FSSA Dual Eligible Special Needs (D-SNP) Programs for Hoosiers
The Indiana Family and Social Services Administration (FSSA) has responsibility of the management, oversight and contracting for the Medicaid agency part of D-SNP programs in Indiana. As these programs include both Medicare and Medicaid benefits, many of the administrative functions are shared with, or done in coordination with, the federal Centers for Medicare & Medicaid Services (CMS).
Though the information on this page is about PathWays Dual Care, a Fully Integrated Special Needs Plan (FIDE SNP), Indiana offers two different types of D-SNPs in our marketplace: Coordination Only D-SNPs (CO D-SNPs) and FIDE SNPs. For more information about these different types of D-SNPs, see the “A FIDE SNP is a type of D-SNP” section below.
Overview of PathWays Dual Care Program and Benefits
The Indiana Family and Social Services Administration (FSSA) is excited to have launched the PathWays Dual Care program as of January 1st, 2026. PathWays Dual Care is a specialized program for Indiana Hoosiers who have Medicare and Medicaid and are aged 60 or older. PathWays Dual Care fully integrates Medicare and Medicaid seamlessly into one program administered through FIDE SNP Medicare Advantage health plans that contract with FSSA and CMS to be able to offer this specialized program. More information for current or prospective members, caregivers, advocates or system navigators can be found below.
FSSA also manages another PathWays Dual care webpage with additional information geared towards providers, FSSA: Medicaid Policy Dually Eligible Special Needs Plan Partners and Providers.
Fully Integrated Special Needs Plans (FIDE SNPs)
A Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) is a special type of Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) that offers the highest level of integration for enrolled members with Medicare plus full Medicaid benefit coverage.
Members with Medicare and full Medicaid benefit coverage are known as full-benefit dual eligible (FBDE) individuals.
- Why consider a FIDE SNP
A FIDE SNP makes it easier for enrolled members to access care and services by bringing together Medicare and Medicaid benefits through a single integrated plan.
Without integration, members with both Medicare and full Medicaid benefits can face many challenges in accessing care and services. These challenges are often due to poor coordination between the Medicare and Medicaid programs that sometimes have different rules and coverage.A FIDE SNP creates coordination between the two programs to better serve members.
The Indiana Family and Social Services Administration (FSSA) has contracted with three D-SNP plans: Anthem, Humana and UnitedHealthcare. These three plans are also contracted with FSSA to administer the Medicaid program Indiana Pathways for Aging, as well as administering PathWays Dual Care as of January 1, 2026, as FIDE SNPs.
To enroll in a FIDE SNP, members must have:- Medicare Parts A and B; and
- Full Medicaid benefits.
* Individuals who do not have full Medicaid benefits (but do have partial Medicaid) can still enroll with a D-SNP, they just cannot enroll in the FIDE SNP type of program. For more information about this, see the “A FIDE SNP is a type of D-SNP” section below.
- What to know about FIDE SNPs
- A FIDE SNP is a type of D-SNP plan that makes it simple for members to access care and services because all Medicare and Medicaid benefits are covered through a single plan.
- A FIDE SNP provides care coordination and offers person-centered care by providing a comprehensive assessment, an interdisciplinary care team, individualized care plan, a care coordinator and a service coordinator for members with home and community-based services (HCBS).
- A FIDE SNP plan covers all Medicare and Medicaid services including medical, behavioral health, and long-term services and supports (LTSS) such as HCBS or nursing home care.
- A FIDE SNP provides additional benefits above and beyond what is covered under the Medicare and Medicaid benefit set.
- A FIDE SNP seamlessly coordinates all the benefits that are covered under the Medicare and the Medicaid programs.
- A FIDE SNP charges no out-of-pocket costs such as copayments, premiums, or deductibles for Medicare Part A and Part B services. There may be no, or very low copays for medications covered by Medicare Part D.
- A FIDE SNP provides an integrated approach to communication materials and provides a single, unified process for members to file appeals or grievances for both Medicare and Medicaid services.
- A FIDE SNP ensures that members have the same rights they have under both the Medicare and the Medicaid programs.
- A FIDE SNP is a type of D-SNP
A FIDE SNP is one type of D-SNP. D-SNPs are a category of Medicare Advantage plans. There are three types of D-SNPs: a Coordination Only (CO) D-SNP, a Highly Integrated D-SNP (HIDE SNP), and a Fully Integrated Special Needs Plan (FIDE SNP).
The Indiana market offers both CO D-SNPs and FIDE SNPs as of January 1, 2026:- CO D-SNPs: Two distinct populations may be enrolled in Indiana’s CO D-SNPs:
- Individuals with full Medicare and only partial Medicaid support (partial Medicaid has no Medicaid medical benefit coverage, only cost sharing support). These individuals are sometimes referred to as “partials.” Partials are enrolled in D-SNPs but due to the partial status do not qualify for the PathWays Dual Care FIDE SNP program.
- Individuals under the age of 60 with full Medicaid and Medicare benefit dual eligibility (often referred to as Fully Benefit Dual Eligbles, or FBDE). As Indiana’s PathWays Dual Care Program is only for individuals aged 60 and older, the only D-SNP option for FBDE not meeting this age eligibility criteria is to enroll in the CO D-SNP option.
PathWays Dual Care Program Overview
The program started on January 1, 2026. This is a voluntary program for Indiana fully benefit dual eligibles.
What is PathWays Dual Care?
With PathWays Dual Care, individuals 60 and older who are eligible for Medicaid and Medicare can access comprehensive benefits and care coordination through a single health plan. If you join PathWays Dual Care, you do not lose any of your Medicare and Medicaid benefits- and may even have additional benefits.
The PathWays Dual Care program is a comprehensive program that brings together all Medicare and Medicaid services into a single, fully integrated health plan.
Indiana has built the Pathways Dual Care program around a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) to ensure that members receive the highest level of integration.
A FIDE SNP is a type of Dual Eligible Special Needs Plan (D-SNP).
You will find that Indiana refers to the FIDE SNP type as a D-SNP in its materials about PathWays Dual Care.
FIDE SNPs provide members with an opportunity to receive higher quality care. Members enrolled in a FIDE SNP receive person-centered care, coordinated care, and benefits above and beyond what the standard Medicare and Medicaid benefit set covers.
A care coordinator is one of the most important features of PathWays Dual Care. Every member will receive a care coordinator to support their needs, goals, and preferences. The care coordinator will work with the member to create a person-centered care plan and ensure member access to additional benefits that are not covered under Traditional Medicare and Medicaid.
The program started on January 1, 2026. This is a voluntary program for Indiana fully benefit dual eligibles.
To be eligible for PathWays Dual Care:
- Members must be aged 60 or older:
- Members must be eligible for Medicaid;
- Members must be eligible for Medicare Part A & Part B; and
- Members must not be receiving services from any of the following programs:
- Traumatic Brain Injury (TBI) waiver recipients
- Intermediate Care Facility /Intellectual Developmental Disability (ICF/IDD) residents
- Program of All-Inclusive Care for the Elderly (PACE) members
- Residential Care Assistance Program (RCAP) members
Members who are eligible for PathWays Dual Care will have a choice to enroll in one of three FIDE SNPs.
Through a FIDE SNP model, members receive access to a:
- Single plan that covers all Medicare and Medicaid benefits with one ID card,
- Person-centered care delivery model including a care coordinator, an interdisciplinary care team, and a comprehensive assessment, and
- Comprehensive provider network for all services, and additional benefits.
- Members must not be receiving services from any of the following programs:
- Family Supports Waiver (FSW) recipients.
- Community Integration and Habilitation (CIH) waiver recipients.
- Traumatic Brain Injury (TBI) waiver recipients.
- Intermediate Care Facility/Intellectual Developmental Disability (ICF/IDD) residents.
- Program of All-Inclusive Care for the Elderly (PACE) members.
- Residential Care Assistance Program (RCAP) members.
Benefits of Integration
The PathWays Dual Care program is an integrated care program designed to coordinate Medicare and Medicaid benefits and services through a single health plan. Integration is important to improve access to care by reducing the barriers to care.
Key benefits of integration include:
- All Medicare and Medicaid benefits provided in one program that works together (acute and chronic medical care, behavioral health, home and community-based services, nursing home and pharmacy benefits)
- One ID card for all Medicare, Medicaid and prescription coverage
- Single point of contact
- Enhanced coordination of care
- Additional benefits and services
- Availability of a specialized provider network that receives training on the unique needs of the dually eligible population
- Integrated member materials
- Improved care experience
- High quality experience
- Integrated appeals and grievance processes
- Improved quality of care
- Reduced costs
- Strong regulatory oversight
PathWays Dual Care Program Benefits
- Medicare & Medicaid Covered Services
- Primary care
- Acute Care
- Behavioral Health
- Emergency Services
- Care Coordination Services
- Service Coordination
- Transition Support
- Pharmacy and Drugs
- Dental
- Transportation
- Vision
- Home and Community-Based Support Benefits
- Adult day services
- Adult family care
- Assisted living
- Attendant care
- Caregiver Coaching
- Community Transition
- Home modifications
- Home-delivered meals
- Integrated Health care coordination
- Nutritional supplements
- Personal emergency response systems
- Pest Control
- Respite
- Specialized medical equipment
- Structured family caregiving
- Transportation
- Vehicle modification
- Long-Term Care Benefits
- Long-term care, or “custodial care” that provided coverage for members to reside in a nursing facility
Long Term Services and Supports (LTSS) Overview
Benefits and more information about LTSS:
LTSS plays a crucial role in the healthcare system by providing essential support to individuals who require assistance with daily living activities.
Understanding LTSS is vital for families, caregivers, and policymakers to ensure that individuals receive the care they need to live fulfilling lives.
One key benefit set members enrolled in PathWays Dual Care may qualify for is Long-Term Services and Supports (LTSS). LTSS encompasses a range of services designed to assist older adults and individuals with disabilities in meeting their daily living needs, promoting independence and quality of life.
A subset of LTSS are home and community-based services (HCBS). HCBS differ from medical care in that HCBS are designed to help individuals improve or maintain functioning with daily tasks as compared to medical treatments that are intended to impact your health condition. The HCBS included in PathWays Dual Care are sometimes referred to as “waiver services.”
Key Features of LTSS
- Care Coordination and/or Service Coordination: Pathways Dual Care members will receive additional care support from a care coordinator and/or service coordinator. This is a key benefit that all members receive to ensure that their all health and social needs are identified and met.
- Personalized Care: LTSS is tailored to meet the individual needs of each person, focusing on their specific health needs and goals. An individualized care plan (ICP) is created for each member after an assessment of your needs and goals is completed.
- Activities of Daily Living (ADLs): LTSS often assists with essential daily activities such as bathing, dressing, eating, and medication management.
- Support for Independence: The goal of LTSS is to help individuals maintain their independence and improve their quality of life, allowing them to live in the least restrictive environment possible.
Benefits and More Information about LTSS
Home and Community-Based Support Benefits
- Adult day services
- Adult family care
- Assisted living
- Attendant care
- Caregiver Coaching
- Community Transition
- Home modifications
- Home-delivered meals
- Integrated Health care coordination
- Nutritional supplements
- Personal emergency response systems
- Pest Control
- Respite
- Specialized medical equipment
- Structured family caregiving
- Transportation
- Vehicle modification
Long-Term Care Benefits
- Long-term care benefits are those that provides coverage for members in a nursing facility. D-SNPs have full responsibility, 365 days per year to cover nursing home benefits for those who qualify. Benefits in the nursing home may be shorter term, possibly to help a members get better after a change in condition (often times this is called “skilled care”) or may be a permanent residence for members (often times referred to as “custodial care.”)
Learn about PathWays Dual Care and How to Enroll and Disenroll
- When Can I enroll?
Great news! Individuals 60 and older with dual eligibility can enroll into PathWays Dual Care any month during the year- you do not need to wait for the Open Enrollment period that happens at the end of each calendar year.
Additionally, if you are becoming eligible for Medicare in the near future and are already enrolled in an Indiana PathWays for Aging health plan, the state will help you get enrolled in a PathWays Dual Care FIDE SNP so you don’t need to take action (see section below about Default Enrollment for more information).
You always have a choice of where to receive your Medicare and Medicaid benefits from. Refer to the section below about
- How do I apply?
Once you are enrolled in the PathWays Medicaid program, then you can apply for PathWays Dual Care. Members can call one of the D-SNPs listed below or you can call the Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800 for assistance with choosing the best PathWays Dual Care FIDE SNP plan to meet your needs.
- Anthem D-SNP: (833) 235-1005 (TTY 711)
- Humana D-SNP: (866) 621-9073 (TTY 711)
- UnitedHealthcare D-SNP: (877) 699-5695 (TTY 711)
- Will PathWays Dual Care affect my Medicare?
If you choose to enroll in a PathWays Dual Care FIDE SNP, you will have access to all parts of your Medicare benefit including Medicare Part A, Medicare Part B, and Medicare Part D.
- Pharmacy considerations
The PathWays Dual Care program offers full prescription coverage by combining both Medicare Part D and Medicaid prescription coverage into one integrated program, so members don’t need to worry about which program covers what drugs. The PathWays Dual Care D-SNP offers support to ensure members get needed medicine and are not overpaying for prescriptions. All members enrolled in PathWays Dual Care are eligible for the Low-Income Subsidy (i.e.-Extra Help) and receive coverage of the Part D premium. Some members may still have low, or no medication copays for Part D covered drugs.
Some PathWays Dual Care Plans offer additional pharmacy supports or benefits that may change from year to year. You can find more information about the additional supports of benefits the PathWays Dual Care Plans as outlined under PathWays Dual Care Health Plan Comparison or by contacting the D-SNPs below.
*Anthem D-SNP: (833) 235-1005 (TTY 711)
*Humana D-SNP: (866) 621-9073 (TTY 711)
*UnitedHealthcare D-SNP: (877) 699-5695 (TTY 711) - How to enroll?
The PathWays Dual Care program provides eligible members with the option to enroll in one of three D-SNP plans. You can find out more about the PathWays Dual Care health plan options in the Indiana PathWays for Aging Dual Care Plan Comparison chart on this website, or at the very top you can view each PathWays Dual Care FIDE SNP plan Townhall presentation.
For assistance in choosing the best D-SNP option to meet needs, members can contact:
Anthem D-SNP
1-833-235-1005 (TTY 711)
Humana D-SNP
1-866-621-9073 (TTY 711)
UnitedHealthcare D-SNP
1-877-699-5695 (TTY 711)
- How to get help comparing Medicare Plans
It's important to find a plan that covers your doctor visits and prescription drugs. You can get help comparing your plan choices if you:
- Contact Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800 for assistance. Representatives provide free, personalized health insurance counseling. SHIP counselors are not affiliated with any health plan.
- Visit Medicare.gov Medicare's web site has tools that can help you compare plans and answer your questions. Click "Find health & drug plans" to compare plans in your area.
You can compare your Medicare coverage options using an online searchable tool on the Medicare.gov website that allows users to compare Medicare coverage options, including Medicare Advantage plans, Medicare Part D plans, and Medigap supplemental policies. You can get information about the coverage, costs, and benefits of different plan options in your area using the Medicare coverage comparison website. You can also enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare coverage comparison website. You can also get information about Medigap supplemental policies on the Medicare.gov website, but you cannot enroll in a Medigap policy directly. To enroll in a Medigap policy, you need to contact the insurance company directly.
- Call 1-800-MEDICARE (1-800-633-4227). Tell them you got a letter saying you have Medicaid now and are going to be eligible for Medicare. Say that you want help with your Medicare choices. This toll-free helpline is available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
- Refer to your Medicare & You Handbook for a list of all Medicare health and prescription drug plans in your area. This handbook is mailed out annually to those eligible for Medicare. If you want to join one of these plans, you can call the plan to get information about their costs, rules, and coverage.
- Steps to find a PathWays Dual Care plan
You have the right to ask questions before deciding if PathWays Dual Care is right for you. You will keep your Medicare and Medicaid benefits if you join a PathWays Dual Care plan.
Step 1. Learn about the plans:
You will want to learn about each plan. Here are some of the ways you can learn about each plan.
- Refer to resources on this webpage for additional information:
- Indiana PathWays for Aging Dual Care Plan Comparison
- Learn more about the PathWays Dual Care Program October 2025 Townhall presentation PathWays Dual Care Town Hall October 2025
- Visit the website of each plan to learn more. See links below.
- If you have questions about the plans, you can call: The Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800 for assistance with choosing a Medicare D-SNP.
- You can call one or all three D-SNPs listed below:
Anthem D-SNP
1-833-235-1005 (TTY 711)
Humana D-SNP
1-866-621-9073 (TTY 711)
UnitedHealthcare D-SNP
1-877-699-5695 (TTY 711)
Step 2. Make a list of the questions you may want to ask the plan:
- Is the doctor I have now in the new plan?
- If not, who will be my doctor?
- Which hospitals can I go to?
- Are my prescriptions covered?
60 Days Until You Enroll in Medicare
If you are eligible to enroll in PathWays Dual care, you will get a letter 90 days (about 3 months) before your 60th birthday. This letter will tell you that you are eligible for the PathWays Dual Care program and provide other helpful information about Medicare.
Plan Change Processes
Dually eligible individuals will have freedom of choice to enroll in their preferred Medicare plan, which include Special Needs Plans (D-SNP, C-SNP, I-SNP); conventional Medicare Advantage plans (non-SNP); and Traditional Medicare (fee-for-service). There are many scenarios where a change in your selected health plan may be desired or need to occur. Below outlines a few of the most common scenarios and options.
A dually eligible member has a non-integrated Medicare option but would like to enroll in a D-SNP
Individuals with full Medicaid and Medicare benefits can enroll into an integrated Dual Eligible Special Needs Plan (D-SNP) once per month. Individuals can also change during the annual enrollment period (AEP) that typically occurs October through December each year.
A member would like to change to a different D-SNP
Individuals with full Medicaid and Medicare benefits can change their Dual Eligible Special Needs Plan (D-SNP) once per month, but only into another integrated D-SNP. Individuals can also change during the annual enrollment period (AEP). Individuals may also change plans if there is a change in status. For example, Medicaid eligibility is lost or they move out of the D-SNP's service area of the D-SNP.
A member needs to disenroll from the selected D-SNP due to loss of Medicaid eligibility
If a member becomes ineligible for Medicaid they will be allowed to continue in their D-SNP plan for up to 6 months, while working to regain Medicaid eligibility. If a member does not re-enroll into Medicaid within 6 months, they will be disenrolled from their current D-SNP. During the 6-month period, the member may contact The Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800 for assistance in choosing a new Medicare plan that works best for them.
-
- How do I disenroll
PathWays Dual Care is a voluntary program. Members may disenroll any month of the year. For assistance and/or questions about disenrolling you can call The Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800. You can also disenroll by directly calling your D-SNP at the number listed below:
Anthem D-SNP: (833) 235-1005 (TTY 711)
Humana D-SNP: (866) 621-9073 (TTY 711)
UnitedHealthcare D-SNP: (877) 699-5695 (TTY 711)
- Navigating PathWays Dual Care FIDE SNP Plans
- PathWays Dual Care for Individuals Under the Age of 65
The PathWays Dual Care program is an option for individuals aged 60 and older with full benefit dual eligibility. Information about qualifying for Medicaid and Medicare when you are under the age of 65 is noted below.
Medicare eligibility requirements:
- Individuals need to be a U.S. citizen or a legal resident. Individuals under the age of 65 may qualify based on disability status.
Medicaid eligibility requirements:
- Individuals under age 65 must meet the requirements for low-income families, pregnant women and children, receiving Supplemental Security Income (SSI), disability or another special situation.
- PathWays Dual Care for People with Waiver Service
PathWays Dual Care does include home and community-based services (HCBS), sometimes referred to as “waiver services.” Indiana PathWays Dual Care includes coverage of the Indiana PathWays for Aging Waiver services for members who meet waiver eligibility (nursing facility level of care).
Indiana does offer other waiver services for individuals with dual eligibility under the age of 60, who are not eligible to enroll in PathWays Dual Care. The Indiana waiver programs that are not part of PathWays Dual Care are:
- Developmental Disability Rehabilitation Services (DDRS) waiver recipients
- Traumatic Brain Injury (TBI) waiver recipients
- Intermediate Care Facility /Intellectual Developmental Disability (ICF/IDD) residents
Indiana PathWays for Aging Dual Care Plan Comparison
PathWays Dual Care plans offer many benefits and simplify health care for members who have both Medicaid and Medicare. In addition, they offer additional supports and services. We know healthcare can be hard to figure out so below are PathWays Dual Care FIDE SNP Plan Navigation matrices to help you access all the supports and benefits you may qualify for.
| Member Services | |||
|---|---|---|---|
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| Integrated Member Services | 833-412-4405 (TTY/TDD 711) | 866-274-5888 (TTY/TDD 711) | 800-832-4643 (TTY/TDD 711) |
| Website | https://anthem.com/pathways-dual-care | https://www.humana.com/medicaid/indiana | https://www.uhc.com/communityplan/indiana |
| Member Services Email | Please use Sydney portal for email correspondence: www.anthem.com/register/ | INHealthyHorizons@humana.com | IN_HPops@uhc.com |
| Hours of Operation | 8 a.m. - 8 p.m. ET, Monday–Friday live | 8 a.m. - 8 p.m. ET, Monday–Friday live | 8 a.m. - 8 p.m. ET, Monday–Friday live |
| Nurse On Call | |||
|---|---|---|---|
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| Live | 833-412-4405 (TTY/TDD 711) | 866-274-5888 (TTY/TDD 711) | 800-832-4643 (TTY/TDD 711) |
| Hours of Operation | 24 hours a day/ 7 days per week | 24 hours a day/ 7 days per week | 24 hours a day/ 7 days per week |
| Provider Services | |||
|---|---|---|---|
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| Provider Helpline Phone Number | 833-569-4739 | 866-274-5888 | 855-248-1474 |
| Provider Services Email Address | https://www.anthem.com/in/provider/state-federal/contact-us/email | INMedicaidProviderRelations@humana.com | IN_providerservices@uhc.com |
| Provider-facing websites | https://www.anthem.com/in/provider/state-federal | https://provider.humana.com/medicaid/indiana-medicaid/dsnp | https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home.html |
| Social Media Pages | Facebook: @AnthemMedicaid; Twitter: @AnthemBCBS; YouTube: @Anthem_BCBS; LinkedIn: @AnthemBCBS; #AnthemCares | Facebook: @humanahealthyhorizons | Facebook: @ UnitedHealthcareCommunityPlan; Instagram: @UnitedHealthcare; Twitter: @UHC; LinkedIn: @uhccs |
| General Indiana PathWays Dual Care Covered Services | |||
|---|---|---|---|
| These are universally covered services. Some of these services will be covered by Medicare and some will be covered by Medicaid. | |||
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| *Primary Care *Acute Care *Behavioral Health *Emergency Services *Care coordination services *Service Coordination *Transitions Support *Long Term Care *Member Portal | *Primary Care *Acute Care *Behavioral Health *Emergency Services *Care coordination services *Service Coordination *Transitions Support *Long Term Care *Member Portal | *Primary Care *Acute Care *Behavioral Health *Emergency Services *Care coordination services *Service Coordination *Transitions Support *Long Term Care *Member Portal | |
| The following are covered in some way by the health plan but coverage may vary by health plan. *Pharmacy and Drugs *Transportation *Dental *Vision | The following are covered in some way by the health plan but coverage may vary by health plan. *Pharmacy and Drugs *Transportation *Dental *Vision | The following are covered in some way by the health plan but coverage may vary by health plan. *Pharmacy and Drugs *Transportation *Dental *Vision | |
| Indiana PathWays for Aging Dual Care Enhanced Programs/ Services | |||
|---|---|---|---|
| These benefits are funded by Medicaid. The amounts and benefits will vary by health plan. | |||
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| Member Rewards Program Earn gift cards and other items when you complete certain preventative care visits. | Member Rewards Program Earn gift cards and other items when you complete certain preventative care visits. | Member Rewards Program Earn gift cards and other items when you complete certain preventative care visits. | |
| Tobacco Cessation and Dependence Treatment Programs available in partnership with the Indiana Tobacco Quitline at 800-QUIT-NOW. | Tobacco cessation and dependence treatment Programs available in partnership with the Indiana Tobacco Quitline at 800-QUIT-NOW. | Tobacco cessation and dependence treatment Programs available in partnership with the Indiana Tobacco Quitline at 800-QUIT-NOW. | |
| Caregiver Supports Support for adult family members or other informal caregivers providing care to individuals. | Caregiver supports Support for adult family members or other informal caregivers providing care to individuals. | Caregiver supports Support for adult family members or other informal caregivers providing care to individuals. | |
| Housing Supports Assisting with transition or post-transition activities including requests and referrals, special needs/accommodations and location of housing options. | Housing supports Assisting with transition or post-transition activities including requests and referrals, special needs/accommodations and location of housing options. | Housing supports Assisting with transition or post-transition activities including requests and referrals, special needs/accommodations and location of housing options. | |
| Fresh Food Connect Healthy food options that meet your lifestyle needs, delivered to your doorstep. | Enhanced Dental Members can receive allowance to apply towards additional cost incurred during dental services. | Enhanced Dental and Vision Benefit from extra services that include more visits and new glasses every year. | |
| Companion Connect Connect with a loved one 24/7 through a smart video speaker. | Enhanced Vision Members can receive allowance to apply towards purchasing glasses (frame and lenses) and/or contacts. | Fitness Memberships Want to work out? Our program includes many gyms across Indiana. Over 20,000 online classes are also available. | |
| Healthy Adults, Healthy Results Online resources to promote stability, mobility and strength, plus choice of home fitness kit. | Enhanced Hearing Members can receive unlimited visits for fitting and evaluations, allowance to use towards purchasing hearing aids and supplies for hearing aid batteries. | Fresh Food Refrigerated meals or fresh fruits and vegetables are available when you need them most. | |
| Home Safety Benefit Safety items like medication lockbox, non-skid tub mat, smoke alarm, fire extinguisher, carbon monoxide detector. | Transition Assistance to Living in Community Transition Assistance to Living in Community Description: Members can receive up to $5,000 allowance to apply towards costs incurred moving from nursing facility into a community setting. | Respite Support If you get help from a friend or family member, we offer a special program to support them. | |
| COPD/Asthma/Allergy Relief Products Choose from items like hypoallergenic bedding, HEPA air filters, pillow and mattress covers, inhalers, nebulizers. | Home-Delivered Meals Members can receive home-delivered meals at no cost after inpatient hospitalization or discharge from a nursing home. | Virtual Community Center It’s never too late to learn how to use and enjoy the internet. Connect with peers who can help you interact online! | |
| Indiana PathWays for Aging Dual Care Supplemental Benefits | |||
|---|---|---|---|
| These services are covered by Medicare. These are high-level summaries but coverage changes from year to year. Coverage will vary by health plan. | |||
| Anthem Blue Cross and Blue Shield | Humana Healthy Horizons | UnitedHealthcare | |
| Vision Coverage for routine eye exams, glasses, and contact lenses not typically covered by Original Medicare | Vision Coverage for routine eye exams, glasses, and contact lenses not typically covered by Original Medicare | Vision Coverage for routine eye exams, glasses, and contact lenses not typically covered by Original Medicare | |
| Dental Extra coverage beyond Medicare and Medicaid for dental services, often including routine exams, cleanings, and fillings, and sometimes offering an allowance for more complex care | Dental Extra coverage beyond Medicare and Medicaid for dental services, often including routine exams, cleanings, and fillings, and sometimes offering an allowance for more complex care | Dental Extra coverage beyond Medicare and Medicaid for dental services, including routine exams, cleanings, fillings, x-rays, and crowns | |
| Hearing Coverage for routine hearing exams and a portion of the cost for hearing aids not typically covered by Original Medicare | Hearing Coverage for routine hearing exams and a portion of the cost for hearing aids not typically covered by Original Medicare | Hearing Coverage for routine hearing exams and an allowance for a broad selection of OTC and brand name hearing aids | |
| Transportation Covers rides to and from non-emergency medical appointments | Transportation Covers rides to and from non-emergency medical appointments | Transportation Covers rides to and from non-emergency medical appointments | |
| Over the Counter Allowance to purchase eligible non-prescription health and wellness products like vitamins, pain relievers, first-aid supplies, and cold medicine | Over the Counter Allowance to purchase eligible non-prescription health and wellness products like vitamins, pain relievers, first-aid supplies, and cold medicine | Over the Counter Allowance to purchase eligible non-prescription health and wellness products like vitamins, pain relievers, first-aid supplies, and cold medicine | |
| Worldwide Emergency Coverage for emergency medical care received outside the United States | Worldwide Emergency Coverage for emergency medical care received outside the United States | Worldwide Emergency Coverage for emergency medical care received outside the United States | |
| Telehealth Covers a range of medical and health services provided remotely via phone or video, including office visits, psychotherapy, and certain urgent care issues | Telehealth Covers a range of medical and health services provided remotely via phone or video, including office visits, psychotherapy, and certain urgent care issues | Telehealth Covers a range of medical and health services provided remotely via phone or video, including office visits, psychotherapy, and certain urgent care issues | |
| In Home Support Covers services like skilled nursing, physical and occupational therapy, and home health aide assistance for eligible individuals who are homebound due to illness or injury | In Home Support Covers services like skilled nursing, physical and occupational therapy, and home health aide assistance for eligible individuals who are homebound due to illness or injury | In Home Support Covers services like skilled nursing, physical and occupational therapy, and home health aide assistance for eligible individuals who are homebound due to illness or injury | |
| Home Safety Devices and Modifications Covers durable medical equipment (DME), which is defined differently from permanent home modifications | Home Safety Devices and Modifications Covers durable medical equipment (DME), which is defined differently from permanent home modifications | Home Safety Devices and Modifications Covers durable medical equipment (DME), which is defined differently from permanent home modifications | |
| Fitness Covers membership to a gym, fitness center, or specific exercise programs | Fitness Covers membership to a gym, fitness center, or specific exercise programs | Fitness Covers membership to a gym, fitness center, or specific exercise programs | |
| Foods/Produce Assistance with groceries/produce | Foods/Produce Assistance with groceries/produce | Foods/Produce Allowance for healthy foods | |
| General Supports for Living Provides non-medical assistance to chronically ill members | General Supports for Living Provides non-medical assistance to chronically ill members | General Supports for Living Provides non-medical assistance to chronically ill members | |
| Post Discharge Meals Provides nutritious, prepared meals to members recovering at home after a hospital or skilled nursing facility stay | Post Discharge Meals Provides nutritious, prepared meals to members recovering at home after a hospital or skilled nursing facility stay | Post Discharge Meals Provides nutritious, prepared meals to members recovering at home after a hospital or skilled nursing facility stay | |
| Annual Physical Exam Personalized prevention plan and a Health Risk Assessment | Annual Physical Exam Personalized prevention plan and a Health Risk Assessment | Annual Physical Exam Annual routine physical exam | |
| Personal Emergency Response System (PERS) Provides a wearable device, like a pendant or wristband, that connects to a response center, allowing the user to call for help in an emergency by pressing a button | Personal Emergency Response System (PERS) Provides a wearable device, like a pendant or wristband, that connects to a response center, allowing the user to call for help in an emergency by pressing a button | Part B Premium Reduction Plan pays some or all of your monthly Part B premium | |
| Meals Allowance for groceries for eligible members | Support for Caregivers of Enrollees Provides assistance and relief support for members and their unpaid family or friend caregivers who are assisting dual-eligible members | ||
| Pest Control Provides professional pest control services for eligible members | Weight Management Programs Providing personalized support to help members achieve and maintain a healthy weight | ||
| Transportation for Non-Medical Needs Provides rides for errands and activities unrelated to medical appointments for qualifying members with chronic conditions | |||
| Indoor Air Quality Equipment and Services Coverage for items that improve indoor air quality for qualifying members with chronic conditions | |||
| Social Needs Benefit Provides help with non-medical needs for qualifying members with chronic conditions | |||
| Services Supporting Self-Direction Assists eligible members with managing their healthcare decisions and decision-making processes. | |||
| Chiropractic Provides extra coverage for chiropractic services beyond what Original Medicare offers | |||
| Acupuncture Provides extra coverage for acupuncture services beyond what Original Medicare offers | |||
Model Integrated Materials
In accordance with federal and state requirements, PathWays Dual Care FIDE SNP plans must provide members with a variety of health plan materials. One of the benefits of PathWays Dual Care is that there are a few special materials that are required to integrate Medicare and Medicaid content. This is important as in a non-integrated option members must look at separate coverage documents from Medicare and Medicaid to try and make sense of what their coverage is, which often is confusing. Starting in 2026, the following integrated materials will be used by each of the PathWays Dual Care FIDE SNP plans:
An Integrated ID Card
PathWays Dual Care members do not have separate member ID cards for the different benefit sets (e.g., Medicare, Medicaid, prescription coverage) as all the benefits are offered in one program with one ID card. This simplifies access to healthcare coverage for members as well as providers.
A Summary of Benefits
The Summary of Benefits document provides a high-level overview of all the PathWays Dual Care benefits in one document, so members don’t need to keep track of what is covered by each benefit set across multiple plan coverage documents. The Summary of Benefits details the services available, explains how the plan coordinates Medicare, Medicaid, home and community-based services and long-term care to help members understand the plan's features.
An Integrated Provider Directory
The integrated provider directory is an online or print resource assembled by the PathWays Dual Care Plan that lists doctors, specialists, hospitals, dentists, providers of long term services and supports (LTSS) and pharmacies that are part of the integrated FIDE SNP provider network. The directory helps members find in-network providers to access all their covered health services and benefits. Having an integrated network helps improve access to care as dual eligibles don’t need to worry about if the care provider they want to see accepts both Medicare and Medicaid.
An Integrated List of Covered Drugs
The integrated list of covered drugs, also known as a formulary is a specific list of brand-name and generic medications that the PathWays Dual Care plan has chosen to cover for its members. The integrated list of covered drugs increases access to medication as it combines all the drugs covered by the Medicaid and Medicare benefit sets into one document making it easier to understand coverage and access prescriptions.
FSSA Contracts with PathWays Dual Care Plans
Since PathWays Dual Care includes both Medicaid and Medicare services into one, fully integrated program, FSSA has two types of contracts with each D-SNP that outline the services, operational and other requirements they must meet to be a PathWays Dual Care plan option. Below are the 2026 contracts:
PathWays for Aging Contracts Cover contract requirements for Medicaid and LTSS services included in PathWays Dual Care.
D-SNP State Medicaid Agency Contract (SMAC): A contract the state Medicaid agency executes with select Medicare D-SNP plans outlining details important to the Medicaid agency above and beyond what is outlined in the full PathWays for Aging Medicaid contract. Anthem, Humana, Unitehealthcare.
