Replacement Plan. They also provide additional benefits but come with certain policy restrictions.
- Medicare Part D: is another purchasable plan not offered by your Traditional Medicare benefits. This Prescription Drug Plan (PDP) provides medication coverage which is not covered by Original Medicare or any of the Medigap Plans.
Then you have the Medigap Plans. There are ten letter plans that offer coverage in Indiana that assist in OOP costs leftover from what Traditional Medicare won’t cover. These plans also assist with deductibles, copays, coinsurance and other medical expenses, leaving less financial responsibility for the Medicare beneficiary.
What Benefits Does Medicare Cover in Indiana
Medicare, both Parts A and B, cover many healthcare costs but still leave a lot of OOP costs leftover for the insured individual responsible to pay. Any hospitalization and associated inpatient service costs are covered by Medicare Part A.
Whereas, any outpatient services, procedures, testing and physician office visits are covered by your Medicare Part B benefits.
Both Medicare Part A and Medicare part B provide 80% coverage for services rendered. This leaves the Medicare beneficiary with the remaining 20% to pay OOP. Depending on your individual healthcare needs, an Indiana Medigap Plan can help reduce your out of pocket expenses.
Qualifying for Indiana Medigap Plans
To be eligible for a Medigap Plan, you must first, be 65 years of age and second, currently be enrolled in Medicare Part B. You then have what is called your Open Enrollment Period (OEP) which starts the three months prior to your 65th birthday. It continues through your birthday month and then the three months after, giving you a total of seven months to obtain insurance.
You want to enroll for Part B as soon as you are eligible as failing to enroll during this time period will result in a penalization.The Part B penalty increases your monthly premium by 10% for each full 12-month period you went without coverage. The longer you go uninsured, the higher your premium will be. Make sure to enroll during OEP to avoid any additional OOP costs.
For some individuals under the age of 65, there is the opportunity to enroll in a Medigap Plan however, certain criteria must be met. If you’re currently receiving disability benefits from Social Security, have End Stage Renal Disease (ESRD) or carry certain Railroad Retirement benefits for 24 months, you have automatic enrollment into Medicare Parts A and B.
Medigap insurance is not a requirement by Federal law for insurance carriers to offer. If you’re on disability and under the age of 65 in Indiana, call us for more information on supplement insurance plans available to you.
How to Apply for Medigap in Indiana
For Medigap insurance there is an Open Enrollment Period that begins on the 1st of the month in which you turn 65. Once your OEP begins you must also be carrying Medicare Part B for eligibility. You have an additional 6 months during your OEP to apply for Medigap.
For example, if your birthday is August 5th and your effective Medicare Part B date is October 9th, then your OEP starts on November 1st. During this time period you have what is called the Guaranteed Issue (GI) right.
With the GI you have the, “guaranteed”, approval for Medigap insurance coverage. The good news with this is that regardless of any pre-existing medical conditions, the carrier has to allow for insurance coverage. Additionally, the insurance carriers cannot charge more on your premiums based on these health conditions.
To avoid any potential of insurance denial, you must enroll during your OEP. Failing to enroll during your OEP with the GI benefits, you may be subjected to the insurance underwriting process. With underwriting, the insurance companies can opt to charge higher monthly premiums. Worst case scenario, they can even deny coverage based on any existing health issues.
Additionally, in Indiana there are certain instances in which the beneficiary can enroll after the OEP and still be granted GI. You can learn more about these circumstances here Special Enrollment Periods.
Medigap Premiums in Indiana
Medigap premiums are determined by each individual state’s private insurance carriers. Premium prices are determined based off of age, sex and location. A Medigap Plan for an 81 year old man in Indianapolis will cost different than a 77 year old female living in Carmel.
Insurance companies also use 1 of 3 different pricing methods when determining premium costs. The three methods used are:
- Community Rated– regardless of age, everyone pays the same premium rates. Also, your premiums will not increase as you age however, they may increase due to other factors.
- Issue Age Rated– premium prices will be based on the age you are at the time of purchase. The older you are obviously, the higher the premium will be. The benefit of this pricing method is it will not increase as you age however, it may increase based on other factors.
- Attained Age Rated– premium pricing again is based on age at time of purchase, but with this method the premiums will increase each year as you age.
The Best Medicare Supplement Plans in Indiana
Each individual insurance carrier offers Medigap plans. Within the Medigap Plan itself, there are 10 different letters that represent the different policies. The insurance benefits are the same regardless of which state you live in. However, pricing may vary based on the individual carrier. Of the 10 letter plans the most popular 3 are Plans F, G and N.
Plan F covers 100% of the Medicare Part A deductible as well as Medicare Part B deductible. This plan also covers the remaining 20% of Part A and Part B’s leftover costs not covered by Original Medicare. Part B’s copayments and coinsurance are also included in this plans coverage. It also has the added benefit of foreign travel coverage which not all the letter plans include. Indiana Medigap Plan F is the most popular of all the plans as it provides the best overall coverage. The best part of all is there will never be any OOP expenses left for the beneficiary to pay.
Plan F High Deductible
This plan includes the same exact benefits as Plan F with the only difference being the cheaper monthly premiums and higher deductible. This plan is a close second in popularity due to the great benefits offered at a lower cost.
Indiana Medigap Plan G is similar to Plan F with benefits. Plan G covers everything the same as Medigap Plan F minus the Medicare Part B deductible. The Medicare Part B deductible is $185 as of 2019 which the beneficiary will be required to pay. This plan is popular as well due to the great benefits offered and more affordable premium prices.
The most affordable of all the plans, Plan N is popular due to its, “cost-sharing”, option. Medigap Plan N has the same benefits as Plan F only without Medicare Part B deductible coverage. Plan N also doesn’t cover excess charges unfortunately, which physicians in Indiana are allowed to up charge. This policy also may require the beneficiary to pay a small copay for some office visits and ER trips.
Indiana Medicare Advantage Plans
Medicare Advantage Plans in Indiana are offered through private insurance carriers just like the Medigap Plans. An Advantage Plan replaces your Original Medicare and provides the exact same coverage offered by Traditional Medicare Parts A and B.
While this plan is typically cheaper than a Medicare Supplement Plan, Medicare Advantage Plans come with restrictions. Restrictions include coverage limitations, in network providers and cancellation restrictions. Additionally, with Advantage Plans you cannot obtain a Medigap Plan for added coverage, so your overall OOP costs will end up being higher in the long run.
In the end you’re better off obtaining a Medigap Plan as it provides more comprehensive coverage and allows for less if not complete elimination of your medical expenses.
With Medicare and the Medigap Plans not providing any prescription drug coverage whatsoever, it’s vital to obtain a Part D Prescription Drug Plan (PDP). A PDP covers most prescription medications written by your medical provider but will not cover any OTC medications.
While generic medications can be more affordable, most brand name drugs come with a hefty price tag. To avoid excessive OOP costs associated with drug cost, a PDP is necessary for completion of your insurance trifecta.
Another benefit of obtaining a PDP is avoiding the added expense brought forth by the Part D penalty. The Part D penalty is enforced after failing to enroll during the 7 month initial enrollment period (IEP). At that time, based upon how long you went without drug coverage, an additional fee will be added onto your monthly premiums.
For Hoosiers, the most comprehensive coverage is the insurance trifecta, Original Medicare, a Medigap Plan and a Prescription Drug Plan combined.
How to Apply for Medicare in Indiana
Applying for a Medigap Plan is easy and as long as you currently carry Original Medicare we can help. Enrolling in a Medigap Plan along with a Prescription Drug Plan ensures the most optimal coverage while leaving you with the least possible medical expenses.
Call today or fill out our online form so we can start saving you money on the 20% leftover from Medicare. As always, our services are 100% free. Our insurance agents are readily available to answer any questions you may have. Also, you may compare rates here.
Indiana Medicare Resources
There are Medicare Savings Programs available for senior citizens not only in Indiana, but nationwide. These programs provide financial assistance and help offset the high cost of medical insurance. There are individual state programs available to provide free counseling and information on health insurance in addition to financial aid. In Indiana you can learn more information here.
Indiana KFF Facts
In 2013, Medicare Supplement insurance in Indiana consisted of 18% disabled beneficiaries, with just over 4,700 diagnosed with ESRD. Then in 2015, it was found that over 1.1 million people were enrolled in Medicare, that’s 17% of the total population residing in the state.
- Does Medicare pay for Assisted Living in Indiana? Unfortunately the short answer to that question is no. The reason being is assisted living facilities are considered custodial care which Medicare won’t cover as it’s not considered medical care. Medicare will only cover short-term nursing care admissions.
- Does Medicare cover hearing aids in Indiana? Hearing exams and hearing aids are not covered under Traditional Medicare. Here is when a Medigap Plan can come in handy. One of the additional benefits offered can include routine hearing care which may include hearing aids. Call us today for more information on plans that include hearing benefits.
- Where can I compare Medicare options in Indianapolis Indiana? Right here! You can compare anything from individual insurance plan benefits to the different policy rates. Call us or fill out our online forms here.