Medicare Advantage Plans - Frequently Asked Questions

IU Health Plans offers a variety of plans in 51 counties across Indiana. Review our plans by county to see if IU Health Plans is available in your area. If you would prefer to speak with a Customer Solutions Representative over the phone please contact 317.963.9700/ 800.455.9776 (TTY/TDD 711).

From Oct. 1–Feb. 14, a representative will be available to speak to you 8 am – 8 pm, seven days a week. Beginning Feb. 15 through Sept. 30, a representative will be available from 8 am – 8 pm, Monday through Friday. You may receive assistance through alternative technology after hours, on weekends and holidays

A copay or copayment is the amount you will owe when you receive care or are prescribed medication.

A deductible is the amount you pay for care or a prescription in a calendar year before your insurance healthcare provider pays its portion. After you have met your plan’s deductible amount, you usually pay only a copayment or coinsurance for covered services.

Some preventative services are paid for even before you’ve met your deductible.

Coinsurance is a percentage you may be required to pay as your share of the cost of services or prescription drugs.

A Maximum Out-of-Pocket is the most you will have to pay for covered services in a plan year after spending this amount on deductibles, copayments, and coinsurance. This does not include your monthly premium costs, or anything you may have spent for services your plan did not cover.

We know that choosing or using your policy can result in many questions—most of which are related to the terms used. Review the glossary for more information around commonly used insurance terms and definitions.

If you have limited income, you may qualify for financial discounts to help cover your monthly insurance premium and reduce prescription drug costs. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 800.MEDICARE (800.633.4227), 24 hours a day, 7 days a week. TTY users should call 877.486.2048.

IU Health Plans offers Medicare Advantage plan options. We recommend reviewing your plan options or, if you’re ready, get a quote now. If you would prefer an in-person consultation, call 866.308.2018 or request a consultation online.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. Extra Help can reduce the plan premium and prescription drug costs. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 800.MEDICARE (800.633.4227), 24 hours a day, 7 days a week. TTY users should call 877.486.2048. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

If you would like help with this application or understanding your options, free counseling is available through the Senior Health Insurance Information Program (SHIP) at 800.452.4800; TTY 866.846.0139 or go to Medicare.in.gov.

The Summary of Benefits will detail what costs your plan will cover, what you will pay and how it varies for different types of care. The Summary of Benefits also lists your monthly premium, deductibles and limits for out-of-pocket costs. You will receive a new Summary of Benefits every year you are enrolled in a plan and it's also available in your member portal.

Your Evidence of Coverage will go into deeper detail about the benefits offered by your plan, including what your plan will cover and how it works. The document will also address any new changes to your plan that were implemented at the start of the year. You can find your plan specific Evidence of Coverage document by logging into your member portal.

You should expect your ID card and welcome packet within 10 business days of IU Health Plans processing and approving your enrollment application. If you do not receive your information after 14 business days, please contact member services, at 800.455.9776, to verify your address and request a new card.

Yes. You will have your choice of a wide variety of highly skilled doctors located in your community. You may choose to see any type of doctor that you need, without a referral, as long as the doctor is in the IU Health Plans network. See our directory of doctors and facilities.

If your doctor is in the Directory of Doctors and Facilities, he or she is within the IU Health Plans network. If you are unable to find your doctor in the directory, he or she is likely not within the IU Health Plans network. Please contact our member services team at 800.455.9776 to assist you in finding a provider that meets your needs.

At IU Health Plans, we understand the importance of finding and managing your health with a doctor you trust. If your doctor is no longer part of the IU Health Plans network, or you are new to IU Health Plans, we can help you find a doctor that meets your needs. IU Health Plans offers a Transition of Care period during which you can continue to see and receive coverage with your current doctor. This period allows time for you to explore our network of leading healthcare providers and helps to create a seamless transition to a new doctor.

Learn more about the Transition of Care process.

To review the healthcare providers and facilities covered in our network, please visit our directory where you can search our healthcare providers and facility locations.

No. Referrals to network specialists for covered services are not required; however, you must go to an in-network specialist. Coverage depends on applicable copayments and coinsurance. Remember to advise your primary care doctor about services received from a specialist so your doctor can maintain your complete medical record. In order to receive the highest level of payment for covered services, make sure you go to an in-network healthcare provider.

To find out if your current medications are covered, please search our comprehensive formulary (list of covered drugs).

If you learn that your prescriptions are not covered under your plan, you still have options. Review our to find out how IU Health Plans can help.

To find an in-network pharmacy in your community, search our pharmacy directory.

No. As an IU Health Plans Medicare Advantage member, you are not required to pay for Medicare-covered annual preventive and wellness services. Review the list of IU Health Plans covered yearly services, including preventative health services.

To learn more about the services provided at no cost through your plan, please refer to your Evidence of Coverage or visit Medicare.gov. You can find your plan specific Evidence of Coverage by logging into your member portal.

This is a very real concern for many of our members. To better understand what you may have to pay, first refer to your Summary of Benefits document and your Evidence of Coverage document. Both of these documents contain information about what your plan covers and what you may be responsible for. These documents can be found on your member portal.

Many doctors’ offices have after-hours care or a doctor on call. If you have an urgent question, contact your doctor first. You also have access to urgent care centers, should your doctor be unavailable. Find the nearest urgent care center to you.

If you have a true emergency, call 911 or go to the nearest emergency room.

Part B drugs are defined by Medicare and include certain chemotherapy drugs, some injections at your doctor’s office and drugs you get at a dialysis facility. Part D drugs are ordered from a retail pharmacy or mail-order vendor and are listed on a formulary of covered drugs.

In the main navigation, click "Member Login." Next, select "sign up" and enter your Membership Number, First Name, Last Name, Group Number and Date of Birth. Your Membership Number and Group Number can be found on your Membership card. If you have difficulties logging in, please reach out to member services at 800.455.9776.

It is important to remember that your premium payment is due to IU Health Plans every month. See options below:

Paying by Check:
Members can also send a check via the mail. Please always provide the bottom portion of the invoice with your check in the mail and allow a minimum of 7 business days for IU Health Plans to receive and process your check.

Paying by automatic withdraw through SSN or bank account:

Our member services team can provide more information about these payment options. Call 800.455.9776 to speak with a representative.

IU Health Plans does not accept payment for providers. If you owe a payment for medical services to a provider, please contact the provider billing office using the phone number on the billing statement.

Please Note: IU Health does not process premium payments for IU Health Plans.

IU Health Plans does not accept payment for hospitals or medical facilities. If you owe a payment for medical services, please contact the billing office using the phone number on the billing statement.

Please Note: IU Health does not process premium payments for IU Health Plans.

A drug coverage determination is any decision (an approval or denial) that IU Health Plans makes when you ask for coverage or payment of a drug that you believe IU Health Plans should provide.

You or your doctor and other prescribers can ask for a coverage determination.You can also appoint someone (such as a relative) to request a coverage determination for you. You can ask for a standard coverage determination; IU Health Plans will give you a decision in 72 hours.

You can also ask for an expedited (fast) coverage determination if you or your doctor or other prescriber believes that your health could be seriously harmed by waiting up to 72 hours for a decision. IU Health Plans will give you an answer in 24 hours.

If IU Health Plans denies your coverage determination, you have the right to request a redetermination appeal. Please see our section on Appeals and Grievances for information about your appeal rights or contact our Member Appeals Department at 866.823.1016 (TTY/TDD 711).

A Prior Authorization is approval from a health plan that is required before you get some services or fill some prescriptions. This approval is needed in order for the service or prescription to be covered by your plan.

Some services, like surgeries, hospitalizations or durable medical equipment, can be done or purchased at different types of places. IU Health Plans wants to ensure that you are using the appropriate services, at the appropriate place, and at the best time for your care plan. With the Prior Authorization process, we have nurses and other clinicians that review your plan of care to make sure you are receiving the best quality of care. Some prescriptions also require a prior authorization.

The physician or provider that is requesting the service should submit paperwork to IU Health Plans for review. Depending on the request, medical documentation is needed for a full review.

A prior authorization can be set up for a certain number of visits or for a particular device (like a hospital bed). The authorization is not really for a length of time but rather related specifically to the services you and your provider are requesting.

Services requiring prior authorization must be called in by the provider prior to any services being done. This excludes emergency services, which do not require services to be prior authorized; these services can be called for authorization after services are provided.