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.

Benefit Packages

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 APackage CPackage PPrior Authorization
Doctor VisitsYesYesYesNo
Early Periodic Screening Diagnosis and Testing (EPSDT)YesYesYesNo
CheckupsYesYesYesNo
Dental CareYesYesYesPrior authorization needed for dental care in hospitals and ambulatory surgery centers.
ChiropractorsYesYesYesNo
Family Planning ServicesYesYesYesNo
Clinic ServicesYesYesYesNo
Nurse Practitioner ServicesYesYesYesNo
Hospital CareYesYesYesYes
 
Pharmacy and Medicine Package APackage CPackage PPrior Authorization
Preferred Drug List MedicationsYes$3 copay generic, compound ane sole source Drugs$10 copay brand-name drugsYesNo
     
Emergencies, Tests and Transportation Package APackage CPackage PPrior Authorization
Emergency ServicesYesYesYesNo
Lab and X-ray ServicesYesYesYesNo
Emergency TransportationYes$10 copay for ambulance transportation.YesNo
Non-Emergency TransportationYes, 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 appointmentsNo, for trips under 50 miles
Specialty Services Package APackage CPackage PPrior Authorization
AnesthesiaYesYesYesNo
Nursing Facility ServicesYesNoNoYes
Hospice CareNoNoNo 
Nurse Midwife ServicesYesYesYesNo
Foot CareSurgical 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 ServicesPackage APackage CPackage PPrior Authorization
Behavioral Health Care*YesYesYesYes, inpatient
Addiction Services (Substance Use Disorder)YesYesYesYes, inpatient
*Includes Counseling (individual and family) Psychiatry and Assessments/Screenings.
TherapiesPackage APackage CPackage PPrior Authorization
Behavioral Health Care (Outpatient)YesYesYesNo
Rehabilitation ServicesYesYesYesNo
Speech TherapyYesYesYesNo
Occupational TherapyYesYesYesNo
Substance Use Disorder TherapyYesYesYesNo
Other Benefits and ServicesPackage APackage CPackage PPrior Authorization
Education/Training ServicesYesDiabetes Self-ManagementPregnancy-RelatedNo
Enhanced CareSource Services (e.g., job counseling, transportation to and from coaching and training sessions for JobConnect program, Smartphones, etc.)YesYesYesNo
Home Health ServicesYesYesYesYes
Medical Supplies and EquipmentYesYesYesYes

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.