Medicare / Medicare Advantage Resources

If you receive Medicare benefits, you likely hold either an Original (or Traditional) Medicare plan, or you have selected a Medicare Advantage plan.

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).

Medicare Advantage plans (also known as Part C) may or may not be in network with Reid Health

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
In most cases, you’ll need to use doctors who are in the plan’s network.
Plans may have lower out-of-pocket costs than Original Medicare.
Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

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.

More Information on Choosing the Right Medicare Plan

The Pros and Cons of Medicare Advantage | Consumer Reports

Choosing between Traditional Medicare and Medicare Advantage requires careful consideration of your finances and health needs. And MA plans can carry hidden risks, especially for people with major health issues. Learn more about the pros and cons of Medicare Advantage.

When to join a Medicare health or drug plan | Medicare.gov

You can only join, switch, or drop a Medicare Advantage Plan (Part C) or Medicare drug plan (Part D) at certain times, called enrollment periods. View a chart outlining the enrollment periods for each plan.

Can I Change Medicare Advantage Plans at Any Time? | aarp.org

You can’t switch Medicare Advantage plans whenever you want, but you do have options if you’re unhappy with your plan. Learn more about enrollment periods and keep these periods in mind if you want to see doctors or use medications that aren’t covered under your Medicare Advantage plan.

Can I Cancel My Medicare Advantage Plan? | MedicareFAQ

If you are unhappy with your current coverage and want to cancel your Medicare Advantage plan, you may need to jump through some hoops. Leaving a Medicare Advantage plan can be difficult outside of an applicable enrollment period. Yet, if your timing is right, canceling your MA plan can be a seamless process.

Medicaid Resources

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

Indiana Medicaid

Indiana Medicaid provides healthcare options for their members. Medicaid members can select a managed Medicaid plan, which is also known as a Managed Care Entity (MCE). A MCE is a health insurance company that offers an insurance plan for Indiana Medicaid members.

Each plan includes a group of healthcare providers (hospitals, doctors, etc.)

Indiana Medicaid offers different managed programs to choose from. Click the link for a list of available Indiana Medicaid managed care programs.

To find out more, visit www.in.gov/medicaid.

Ohio Medicaid

Ohio Medicaid managed care provides healthcare benefits for individuals enrolled in the Ohio Medicaid program. Most people approved for Medicaid in Ohio are automatically eligible for Medicaid managed care coverage.

The “Next Generation of Ohio” is the new program handling all managed care plans for Ohio Medicaid participants. To visit the Ohio Medicaid main website, visit Medicaid.ohio.gov

If you still have questions, the links below may be helpful.

I want to:

What if I Have Questions?

In Indiana:

Visit: The Indiana Medicaid for Members webpage.

Or Call: 877-438-4479

Find your plan listed (i.e., Healthy Indiana Plan, Hoosier Healthwise, etc.)
Call the Helpline number listed with the information for your plan.

In Ohio:

Visit: The Ohio Medicaid Managed Care webpage

Or Call: 800-324-8680