Overview of PathWays Dual Care Program and Benefits
The Indiana Family & Social Services Administration (FSSA) is excited to be officially launching 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 located here.
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 & 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 Pathways for Aging, and will also be 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.
- 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 will offer both CO D-SNPs and FIDE SNPs in 2026:- CO D-SNPs: for 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.
- FIDE SNP: for individuals with full Medicare and Medicaid coverage. These individuals are sometimes referred to as full benefit dual eligibles, or “FBDEs”. The Indiana FIDE SNP program is called PathWays Dual Care and is only available for FBDEs.
Enrolled members in a FIDE SNP receive all Medicare and Medicaid benefits from one health plan.
You will find that Indiana refers to the PathWays Dual Care FIDE SNP type as a D-SNP in its materials.
PathWays Dual Care Program Overview
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 starts 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:
- Developmental Disability Rehabilitation Services (DDRS) 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
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 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.
Long Term Services and Supports (LTSS) Overview
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.”
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.
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
- Can I get PathWays Dual Care?
Yes. You can get Pathways Dual Care in Indiana if you are aged 60 and older and have both Medicare and full Medicaid benefits. Members cannot be receiving services from any of the following programs and be enrolled in Pathways Dual Care:
- Developmental Disability Rehabilitation Services (DDRS) 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
PathWays Dual Care is a program that brings together your Medicare and Medicaid benefits into a single plan. You will receive one ID card. You will also receive a care coordinator to support you in accessing the care and services that you need and want.
- 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 Medicare 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?
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 Medicare 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)
- 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 are provided in 2026 here.
- How do I enroll?
The PathWays Dual Care program provides eligible members with the option to enroll in one of three D-SNP plans. For assistance in choosing the best D-SNP option to meet needs, members can contact:
The Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800, and/or an individual D-SNP.
For assistance in enrolling in a PathWays Dual Care D-SNP, the member must select a D-SNP plan.
The selected D-SNP organization will assist with completing an enrollment form and selecting a primary care provider (PCP) from the available network. The D-SNP then processes the enrollment.
The three D-SNP plans available are:
Anthem D-SNP
1-833-235-1005 (TTY 711)
<Insert Anthem Indiana PathWays Dual Care website once available>
Humana D-SNP
1-866-621-9073 (TTY 711)
<Insert Humana Indiana PathWays Dual Care website once available>
UnitedHealthcare D-SNP
1-877-699-5695 (TTY 711)
<Insert UHC Indiana PathWays Dual Care website once available>
- 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 will have to make a decision about whether you want to get your Medicaid and Medicare coverage through 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.
- Go to the website of each plan you can choose from.
- 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: (833) 235-1005 (TTY 711)
Humana D-SNP: (866) 621-9073 (TTY 711)
UnitedHealthcare D-SNP: (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?
IMPORTANT: Remember that if a member has a different Medicaid MCE than their current Medicare D-SNP, the Family and Social Services Administration (FSSA) will automatically enroll the member in a health plan to match the Medicare D-SNP plan by no later than January 1, 2026.
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 Original 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 occurs October 15th through December 7th, 2025.
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). They may also change plans if they have a change in status. For example, if they lose Medicaid eligibility or move out of the service area of the D-SNP, they can change their plan.
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.
- Prioritized Alignment
Prioritized Alignment is a one-time process occurring in Indiana between December 2025 through January 2026 as the state D-SNP plans transition into fully integrated dual eligible (FIDE) D-SNPs. The “alignment” specifically refers to the process by which a member’s Medicaid and Medicare benefits will be provided by the same D-SNP health plan provider. For dual eligibles prior to 2026 with a different Medicaid PathWays Dual Care MCE than their Medicare D-SNP, the “alignment” is to move the Medicaid benefit to the current D-SNP a member is already enrolled with. In this scenario, the Medicare choice will not change, only the Medicaid MCE plan changes so both the Medicaid and Medicare benefits can be offered in one, seamless program.
Most current dual eligible members who are not in an aligned plan will have the plan alignment enrollment action occur in December, 2025. Members continue to have the ability to change D-SNP plans monthly.
- 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
