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Indiana Medicaid: Ultimate Consumer Guide

Interested in saving on health care costs by enrolling in Medicaid? You are not alone! About 29% of the Indiana population falls into the “low income” category, and 20% are enrolled in Medicaid. That’s about:

  • 1 out of every 6 Indiana adults
  • 1 out of every 3 Indiana kids
  • 5 out of every 8 Indiana nursing home residents
  • 3 out of every 7 disabled Indiana residents

If you are disabled, elderly, or living with low income, there is a good chance that you qualify for Indiana state Medicaid.

The Indiana Medicaid Ultimate Consumer Guide Includes:

Do you meet the Indiana Medicaid Eligibility Requirements?

There are five main Indiana Medicaid eligibility groups: kids, pregnant women, adults, aged/blind/disabled, and home and community-based services. Your income and family size are considered for eligibility.

Indiana Medicaid Eligibility | Medicare Plan Finder

If you do not qualify under either of those categories, you may still qualify if you need financial help and are diagnosed with ESRD (End-Stage Renal Disease), have a severe medical emergency, or need family planning assistance. Complete your Indiana Medicaid application to find out if you are eligible.

Have Questions? Ask a Licensed Agent in Your Area

What Does Indiana State Medicaid Cover?

IN Medicaid has two packages, A and C. Package A applies to Hoosier Healthwise, Hoosier Care Connect, and the Traditional Medicaid option. Package C applies to some people with Hoosier Healthwise, depending on income.

*Those in the “Hoosier Healthwise Package C” program will have some benefit limits, but most other beneficiaries will have access to the whole list above.

**May require a small copay (averaging at $3)

Indiana Medicaid Benefits | Medicare Plan Finder

Finding Indiana Medicaid Providers

To find a hospital, doctor, pharmacist, or specialist in your area who accepts IHCP (Indiana Health Coverage Programs), use this search tool. The results will tell you where the doctor is located, how to contact the doctor, and what IHCP health plans the doctor accepts.

Indiana Medicaid Dental Coverage

Through Dentaquest, IN Medicaid beneficiaries have access to one dental exam and cleaning per year (kids get two per year). Adults can also receive limited yearly x-rays, fillings and crowns, surgical treatment, dentures, and extractions. Kids can get everything adults can plus the addition of sealants and sedatives.

Glasses & Eye Care with IN Medicaid

Vision coverage is a bit more comprehensive for kids than it is for adults with Indiana state Medicaid. Kids can receive one yearly exam each year, as well as new glasses if necessary. Adults (21+) can receive vision exams every two years, as well as new glasses if necessary. If new glasses are not medically necessary, adults can only get a new pair once every five years. Generally, contact lenses are only covered if they are medically required as opposed to glasses. Medically necessary tests and treatments for eye diseases are always covered.

Indiana Medicaid Mental Health Coverage

IHCPs can cover behavioral health services offered by physicians, psychiatric hospitals, and licensed psychologists. This includes mental health disease evaluations and treatment as well as addiction counseling, peer recovery services, crisis intervention, and medication training and support. This is one of the most comprehensive Medicaid-covered mental health programs in the country.

Indiana Medicaid Transportation Benefit

Indiana Medicaid works with Southeastrans for non-emergency transportation. This may be slightly different for those in Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana. Traditional Indiana Medicaid allows for 20 one-way non-emergency trips per year. Southeastrans can take you to doctor’s appointments, pharmacies, and other medical services. If a family or friend drives you instead, your driver can ask Indiana Medicaid for a gas mileage reimbursement.

Unless it is not possible for you to do so, you must schedule your ride at least two business days before your appointment. When you schedule your ride, you will need your member ID and both your pick-up and drop-off location addresses.

Have Questions? Ask a Licensed Agent in Your Area

IHCP Plans

IHCP plans vary based on your age, your health condition, and your income level. Read through the categories below to figure out which plan best applies to you. When you complete your Indiana Medicaid application, you will automatically be placed in the plan that works best for you, so you don’t have to worry about selecting the right one. However, it is a good idea to look ahead and figure out what you can expect.

Traditional Medicaid

The traditional Indiana state Medicaid program covers those who live in nursing homes or other care facilities, those who are eligible for both Medicaid and Medicare, and those eligible for home and community-based services. All others will fall into one of the categories below. Traditional Medicaid beneficiaries get “Package A” coverage with no additional costs.

Hoosier Care Connect

Hoosier Care Connect is for aged, blind, and/or disabled beneficiaries who are not eligible for Medicare. Hoosier Care Connect plans are offered through Anthem and Managed Health Services (MHS). Both plans offer the benefits that Traditional Medicaid provides (Package A), plus the option to add health care coordination, medication therapy management, and access to a 24-hour nurse helpline.

Healthy Indiana Plan (HIP)

Healthy Indiana is for those ages 19 to 64 who meet the appropriate income levels (2018):

  • Single adults with income up to $16,954/year
  • Couples with income up to $22,987/year
  • Family of four with income up to $5,053/year

You do not necessarily have to qualify for Traditional Medicaid to qualify for HIP. Basic HIP only covers the essential health benefits (hospitalization, emergency, ambulance, maternity/newborn care, mental health, prescription drugs, lab services, preventative/wellness, pediatric). Members have the option to make “POWER account payments” each month to gain access to HIP Plus, which provides additional benefits like dental, vision, and even chiropractic coverage. You’ll pay from $1 to $20 based on your income level, and your spouse can receive the same benefits for a discounted monthly charge. Your POWER account is a health savings account - the money that goes into your account is YOUR money to spend on health care services.

HIP Basic members will not be responsible for any monthly costs but will pay a $4 copay for outpatient services, $75 for inpatient, $4 for preferred drugs, $8 for non-preferred drugs, and $8 for non-emergency ER visits.

Hoosier Healthwise

Hoosier Healthwise is for kids up to age 19 and pregnant women. It covers preventative care, doctor visits, prescription drugs, mental health, dental, hospitalization, and surgeries at little or no cost. Hoosier Healthwise beneficiaries can choose from Anthem, CareSource, Managed Health Systems, and MDwise. Those who qualify for Package A will not face any cost-sharing, but Package C includes a small monthly premium and some small copays.

Hoosier Healthwise beneficiaries can qualify for either Package A or Package C based on income and family size:

Hoosier Healthwise Eligibility | Medicare Plan Finder

Hoosier Rx

Hoosier Rx is not a full Medicaid plan option. It is a program that can help you pay for your medications if you also have Medicare. With Hoosier Rx, you can receive up to $70 per month to help pay for your Medicare Part D costs. To qualify, you must be at least age 65, have Medicare, have an income under 150% of the federal poverty level*, and been denied Medicare Extra Help from Social Security. To enroll, you must also have a Medicare Part D plan through either AARP, Cigna, EnvisionRx, First Health, Indiana University Health Plans, SilverScript, or WellCare.

*For 2018, your income must be below $18,450/year if single, or $24,930 if married.

Have Questions? Ask a Licensed Agent in Your Area

Completing the Indiana Medicaid Application

You can complete the Indiana Medicaid application online, in person at your local DFR (Division of Family Resources) office, or by phone at 1-800-403-0864. You can also download the application here and mail it in.

If you qualify for both Medicaid and Medicare, we can help you pick a Medicare Advantage plan specific to your needs. Most people who qualify for both Medicare and Medicaid can have their Medicare costs covered by Medicaid. To find out more, call us at 833-438-3676 or complete this form.

Have questions? Ask a Licensed Agent!