Medicare and Indiana Medicaid: PathWays for Aging and the Medicare Savings Programs

Some Hoosiers qualify for both Medicare and Medicaid — often called being “dual eligible.” When that happens, Medicare pays first, and Indiana Medicaid may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Medicaid works for seniors in Indiana

Indiana Medicaid is administered by the Family and Social Services Administration (FSSA), and eligibility is decided by its Division of Family Resources — not by an insurance agency. For adults 65 and over, eligibility is based on income and resources under the aged, blind and disabled rules; the resource limit in that category is $2,000 for a single person and $3,000 for a couple. You apply through the FSSA Benefits Portal, by phone at 800-403-0864, or at a local Division of Family Resources office.

Once eligible, how you receive Medicaid depends on your age. Since July 1, 2024, Hoosiers 60 and older in the aged, blind and disabled category — including dual eligibles, nursing-facility residents and people on home- and community-based waiver services — are enrolled in Indiana PathWays for Aging, a managed-care program in which a health plan from Anthem, Humana or UnitedHealthcare coordinates Medicaid services, including long-term services and supports, with the stated goal of helping people stay at home rather than in a nursing home. Medicare continues to pay first for medical care. FSSA put the eligible population at more than 123,000 Hoosiers at launch. People under 60 who are blind or disabled and not on Medicare are served by Hoosier Care Connect; those under 60 who have both Medicare and Medicaid are generally served through Traditional Medicaid rather than a managed-care plan.

Programs that can lower your costs

• Medicare Savings Programs (MSPs) — QMB, SLMB and QI — pay the Part B premium ($202.90 in 2026) and, for QMB, Medicare’s deductibles, copays and coinsurance as well. Income limits change each year and resource rules apply. You apply through FSSA, and you do not have to be on full Medicaid to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MSP or Medicaid you get Extra Help automatically; otherwise apply through Social Security.
• HoosierRx is Indiana’s own state pharmaceutical assistance program. It pays up to $70 a month toward a Medicare Part D plan premium for Indiana residents 65 and older under its income limits, and it is run through Indiana Medicaid.
• Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both Medicare and Medicaid; they coordinate the two programs, usually at $0 plan premium, and often add extras while keeping your Medicaid benefits intact. Each of the three PathWays companies is also a Medicare Advantage carrier, so where it offers a D-SNP in your county, the Medicare and Medicaid sides can sit under one company.

Free, unbiased state counseling on all of this is available from Indiana SHIP — the State Health Insurance Assistance Program, run by the Indiana Department of Insurance — at 800-452-4800. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how a Medicare Savings Program, Extra Help and HoosierRx could reduce your costs, and how to keep your Medicaid benefits working alongside Medicare. Eligibility decisions rest with FSSA and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by Indiana Medicaid, the Indiana Family and Social Services Administration, or the federal Medicare program.