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Indiana PathWays for Aging

Through the Indiana PathWays for Aging (PathWays) program, we’ll help take care of your long-term physical, behavioral, medical, and social needs.

PathWays is an Indiana health coverage program for Hoosiers aged 60 and older who are eligible for Medicaid. Research shows that most older adults - 75% or more - want to age at home and in their communities. PathWays makes it possible for Hoosiers to age their way, offering more choices to get nursing facility level of care at home or in a community setting, while living independently.

PathWays is designed to be age-friendly and help you access the healthcare and community-based services you need. We will work with you to help you meet your goals. We want to support you in living in a setting of your choice. We’ll coordinate your care between your doctors, specialists, in-home services, and caregivers. As a person-centered health plan, our goal is to focus on what matters most to you.

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Am I Eligible?

PathWays is for individuals age 60 years and older and on Medicaid, including those who are:

Eligibility Factors

  • Blind or disabled
  • Getting Supplemental Security Income (SSI)
  • Enrolled through M.E.D. Works
  • Full-benefit, dually-eligible (receiving Medicare and Medicaid)
  • Eligible for the Aged and Disabled (A&D) waiver
  • In a nursing facility
  • Receiving hospice services

Dual-Eligibility

Dually eligible individuals are people who are enrolled in both Medicare and Medicaid. With PathWays, we will work with your Medicare providers or care managers to ensure you have the support and seamless care you need.

What You Receive With PathWays

We’re proud to offer these benefits to keep you healthy. And with Anthem, you may qualify for more.

  • Doctor care
  • Hospital services
  • Emergency and urgent care
  • Home- and community-based services
  • Care and service coordination
  • Lab tests and X-rays
  • Medical supplies
  • Chiropractic services
  • Behavioral healthcare
  • Prescription drugs
  • Immunizations
  • Smoking cessation support
  • Podiatry services
  • ​Transportation
  • Housing support
  • Caregiver support

See the PathWays member handbook for more details.

Dental Care You Receive

  • Two exams and one cleaning every year
  • Bitewing X-ray once every year and one complete set of X-rays every three years
  • Other medically necessary services 
     

For Help Finding A Dentist In Your Area

Call DentaQuest toll free at 888-291-3762 or visit DentaQuest.

Administered by DentaQuest, an independent company that does not provide Blue Cross and/or Blue Shield products.

Eye Exams

  • One eye exam every two years.
  • Additional examinations must be medically necessary.

Eyeglasses (Including Frames And Lenses)

  • One pair of eyeglasses every 5 years.

For Help Finding An Eye Doctor In Your Area

Call Superior Vision toll free at 866-866-5641 (TTY 866-428-4833) or visit their website.

You may have conditions that require special care and providers. We have care coordination programs and services to help you. They help manage your physical, behavioral, medical and social needs.

Condition Care

We help guide the care for our members with chronic health conditions. We’ll help you to understand your condition and meet healthcare goals through education, resources, and referrals to providers for care.

Care Management

Our care management team helps members who need assistance with care coordination, making preventive care appointments, or accessing care to address chronic physical or behavioral health conditions.

Complex Case Management

Anthem's Complex Case Management program is for members with complex needs who need help managing their healthcare. We can work with you and your provider, or just with your provider, to make sure you are getting the right care, at the right time and in the right place.

Service Coordination

We will help coordinate services in your home that will help you maintain your independence. We also provide an extra layer of support for those who are in a nursing facility to ensure you have the care and support you need, including transitioning back home if you choose to.

If you have a higher need for care and meet the requirements for Nursing Facility Level of Care (NFLOC), you will qualify for Home and Community Based Services, or you may choose to receive your care in a nursing facility. If you meet NFLOC requirements, you will receive Service Coordination in addition to Care Coordination.

Learn more

Your benefits include a wide range of prescription and many over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

On top of your regular PathWays benefits, you can receive these extras just for being our member. You can access these benefits in a few different ways.

Some extra benefits can be ordered by logging in to the secure Benefit Reward Hub. These include:

  • Up to $50 for over-the-counter personal care products
  • One item of COPD relief products 
  • One healthy lifestyle aid, such as a digital scale, lumbar pillow, and diabetic supplies 
  • Choose up to $75 in sensory products, including coloring books, puzzles, games, arts and crafts, or weighted blankets 
  • $50 in basic home essentials, such as bedding, cutlery, dishes, and towels
  • One home safety product per year, such as carbon monoxide detectors, medication lock boxes, smoke alarms, fire extinguishers, or non-skid tub mat
  • A memory aid kit including a photo album, digital music player, $10 music gift card, and personalized name labels 
For these extras, call Member Services 833-412-4405 (TTY 711):
  • Healthy Adults Healthy Results – online fitness programs and resources and a home fitness kit
  • Post-discharge meals ― medically-tailored meals delivered to your home after your hospital stay 
  • Fresh Food Connect ― your choice of healthy food deliveries to your doorstep  
  • Companion Connect ― connect with a loved one through a smart speaker including video capabilities 
  • Caregiver Support ― support and training opportunities for caregivers 
  • Vision Rehabilitation Training ― community-based services and in-home programs for individuals with visual impairments 
  • Transportation essentials — Up to six round trips to the Social Security office, senior centers, group programs, Medicaid redetermination appointments,  and Anthem health and education training classes. Also, choose a $50 gas card or ride-share card to help get you to other places you need to go. 
More resources you can access directly:
  • Digital Mental Health Toolkit ― access the Emotional Well-being Resources and CommonGround Library to help you better control the thoughts and behaviors that affect your emotional well-being 
  • Community Resource Link — find food, jobs, housing, and other help you may need
  • Smartphone Member Connect ― stay connected to family, friends, doctors, and social services with the upgraded Lifeline and Affordable Connectivity Program. 

You can redeem some benefits online through your Sydney Health secure account. You may need to complete activities like an online health screening or yearly wellness or dental visit to be eligible for certain extras. View the extra benefits you are eligible for on the Benefit Reward Hub or call the Member Services number on the back of your member ID card. Log in to get started today.

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Referrals

A referral is when your primary medical provider (PMP) sends you to another provider for care. This care is often from a specialist. Your PMP may send you to a specialist for special care or treatment. Your PMP can:

  • Help choose a specialist to give you the care you need.
  • Help you set the day and time for the office visit with a specialist.
  • Ask Anthem is if you can get services from a specialist. Your PMP knows when to ask for preapproval. (See below.)

Some types of services are known as self-referral services. That means you can get these services without a referral from your PMP. You can see any Indiana Health Coverage Programs (IHCP) doctor for many of these services. See your member handbook for a list of these services.

Preapproval

Some services require preapproval, or an OK, from Anthem. Your PMP will ask Anthem to make sure they’re offered. If they are, both Anthem and your PMP or specialist agree the services are medically necessary. Getting a preapproval will take no more than five calendar days or, if urgent, no more than 48 hours.

These are types of services, if offered in your health plan, that need preapproval:

  • Air ambulance
  • Certain behavioral health services
  • Biofeedback
  • Drug injections
  • Certain dental services
  • Some equipment
  • Genetic testing
  • Home health and hospice care
  • Hyperbaric oxygen therapy
  • Infusion therapy and chemotherapy
  • Inpatient hospital services
  • Certain laboratory tests
  • Services not in your plan
  • Referrals to specialists
  • Radiology services
  • Select outpatient surgeries/procedures
  • Sensory integration therapy
  • Transplant services
  • Certain vision services

Your PMP will know which services need preapproval. We may not approve payment for a service you or your doctor asks for. If your case doesn’t meet the rules for medically needed, we’ll send you a letter. The letter will tell you we could not approve the service and why. The letter will also let you know how to appeal our decision if you disagree with it. For more help, please call Member Services at 833-412-4405 (TTY 711).

Get The Most Out Of Your Healthcare

We know everyone’s health is different, so we offer services that keep you in mind. Through our Integrated Medical Management Model approach, we analyze information you give us, claims data, as well as an ongoing review of your health to find a care plan to fit you and your family. We also work side-by-side with your doctor, so the care meets your physical, behavioral, and social needs.

Key Member Resources

PathWays for Aging Quick Start Guidebook (coming soon)

New Member Welcome Resources

Caregiver Resources

Being a caregiver is an important responsibility, but it also can be complex and stressful. Providing support for caregivers is a crucial component of ensuring the health of our members. Visit the Caregiver Resources page to find information and support to help you care for your loved ones and yourself.

Team Up With The Indianapolis Colts!

Do you have your Blue Ticket to Health?

Anthem Blue Cross and Blue Shield and the Indianapolis Colts are teaming up to help you stay healthy through the Blue Ticket to Health program. Call your doctor to schedule a wellness checkup today and enter to win!

Learn more about Blue Ticket to Health

Get Your Flu Shot

Flu shots, pneumonia shots, FluMistTM and antiviral medications are approved benefits under most health plans. For specific information, check your member handbook (coming soon) or call the number on your ID card.

Help you need, close to home

See what our Community Resource Link can do for you.
 

PathWays gives you benefits beyond what you expect.

Learn how to enroll with us.

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Page Last Updated: 6/6/2024