We believe our patients should be able to receive care at Reid Health without worrying if the care they need will be denied or postponed by their insurance plan. To that end, Reid Health is streamlining the number of Medicare Advantage plans we accept.
Medicare / Medicaid Resources
If you receive Medicare benefits, you likely hold either an Original (or Traditional) Medicare plan, or you have selected a Medicare Advantage plan.
Reid Health always accepts Original (Traditional) Medicare and all Medicare Supplements.
Beginning January 1, 2025, Reid Health will accept only these Medicare Advantage plans:
Anthem Medicare Advantage
UnitedHealthcare Medicare Advantage
If you would like to continue seeing your Reid Health provider next year, you will need to select either one of the two Medicare Advantage plans listed above or return to Original Medicare during open enrollment, which begins October 15.
Original Medicare and all Supplements are always in network with Reid Health.
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage (Medigap insurance).
Reid Health always accepts Original (Traditional) Medicare.
Additional Resources
Original/Traditional Medicare vs. Medicare Advantage
| Original/Traditional Medicare | Medicare Advantage |
|---|---|
| Government-owned and managed. | Private insurance alternative subsidized by the government Medicare program. |
| Split into different “parts” to cover different services. Part A covers hospital care, Part B covers medical/doctor appointments, Part D covers prescription and pharmacy benefits. | Medicare Advantage is also known as “Medicare Part C” and includes Part A, Part B, and usually Part D. |
| Keep the physician you know and trust. Visit any doctor or hospital in the U.S. that takes Medicare. | In most cases, plans will not travel with you. You are limited to the physicians and hospitals in your plan’s network and service area, even if you are traveling, move mid-year or need to see a specialist in another state. |
| Rarely requires referrals, so you can get the care your physician recommends. | Requires referrals for advanced care. Prior authorizations are required before many types of care can be delivered or paid for. |
| Easier to get higher level, specialty care, like hospital visits, surgeries, and skilled nursing or rehabilitative care. | Often requires prior approval for specialist visits, surgeries, post-acute, and other care. This can result in delays in care and denials for payment – even after care has taken place. |
| Some benefits, like eye exams, routine dental, and hearing care, are not covered. | Some plans may cover benefits like vision, hearing, and dental services. |
| Potential 20% out-of-pocket costs, but often you have the option to select Medigap insurance, which covers the out-of-pocket cost. | Your out-of-pocket costs will vary. Medicare Advantage enrollees cannot use Medigap. If you leave a Medicare Advantage Plan, you might have to pay more for pre-existing conditions when applying Medigap policy after the initial enrollment period. |
| Separate premium for Medicare drug coverage (Part D). | Most plans include Medicare drug coverage (Part D). |
| There is no annual limit on out-of-pocket costs. | There is an annual limit on out-of-pocket costs. |
For Those Patients Who Also Receive Indiana Medicaid Benefits
Medicaid Managed Care works like private health insurance. Each state manages their own Medicaid program. Below, you’ll find both Indiana and Ohio Medicaid Managed Care plans, including important websites and information on how to find out more.
Remember: Medicaid Managed Care programs are different than Medicare programs. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with certain medical conditions.
For more information on Medicare programs, scroll to the top of the page, or visit: medicare.gov
The State of Indiana mandates that if an Indiana Pathways for Aging member chooses to enroll in a Medicare Advantage plan, your Medicare Advantage plan must be managed by the same insurance provider as your Medicaid plan. (For instance, if you receive Managed Medicaid benefits through Insurance Company A, you must also choose Insurance Company A for your Medicare Advantage plan.)
For more information about the Indiana PathWays program or to change your plan, please contact Indiana Medicaid at (800) 457-4584.
Helpful Links
We are committed to keeping our patients updated with the information they need so check here often.
You can also call the Reid Health Community Helpline at: 765-965-4250.