Hoosier Healthwise (HHW) Benefits & Services
Hoosier Healthwise is a health care program for low income parents/caretakers, pregnant women and children. The program covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, surgeries and family planning at little or no cost to the member or the member’s family.
The benefits covered by Hoosier Healthwise include preventive care (like well-baby/well-child care and regular checkups) and mental health and substance abuse treatment. Hoosier Healthwise also has benefits for children with special health care needs like asthma or diabetes.
Hoosier Healthwise covers:
- Children up to age 19
- Pregnant women
There are three benefit packages in Hoosier Healthwise. The state will determine your eligibility and select the coverage that is right for you.
Package A: Standard Plan – Package A is a full-service plan for children and pregnant women.
Package C: Children’s Health Insurance Program (CHIP) – Package C is a full-service plan for children up to age 19. There is a small monthly premium payment and copay for some services based on family income. Most children will fall into the Hoosier Healthwise program. You may qualify for one of two benefit packages based on income. Follow this link to see CHIP program options.
Package P: Presumptive Eligibility for Pregnant Women (PEPW) – Package P is a limited-service plan for pregnant women that provides coverage for prenatal care. You can be eligible for Package P services while your full application is being processed. If you are a Package P member, you have no copays for health visits or pharmacy. To learn more about Package P and the PEPW program, please go to the Presumptive Eligibility webpage.
HHW Benefit Summary
The following chart shows a list of benefits most used by members and listed by HHW Package. If the service you are looking for is not shown in the chart, please call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711).
|Office Visits/Hospital||Package A||Package C||Package P||Prior Authorization|
|Early Periodic Screening Diagnosis and Testing (EPSDT)||Yes||Yes||Yes||No|
|Dental Care||Yes||Yes||Yes||Prior authorization needed for dental care in hospitals and ambulatory surgery centers.|
|Family Planning Services||Yes||Yes||Yes||No|
|Nurse Practitioner Services||Yes||Yes||Yes||No|
|Pharmacy and Medicine||Package A||Package C||Package P||Prior Authorization|
|Preferred Drug List Medications||Yes||$3 copay generic, compound ane sole source Drugs$10 copay brand-name drugs||Yes||No|
|Emergencies, Tests and Transportation||Package A||Package C||Package P||Prior Authorization|
|Lab and X-ray Services||Yes||Yes||Yes||No|
|Emergency Transportation||Yes||$10 copay for ambulance transportation.||Yes||No|
|Non-Emergency Transportation||Yes, unlimited to covered appointments.||$10 copay for ambulance service for non-emergencies between medical facilities when requested by a participating physician. |
Any other non-emergency transportation is not covered.
|Yes, unlimited to covered appointments||No, for trips under 50 miles|
|Specialty Services||Package A||Package C||Package P||Prior Authorization|
|Nursing Facility Services||Yes||No||No||Yes|
|Nurse Midwife Services||Yes||Yes||Yes||No|
|Foot Care||Surgical procedures involving the foot, laboratory or x-ray services, and hospital stays are covered when medically necessary.|
No more than six routine foot care visits per year are covered.
|Routine foot care services are not covered.|
Surgical procedures, lab or x-ray services, and hospital stays involving the foot are covered.
|Coverage is limited to services related to pregnancy.||No|
|Behavioral (Mental) Health Services||Package A||Package C||Package P||Prior Authorization|
|Behavioral Health Care*||Yes||Yes||Yes||Yes, inpatient|
|Addiction Services (Substance Use Disorder)||Yes||Yes||Yes||Yes, inpatient|
|*Includes Counseling (individual and family) Psychiatry and Assessments/Screenings.|
|Therapies||Package A||Package C||Package P||Prior Authorization|
|Behavioral Health Care (Outpatient)||Yes||Yes||Yes||No|
|Substance Use Disorder Therapy||Yes||Yes||Yes||No|
|Other Benefits and Services||Package A||Package C||Package P||Prior Authorization|
|Education/Training Services||Yes||Diabetes Self-Management||Pregnancy-Related||No|
|Enhanced CareSource Services (e.g., job counseling, transportation to and from coaching and training sessions for JobConnect program, Smartphones, etc.)||Yes||Yes||Yes||No|
|Home Health Services||Yes||Yes||Yes||Yes|
|Medical Supplies and Equipment||Yes||Yes||Yes||Yes|
Call CareSource Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) if you have any questions about your benefits. Learn more about Hoosier Healthwise on the state of Indiana’s Hoosier Healthwise website.