Who qualifies for Medicare in Indiana?
Medicare in Indiana has a long history. The Medicare program was originally launched in 1965 to provide basic health coverage for adults who would not have had health insurance otherwise. Initially, eligibility for the Medicare program was limited to Americans 65 years old or more. Today, there are many Medicare beneficiaries younger than 65.
Your eligibility for Medicare in Indiana can start before age 65 if you have one of the following:
- Long-term disability
- Lou Gehrig’s disease/amyotrophic lateral sclerosis (ALS)
- End-stage renal disease (ESRD)
The federal government recently expanded Medicare coverage for people with end-stage renal disease:
- As of 2021, new Medicare beneficiaries with ESRD have a guaranteed issue right to join a Medicare Advantage Plan during Open Enrollment.
- Since 2020, Medicare coverage includes immunosuppressant drugs following a kidney transplant. Effective 2023, this coverage will continue for the life of the organ transplanted.
Is Medicare in Indiana free?
Through Medicare tax payments, you earned your Medicare benefits, but your Medicare coverage does not preclude out of pocket costs. You are responsible for deductibles, coinsurance and copayments.
How Much does Medicare Part A Cost?
Part A Premium
Your premium for Medicare Part A is based on credits you earn during your working lifetime. The most you can earn is one credit per quarter or four credits per year. The amount you have to earn for one credit in 2021 is $1,470. This amount generally increases annually. When you are an employee, Medicare taxes are automatically deducted from your pay. If you are self-employed, you have to pay these taxes directly to the IRS.
2021 premium based on quarters worked/credits earned:
- Less than 30: $471
- 30 through 39: $259
- 40 or more: $0
The 2021 Part A deductible is $1,484 per benefit period. A benefit period:
- Begins the day you are admitted to a hospital or skilled nursing facility
- Ends after you have gone 60 consecutive days without inpatient care
Following are the coinsurance costs per benefit period for 2021:
- $0 for days 1 to 60
- $371 daily for days 61 to 90
- $742 daily after day 90 for a maximum of 60 days in a lifetime
- 100% of the costs if your inpatient stay exceeds lifetime reserve days
How Much does Medicare Part B Cost?
Part B Premium
- 2021: $148.50 standard, higher if you earn above a specified level
- 2021: $203 per year
- 20% of the Medicare-approved amount for services or supplies
How Much Is a Medicare Part D Prescription Drug Plan?
Factors that impact the cost of your prescription drug coverage:
- Premium, deductible, copays and coinsurance required by the plan you select
- Types of prescription drugs you take, i.e., generic, brand or specialty
- Whether you have reached the catastrophic phase, which is when your out of pocket costs for covered drugs are capped for the rest of the year
- Your eligibility for Extra Help, a program for low-income beneficiaries
What if I Choose a “Free” $0 Premium Medicare Advantage Plan?
If you select a premium-free Medicare Advantage (MA) plan, you still have to pay the premium for Part B Medicare benefits. However, if the plan bundles Part D with Medicare Part A and Part B, you won’t have to pay a separate Part D premium.
Some Medicare Advantage plans offer extra benefits, such as:
How Much Does a Medicare Supplement Plan Cost?
There are 10 Medigap health plans. Benefits, not pricing, are standardized. The Medigap premium, which is in addition to the Part B premium, is influenced by:
Key benefits of Medicare Supplement plans:
- Freedom from constraints of a network
- Comprehensive health care coverage options
- Predictable, consistent health insurance
What Medicare plans are available in Indiana?
Following are considerations as you review your coverage Medicare options in Indiana.
Best for Network Freedom: Medicare Supplement
- Nationwide coverage – not restricted to a certain service area
- No annual plan changes
- Referrals to specialists not necessary
- Monthly premium range (subject to change): $125 – $150
Best for Lowest Premiums: Medicare Advantage
- Preferred Provider Organization (PPO): larger network, no referrals required, $0 to $100 premium
- Health Maintenance Organization (HMO): limited network with restrictions to HMO service area, referrals needed, typically $0 premium
Best for Low Income or Health Conditions: Medicare Advantage D-SNP
- For low-income individuals or people with chronic health care needs
- May not cover services out-of-network
- Includes prescription drug coverage
- Referrals to specialists usually required
- Coordination between Original Medicare and Medicaid if eligible for both
Indiana Medicare FAQs:
What is the income limit for Medicare in Indiana?
The standard Part B premium for 2021 is $148.50. Your premium may be higher, depending on how you filed your tax return and your modified adjusted gross income (MAGI).
The extra amount added to your premium is called an Income Related Monthly Adjustment Amount (IRMAA). IRMAA kicks in if one of the following applies to the return you filed two years ago:
- Individual tax return – MAGI over $88,000
- Joint tax return – MAGI over $176,000
- Married and separate – MAGI over $88,000
How do I apply for Medicare in Indiana?
If one of the following scenarios applies to you, your Medicare enrollment will be automatic:
- You’re already receiving benefits from Social Security (SS) or the Railroad Retirement Board (RRB).
- You have a disability and have been receiving disability benefits from SS for 24 months. In some cases, this also applies to RRB disability benefits.
- You have Lou Gehrig’s disease.
If you’re not eligible for automatic enrollment, contact the Social Security Administration (SSA) to apply for Medicare in Indiana.
When can I apply for Medicare in Indiana?
Initial Enrollment Period
Seven-month window encircling your 65th birthday:
- Starts three months before the month you turn 65
- Includes the month you become 65
- Ends three months following the month you turn 65
Special Enrollment Period
Part B covers your doctor’s services, outpatient care, durable medical equipment and annual wellness visits. You may delay signing up for Part B if you have creditable medical insurance through a group health care plan. If you qualify:
- Usually, no late enrollment penalty will be imposed.
- You can enroll in Part B while covered under the group plan.
- You may wait until your employment or group coverage ends, whichever comes first.
- The Special Enrollment Period is eight months from the date in number 3.
If you are a Medicare recipient based on end-stage renal disease, you are not eligible for a Special Enrollment Period.
General Enrollment Period
- Occurs annually: January 1 – March 31
- Coverage effective date: July 1 of the same year
- May be charged late enrollment penalty
Where do I apply for Medicare?
Most people in Indiana enjoy the ease of Medicare enrollment online on the SSA website.
- Call your local SS office.
- Call the SS national toll-free number at 1-800-772-1213.
- Call 1-800-325-0778 if you have trouble hearing or use TTY equipment.
For Medicare Part C (Medicare Advantage Plans) or Medicare Part D (prescription drugs), you must apply to private insurance companies. Our insurance agents can help you compare coverage options and navigate the application process for Medicare-approved insurance plans.
What should I bring when applying for Medicare?
Suggested list of documents as applicable to you:
- Birth certificate
- Proof of American citizenship or permanent residency
- SS card
- Other health coverage policy
- Tax return from two years prior
- Military documents
Is enrollment in Medicare mandatory at age 65?
Not all parts of Medicare are mandatory.
- Required: Part A (hospital insurance)
- Optional: Part B (medical insurance for physician services, and outpatient care and equipment)
- Optional: Part C (Medicare Advantage plans)
- Optional: Part D plans (prescription drugs)
The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS) and is closely linked to SS. Sign up for Original Medicare (Medicare Part A and Part B) through the SSA. For Parts C and D, you must apply to one of the private Medicare-approved insurance companies.
If you sign up for SS and haven’t yet enrolled in Part A, your enrollment will happen automatically, effective:
- Day 1 of the month of your 65th birthday if your birthday is after the first
- Day 1 of the preceding month if your birthday falls on the first
Ready to Learn More?
If you’re a beneficiary of Medicare in Indiana or if you’re going to be signing up soon, we can help you compare insurance plans and look for the best rates. Call us today to talk to one of our licensed insurance agents so that we can explain your plan options and help you choose a company with a 5-star rating.
- In Indiana, Medicare Advantage & Medicare Supplement plans are the most popular choices.
- Your initial Medicare enrollment period begins three months before your 65th birthday and includes the entire month
- Apply for Medicare online, by phone or at a Social Security office in your service area.