The Healthy Indiana Plan (HIP) is an alternative to Medicaid that exists via a waiver from Medicaid rules. HIP was created to cover uninsured Hoosier adults between the ages of 19-64, who are not otherwise eligible for Medicaid. Unlike many other government-sponsored programs, parents and childless adults can participate. Parents and caretaker relatives of children in the Hoosier Healthwise program are likely candidates for HIP.
HIP Eligibility Requirements:
- Individuals must earn less than 200% of the federal poverty level (FPL). A single adult earning no more than $21,660 a year, or families of four earning approximately $44,000 likely meet the basic financial requirements.
- Individuals must not have access to employer sponsored health insurance coverage, whether or not it is utilized by the individual.
- Individuals must be uninsured for the previous six months.
- Individuals are required to make monthly contributions toward coverage
HIP has variety of services that are included in the plan. Services include: physician services, prescriptions, diagnostic exams, home health services, outpatient hospital, inpatient hospital, hospice, preventive services, family planning, and case and disease management. Mental health services include: substance abuse treatment, inpatient, outpatient, and drugs. In the plan there are no co-pays except for ER use, which are based on a sliding scale and will never exceed $25 per ER visit. HIP does not cover vision, dental or maternity services.
Each individual is given a POWER (Personal Wellness and Responsibility) account. The POWER Account is designed to provide incentives for members to stay healthy and use services in a cost-efficient manner. All HIP members receive a POWER Account debit card with $1100 on the card for medical services. Contributions to the account are made by the state and each individual on a sliding scale based on the individual’s ability to pay. No individual will pay more than 5% of their gross family income on the plan.
HIP places emphases on prevention, and gives Indiana residents an incentive to complete preventative services. The plan offers coverage for free preventative services including annual exams, smoking cessation, and mammograms. HIP makes staying healthy affordable for many Hoosiers who would not otherwise have access to health care.
If a person completes all age and gender appropriate preventive services, state and individual contributed funds will roll over to the individual’s POWER account for the next year. If preventative services are not completed, only individual contributed funds will roll over to the individual’s account for the next year.
The following health plans are contracted with the State of Indiana to serve the Healthy Indiana Plan population:
- Anthem Blue Cross and Blue Shield
- Managed Health Services (MHS)
More information about HIP can be found at http://www.in.gov/fssa/hip/.