PathWays Dual Care Indiana: Who Qualifies and How to Enroll (2026)

If you're 60 or older in Indiana and have Medicare plus full Medicaid, PathWays Dual Care can put both programs in one health plan, an option Indiana launched on January 1, 2026.1 PathWays Dual Care runs through three plans, Anthem, Humana and UnitedHealthcare, the same companies that run Indiana's PathWays for Aging Medicaid program.1 Joining PathWays Dual Care is voluntary, and eligible Hoosiers can sign up in any month.2 Indiana's Family and Social Services Administration (FSSA) says members don't lose any Medicare or Medicaid benefits by joining PathWays Dual Care.2 Hoosiers under 60, and Hoosiers with only partial Medicaid help, can't join PathWays Dual Care, but they can join a different kind of plan, a coordination-only D-SNP.1

In This Guide

• What Is PathWays Dual Care?
• Do You Qualify for PathWays Dual Care?
• What PathWays Dual Care Covers
• What You Pay
• The Three PathWays Dual Care Plans
• How to Enroll, Switch or Leave
• If Your Plan Changed in December 2025
• If You Lose Medicaid While in a Plan
• What Changes in 2027
• Where to Get Free Help in Indiana
• Frequently Asked Questions
• Learn More

What Is PathWays Dual Care?

PathWays Dual Care runs through Medicare Advantage plans that contract with both the Indiana Family and Social Services Administration (FSSA) and the Centers for Medicare & Medicaid Services (CMS). Each plan is a Fully Integrated Dual Eligible Special Needs Plan, one of the Medicare Special Needs Plans built for people with both Medicare and Medicaid. Indiana's provider bulletin describes PathWays Dual Care as one program that fully integrates Medicare and Medicaid.1

The name is easy to confuse with PathWays for Aging, the Medicaid managed long-term services and supports program FSSA launched in July 2024.5 PathWays for Aging delivers the PathWays for Aging Waiver for Hoosiers 60 and older.6 PathWays for Aging covers your Medicaid benefits. PathWays Dual Care adds your Medicare benefits to the same plan, so one company handles both. The three PathWays Dual Care plans are the same three companies FSSA contracts with to run PathWays for Aging.1

Indiana's market has two kinds of dual eligible special needs plans (D-SNPs) in 2026: the FIDE SNPs that make up PathWays Dual Care, and coordination-only D-SNPs. CMS's 2026 integration file lists Indiana among the states with both types.1 Nationally, FIDE SNPs are rare: the Medicare Payment Advisory Commission (MedPAC) found that in 2024 only 3 percent of all people with both Medicare and Medicaid were enrolled in one.3

Do You Qualify for PathWays Dual Care?

FSSA sets four requirements for PathWays Dual Care. You must:2

1. Be 60 or older.
2. Have full Medicaid benefits. FSSA says people with only partial Medicaid can join a D-SNP but don't qualify for the PathWays Dual Care FIDE SNP program.2,1
3. Be eligible for Medicare Part A and Part B.
4. Not be receiving services from certain other programs. FSSA lists the Traumatic Brain Injury (TBI) waiver, Intermediate Care Facility for Individuals with Intellectual/Developmental Disabilities (ICF/IDD) residents, the Program of All-Inclusive Care for the Elderly (PACE), and the Residential Care Assistance Program (RCAP). A second list on the same FSSA page also names the Family Supports Waiver (FSW) and the Community Integration and Habilitation (CIH) waiver.2

There's also an order of operations. FSSA says you must be enrolled in the PathWays Medicaid program first, and then you can apply for PathWays Dual Care.2

Which D-SNP option fits your situation

"Full Medicaid" and "partial Medicaid" are different things. A full-benefit dual eligible has Medicare plus full Medicaid coverage. A partial-benefit dual eligible has Medicare plus help only through a Medicare Savings Program (QMB, SLMB, QI or QDWI).7

The eligibility answers in these rows come from FSSA, which lists the excluded programs and says partial duals "can still enroll with a D-SNP, they just cannot enroll in the FIDE SNP type of program," and that a full-benefit dual eligible under 60 can only choose a coordination-only D-SNP.2,1

The last row's advice to talk with SHIP is ours, not FSSA's. If you get services through PACE, RCAP, an ICF/IDD or one of those waivers, talk with Indiana SHIP before you change plans: SHIP's free one-on-one counseling covers questions about Medicare, Medicaid, managed care plans and long-term care.4

If you're under 60 and need home care through Medicaid, your waiver is generally the Health and Wellness Waiver, which covers people 59 and under; the PathWays for Aging Waiver covers people 60 and older.6

What PathWays Dual Care Covers

FSSA says a PathWays Dual Care plan covers all of your Medicare and Medicaid benefits in a single plan with one ID card.2 That includes:

• Medicare: all parts of your Medicare benefit, including Part A, Part B and Part D.
• Home and community-based services: the PathWays for Aging Waiver services, for members who meet waiver eligibility, which means needing a nursing facility level of care.
• Nursing home care: the plan covers nursing home benefits for members who qualify.
• A care coordinator: every member gets one.

One more difference matters if you ever disagree with a denial. A FIDE SNP gives members "a single, unified process for members to file appeals or grievances for both Medicare and Medicaid services," according to FSSA. You don't have to figure out which program to appeal to.2

The plans also offer extra benefits beyond standard Medicare and Medicaid. FSSA's 2026 comparison lists, for all three plans, routine vision coverage, extra dental coverage, routine hearing exams with help toward hearing aids, rides to non-emergency medical appointments and an over-the-counter allowance. FSSA is clear that these vary: the Medicaid-funded extras' "amounts and benefits will vary by health plan," and the Medicare supplemental benefits' "coverage changes from year to year." Check each plan's current list before you choose.2

What You Pay

According to FSSA, a PathWays Dual Care plan "charges no out-of-pocket costs such as copayments, premiums, or deductibles for Medicare Part A and Part B services."2

Prescriptions work a little differently. FSSA says all PathWays Dual Care members are eligible for the Low-Income Subsidy, known as Extra Help, and receive coverage of the Part D premium. PathWays Dual Care drug copays aren't promised to be zero: FSSA says "there may be no, or very low copays" for drugs Medicare Part D covers.2

The Three PathWays Dual Care Plans

FSSA contracts with three companies for PathWays Dual Care. Call the enrollment line to ask about doctors, drugs and extras, or to join. Each line takes TTY 711.2

The phone numbers above are the PathWays Dual Care enrollment lines FSSA publishes, and the table's last column reflects FSSA's statement that all three companies also run PathWays for Aging.2,1

Before you pick a PathWays Dual Care plan, FSSA suggests asking each plan whether your current doctor is in the plan, which hospitals you can go to, and whether your prescriptions are covered.2 PathWays Dual Care extra benefits change from year to year, so check them again each year.2

How to Enroll, Switch or Leave

These steps come from FSSA's enrollment rules for PathWays Dual Care.2

If you aren't sure whether you have full Medicaid, that's a question Indiana SHIP can help with too: its counselors assist with questions about Medicaid as well as Medicare.4

If you're already in PathWays for Aging and becoming eligible for Medicare

FSSA says Indiana will help a PathWays for Aging member who is becoming eligible for Medicare enroll in a PathWays Dual Care plan, so that member doesn't need to take action. The member can still choose a different Medicare option.2

Switching plans

In Indiana, PathWays Dual Care members with full Medicaid and Medicare can change D-SNPs once per month, but only into another integrated D-SNP. PathWays Dual Care members can also change plans during Medicare's annual enrollment period.2

Leaving PathWays Dual Care

PathWays Dual Care is voluntary, and members may disenroll in any month by calling their D-SNP. Indiana SHIP at 1-800-452-4800 can help with questions about disenrolling. FSSA says dual eligibles have freedom of choice among other Medicare options, including other special needs plans, regular Medicare Advantage plans and Traditional Medicare.2

If Your Plan Changed in December 2025

Some Hoosiers saw their Medicaid plan change at the end of 2025. FSSA's own timeline shows that in January 2024 it limited D-SNPs in Indiana to companies that also had a PathWays for Aging contract, and in January 2025 highly integrated D-SNPs (HIDE SNPs) were in the market as a step toward the new program.5

In December 2025, FSSA aligned each dual eligible's PathWays Medicaid plan to the D-SNP that person had already chosen. FSSA calls this Prioritized Alignment: whichever D-SNP you had selected became the plan your Medicaid benefits moved to. On January 1, 2026, PathWays Dual Care replaced the HIDE SNPs.5

Two protections came with the move. For members moved to a new PathWays plan on December 1, 2025 or January 1, 2026, an Indiana provider bulletin says the receiving plan honors prior service authorizations for 90 calendar days from the member's enrollment date with the new plan. And FSSA told members that "dual eligibles always have the right to change their D-SNP plan choice."5

If You Lose Medicaid While in a Plan

PathWays Dual Care depends on keeping your Medicaid. FSSA says that a PathWays Dual Care member who becomes ineligible for Medicaid will be allowed to stay in the D-SNP for up to 6 months while working to regain Medicaid eligibility. A member who doesn't re-enroll in Medicaid within 6 months is disenrolled from the D-SNP.2

That "up to" matters. Under federal rules, each special needs plan picks its own grace period, anywhere from one to six months, and must apply it the same way to all members. A special needs plan should send a disenrollment notice at least 30 days before ending a member's coverage.8 Call SHIP right away if you get a notice that your Medicaid could end.

What Changes in 2027

A federal rule takes effect in 2027 for D-SNPs whose company also runs a Medicaid managed care plan for full-benefit dual eligibles in the same area. Starting in 2027, a D-SNP whose company also runs such a Medicaid plan must limit new enrollment to people enrolled in, or enrolling in, that company's Medicaid plan. Starting in 2030, a D-SNP whose company also runs such a Medicaid plan may only enroll or keep members who are in that Medicaid plan.9

The 2027 and 2030 enrollment limits apply to every type of D-SNP, coordination-only plans included, whose company also runs such a Medicaid plan; a D-SNP whose company runs no Medicaid plan for full-benefit dual eligibles in the state is unaffected. Under the same federal rule, existing D-SNP members who aren't in the matching Medicaid plan can stay in their D-SNP until 2030.9

The rule also has exceptions that matter for the Hoosiers this guide sends to coordination-only plans. Under the federal D-SNP enrollment-alignment rule, a company that also runs a Medicaid managed care plan may, if state policy allows, also run coordination-only D-SNPs limited to partial-benefit dual eligibles in the same area. And under an exception added for 2027, where a state doesn't require Medicaid managed care for all full-benefit dual eligibles and the state contract allows it, a company may enroll full-benefit dual eligibles who are in Medicaid fee-for-service in a coordination-only D-SNP or HIDE SNP.9

PathWays Dual Care already lines the two up, because your D-SNP choice moves your Medicaid plan with it.2 Indiana is also one of 23 states and territories whose integrated D-SNPs use the joint CMS and state model member materials, such as the member handbook and ID card, for contract year 2027.10 If you're in a coordination-only D-SNP, ask SHIP or the plan whether the 2027 limits or their exceptions apply to that plan.

Where to Get Free Help in Indiana

Indiana SHIP, the State Health Insurance Assistance Program provided by the Indiana Department of Insurance, gives free, impartial Medicare counseling and isn't affiliated with any insurance company. Indiana SHIP's central office line is 1-800-452-4800.4 FSSA points PathWays Dual Care members to the same number for help choosing a plan and for questions about disenrolling.2

Learn More

Find personalized help choosing an Indiana dual eligible plan at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.