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Many seniors near South Bend, Indiana, seeking out new Medicare Advantage or Medigap plans may not know what is in their best interest. Picking the right plan can be a difficult task, especially when there are so many choices! We will take a look at Indiana Medicare plans and explore some of their features, to help find the right one for you. Specifically, we will address Medicare Advantage and Medigap plans in South Bend, St. Joseph County, Indiana.
St. Joseph County is located on the northern border of Indiana. It’s the fifth most populous county in the state of Indiana and is home to over 270,000 people. St. Joseph County is made up of several cities, including South Bend, Granger, Lakeville, North Liberty, New Carlisle, Roseland, Walkerton, Osceola, Mishawaka, Indian Village, and the Notre Dame CDP.
Approximately 15% of the population of St. Joseph County is age 65 or older. Additionally, the median age in this county is nearing retirement. Therefore, we expect a lot of new signups to Medicare Advantage or Medigap plans in the future. Now let’s dive into some of the Medicare Advantage plans available for St. Joe residents.
When choosing a plan, the first thing to consider is the company offering that plan. In St. Joseph County, Aetna, Humana, Lasso, Anthem, UnitedHealthcare, Allwell, and Wellcare all offer Medicare Advantage Plans.
UnitedHealthcare offers two HMO-POS plans, their AARP Medicare Advantage Plan 1 and AARP Medicare Advantage Plan 2. They also have two PPO options – the AARP Medicare Advantage Choice Plan 1 and the AARP Medicare Advantage Choice Plan 2.
Anthem Blue Cross
Anthem offers two different HMO plans in St. Joseph County – their Anthem MediBlue Plus and their Anthem MediBlue Extra. These plans are available through HealthKeepers, Inc.
Anthem also has two PPO plans available. They are Anthem MediBlue Access Plus PPO and Anthem MediBlue Access Basic (Regional PPO).
Allwell offers an HMO and a PPO plan, both named Allwell Medicare.
WellCare offers two HMO-POS plans – WellCare Edge and WellCare Essential.
Aetna Medicare Advantage Plans
Aetna has two PPO plans available, so you can choose hospitals outside of the network if you have a particular need. These plans are Aetna Medicare Value and Aetna Medicare Premier.
Two hospitals work with Aetna’s Medicare Advantage plans in St. Joseph County – the Mishawaka Medical Center located in Mishawaka and the Memorial Hospital, located in South Bend. The Mishawaka Medical Center is part of the St. Joseph Health System and specializes in imaging and radiology, surgical services, and stroke care. The Memorial Hospital is part of the Beacon Health System and specializes in newborn and pediatric care, cancer care, trauma care, and surgical care and rehabilitation.
Humana Medicare Advantage Plans & Coverage
Humana offers four different PPO plans in St. Joseph County, as well as two regional PPO plans, one PFFS plan, and one HMO plan. The PPO plans are the Humana Choice H5216-192, Humana Honor, Humana Choice H5216-111, and Humana Choice H5216-055. The regional PPO plans are the Humana Choice R0865-001 and the HumanaChoice R0865-003. Additionally, the HMO plan offered by Humana in this county is the Humana Gold Plus H5619-052, while the PFFS plan (Private Fee-for-Service) offered is the Humana Gold Choice H8145-011.
Lasso Medicare Advantage Plans & Coverage
Lasso offers one plan in St. Joseph County – the Lasso Healthcare MSA plan. Lasso is a high deductible plan which gives beneficiaries a contribution to a medical savings account each year. The MSA can be used to pay for out of pocket medical expenses, including dental, vision, hearing, and prescription drug copays. If you do not use all of your contribution, it can be rolled over from year to year. There is no network for this plan, so you can use any doctor who accepts Medicare.
When comparing Medicare Advantage plans, you will want to consider Network restrictions, copays, out-of-pocket limits, extra benefits offered by the plan, and the plan’s star rating. Much of this information can be found on Medicare.gov, but you would have to dive deeper and visit each plan’s website for additional detail. It can be confusing to go it alone, so why not get help from a knowledgeable Medicare insurance broker, like the ones at Bobby Brock Insurance? Go to bobbybrockinsurance.com or call 1-877-877-5505 to talk with your Medicare expert.
HMOs and PPOs require you to use contracted providers. Doctors and hospitals agree to be a part of these plans because the plan assures providers will have a steady stream of patients referred by the plan. In exchange, they give special pricing to the plans. The discounts are passed on to consumers in the form of lower copays.
HMOs have the strictest restrictions for going outside the plan, but they often offer the lowest overall costs. All HMOs will cover you if you have a medical emergency and must see a provider out of your area, but non-emergency care must be received by plan providers to be covered. A person who travels a lot may not feel comfortable with an HMO. PPOs require you to see plan providers pay the lowest out-of-pocket costs, but the plan will still cover you if you go outside the network.
Private Fee for Service Plans (PFFS) does not require you to use a network. You can use any doctor that agrees to the plan’s terms of service. PFFS high deductible plans don’t pay anything until your medical expenses reach the deductible. Still, they may provide you an annual Medical Savings Account contribution, which you can use to pay for qualified medical expenses. You can use the funds to pay for doctor visits, hospital costs, prescription copays, dental, vision, hearing, and other qualified medical expenses. If you use the funds for non-qualified expenses, you may be subject to income taxes. If you do not use all of the MSA funds, they can be rolled over from year to year.
Some people prefer Original Medicare and a Medigap policy over Medicare Advantage. Original Medicare with a Medigap plan gives the beneficiary a more manageable budget than Medicare Advantage because Medigap policies pay nearly all Hospital and Medical out-of-pocket expenses. The claims are also automatically filed, which takes away the stress of reconciling bills and writing checks for medical care.
In total, there are 11 Medigap plans to choose from in St. Joseph County. Anthem Blue Cross and AARP offer Medicare supplement plans in Indiana as well as Aetna, Mutual of Omaha, CSi Life, IAC, Pekin, and many others. The premiums for the same plans vary significantly from company to company. There can be as much as a $250 difference in monthly premiums for the same plans. We have specialized software available to compare premiums. You can go to bobbybrockinsurance.com to use the tool or contact our office.
If you want to find the best Medigap plan for your specific needs, call us at (877) 877-5505 or reach out via our online form. We have specialized software that can quickly pull quotes from top health insurance companies and provide a side-by-side comparison.
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