Healthy Indiana Plan (HIP) Benefits & Services
The Healthy Indiana Plan (HIP) is a health insurance program offered by the state of Indiana for qualified adults ages 19–64 within certain income levels. You can find the current income limits to qualify for HIP plans at the Healthy Indiana Plan web page.
There are five types of HIP plans: HIP Plus, HIP Basic, HIP State Plan Plus, HIP State Plan Basic and HIP Maternity for pregnant women.
- All HIP plans pay for medical costs for members. Some HIP plans also have vision, dental and chiropractic coverage.
- Most HIP members pay part of their coverage cost. HIP Plus members pay monthly POWER Account Contributions (PAC); HIP Basic members pay copayments when they use their benefits. Pregnant women, Native Americans and Native Alaskans do not pay any copays or PAC.
- All HIP members have a POWER Account funded by HIP. HIP Plus members pay a small part of their POWER Account through their PAC. Members will use POWER Account funds to pay for the first $2,500 of medical care each year.
- Members cannot use POWER Account funds to pay for any plan-required copayments.
HIP Plus
HIP Plus is suggested for all HIP members. HIP Plus provides the best value coverage. HIP Plus covers all key health benefits required by federal law, plus vision, dental and chiropractic services.
- It has more visits to see physical, speech and occupational therapists than the HIP Basic program.
- It also covers extra services like weight loss surgery and jaw care (TMJ).
- With HIP Plus, your monthly cost is called your POWER Account Contribution (PAC). Your PAC will fall into one of five tiers of payment based on your income and family size. You will not pay any other costs unless you go to the emergency room for non-emergency services. If you stop making payments as a HIP Plus member, you could lose all benefits or be changed to HIP Basic, which may cost you more.
HIP Basic
HIP Basic is only offered to HIP members at or below the federal poverty level (FPL). You can find the current income limits to qualify for HIP Basic by visiting the state Healthy Indiana Plan web page.
- Provides basic benefits that meet the minimum coverage requirements.
- Does not provide coverage for vision, dental or chiropractic services, weight loss surgery or jaw care (TMJ).
- Allows fewer visits to physical, speech and occupational therapists.
- Requires copayments for most health services including seeing the doctor, filling a prescription and staying in the hospital. This may cost you from $4 to $8 per doctor visit or prescription and be as high as $75 per hospital stay. The chart below shows the copay HIP Basic members pay for health care benefits. HIP Basic members pay these instead of PACs.
Members who qualify for HIP Basic can upgrade to HIP Plus by paying the monthly PAC when they enroll. This gives them the extra benefits of HIP Plus and limits their costs. HIP Basic members can also upgrade to HIP Plus during the plan selection period each fall. If a member upgrades to HIP Plus, but falls behind on their PAC, they will be moved to HIP Basic.
HIP State Plan
The HIP State Plan offers enhanced benefits to those who qualify, including:
- Those who have complex medical or behavioral health conditions
- Very low income parents or caretakers
You will be told if you qualify for the HIP State Plan. The HIP State Plan offers complete medical benefits that meet federal requirements and include extra behavioral health services. You will need to make copays or a monthly PAC.
HIP Benefit Summary
The following chart shows a summary of benefits used most by HIP members. 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).
| Benefit | HIP Plus: Available to all members who make their POWER Account Contribution | HIP Basic: For members at or below 100% FPL who fail to make a POWER Account Contribution | HIP Maternity | HIP State Plan | |
| Plus | Basic | ||||
| Deductibles | $2,500 | $2,500 | $0 | $2,500 | $2,500 |
*Note: HIP members use their POWER Account to pay their deductible.
| Office Visits/Hospital | HIP Plus | HIP Basic | HIP Maternity | HIP State Plan | Prior Authorization | |
| Plus | Basic | |||||
| Doctor Visits | Yes | $4 copay | Yes | Yes | $4 copay | No |
| Early Periodic Screening Diagnosis and Testing (EPSDT) | Yes EPSDT for ages up to 21 | Yes EPSDT for ages up to 21 | Yes EPSDT for ages up to 21 | Yes EPSDT for ages up to 21 | Yes EPSDT for ages up to 21 | No |
| Checkups | Yes | Yes | Yes | Yes | Yes | No |
| Chiropractors | Yes, includes up to 6 spinal manipulations per year from a licensed chiropractor | No | Yes | Yes Limit 50 visits | $4 copay Limit 50 visits | No |
| Family Planning Services | Yes | Yes | Yes | Yes | Yes | No |
| Clinic Services | Yes | $4 copay | Yes | Yes | $4 copay | No |
| Nurse Practitioner Services | Yes | Yes | Yes | Yes | Yes | No |
| Nurse Midwife Services | Yes | Yes | Yes | Yes | Yes | No |
| Hospital Care | Yes | up to $75 copay | Yes | Yes | up to $75 copay | Yes |
| Pharmacy and Medicine | HIP Plus | HIP Basic | HIP Maternity | State Plan | Prior Authorization | |
| Plus | Basic | |||||
| Preferred Drug List (PDL) Medications | Yes | copays:$4 Preferred Drugs$8 Non-Preferred Drugs | Yes | Yes | copays:$4 Preferred Drugs$8 Non-Preferred Drugs | Some medications need PA. Visit www.caresource.com for most recent updates. |
| Emergencies, Tests and Transportation | HIP Plus | HIP Basic | HIP Maternity | HIP State Plan | Prior Authorization | |
| Plus | Basic | |||||
| Emergency Services | If the emergency service is deemed a non-emergency, copay is $8 or $25. | If the emergency service is deemed a non-emergency, copay is $8 or $25. | Yes | If the emergency service is deemed a non-emergency, copay is $ $25. | If the emergency service is deemed a non-emergency, copay is $25. | No |
| Lab and X-ray Services | Yes | $4 copay | Yes | Yes | $4 copay | No |
| Emergency Transportation | Yes | Yes | Yes | Yes | Yes | No |
| Non-Emergency Transportation | Yes | Yes if going to a covered service | Yes | Yes | Yes | No, for trips under 50 miles |
| Specialty Services | HIP Plus | HIP Basic | HIP Maternity | HIP State Plan | Prior Authorization | |
| Plus | Basic | |||||
| Foot Care | Yes 6 visits per year | $4 copay 6 visits per year | Yes 6 visits per year | Yes 6 visits per year | $4 copay 6 visits per year | No |
| Vision Care | Yes One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | No | Yes One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | Yes One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | Yes One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | No |
| Dental Care | Yes Periodic exams covered every 6 months. | No | Yes Periodic exams covered every 6 months. | Yes* Periodic exams covered every 6 months. | Yes* Periodic exams covered every 6 months. | Yes for dental care in hospitals and ambulatory surgery centers |
| Nursing Facility Services | Yes 100 days per benefit period | $75 copay 100 days per benefit period | Yes when related to pregnancy | Yes | Yes | Yes |
| DME/Orthotics/ Prosthetics | Yes | $4 copay | Yes | Yes | $4 copay | Yes |
| Home Health Services | Yes 100 visits | $4 copay, outpatient $75 , inpatient 100 visits | Yes 100 visits | Yes | Yes | Yes |
| Hospice Care | Yes | $4 copay | Yes | Yes | Yes | Yes |
| Medical Supplies and Equipment | Yes | $4 copay | Yes | Yes | $4 copay | Some items require prior authorization. |
| Behavioral Health* | Yes | $4 copay | Yes | Yes | $4 copay | Yes, Inpatient Services |
| Addiction Services | Yes | $4 copay | Yes | Yes | $4 copay | Yes, Inpatient Services |
| *Includes Counseling (individual and family), Psychiatry, and Assessments/Screenings | ||||||
| Physical, Occupational, Speech | Yes | $4 copay | Yes | Yes | $4 copay | Yes |
| Rehabilitation Services | Yes | $4 copay | Yes | Yes | $4 copay | Yes |
| *HIP State Plan Plus and HIP State Plan Basic have enhanced dental benefits. | ||||||
Important HIP Notes
- Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. All other HIP plans cover members ages 19 to 64.
- After February 2018, pregnant members will stay in HIP when pregnant and move into HIP Maternity. You will no longer have to make copayments or a monthly PAC. You will also have access to more benefits. Please contact us as soon as you know you are pregnant.
- Learn more about the Healthy Indiana Plan on the state of Indiana HIP website.
- Access HIP Plus vs. HIP Basic and HIP POWER Account to learn more about HIP benefits and services.