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What is HIP 2.0?
HIP 2.0 is the State of Indiana’s plan to improve and expand the successful Healthy Indiana Plan (HIP) and concurrently replace traditional Medicaid in Indiana for all non-disabled Hoosiers ages 19-64. HIP 2.0 builds on the successes of the original HIP design. It adds new pathways for coverage that promote employer-sponsored coverage and continue HIP’s private market consumer-directed model with incentives for members to take personal responsibility for their health.
Through HIP 2.0, Indiana will preserve the core principals of HIP while working to:
What is consumer-driven health care?
Consumer-driven health care (CDHC) plans pair high deductible health plans with health savings accounts (HSAs) or similar products to pay for initial health care expenses or deductibles. The high-deductible health plan (HDHP) protects them from catastrophic medical expenses, while the deductible exposes members to the costs of their care and engages them to manage their use of services appropriately. The design is referred to as "consumer-driven health care" because basic and routine costs are paid by the patient-managed account versus the insurance company. This promotes consumer behavior by giving patients greater control over their own health budgets and the health care they receive. The use of CDHPs fosters competition in the marketplace as patients become active consumers and providers compete to provide services, lowering prices and increasing quality.
Why is the Indiana using a consumer-driven model?
The state of Indiana has a long history of success with the consumer-driven health care model. The original consumer-driven health care concept was piloted by Hoosier Patrick Rooney who played a key role in winning congressional authorization for HSA accounts in 2003. Perhaps due to its status as a pioneer of the consumer-driven model, Indiana ranks highly among states in consumers covered by high deductible health plans attached to Health Savings Accounts. Studies show that employer adoption of the consumer-driven model considerably decreases total health care spending. Consumer-driven plans are also popular among employees. About 96 percent of Indiana state employees have voluntarily elected to enroll in a consumer-driven health plan option. In its first four years of offering consumer-driven health plan options to state employees, the state saved 10.7 percent annually, as employees used hospital emergency departments at lower rates, had fewer physician office visits, lower prescription costs and a higher generic medication dispensing rate.
How does HIP coverage work?
In the HIP program, the first $2,500 of medical expenses for covered benefits are paid with a special savings account called a Personal Wellness and Responsibility (POWER) account. The state will pay most of this amount, but you will also be responsible for paying a small portion of your initial health care costs. Your portion is an affordable, monthly contribution to your POWER account based on your income.
Managing your account well and getting preventive care can reduce your future costs. If your annual health care expenses are less than $2,500 per year, you may rollover your remaining contributions to reduce your monthly payment for the next year. You can also have the amount of your reduction doubled if you complete preventive services. If your annual health care expenses are more than $2,500, the first $2,500 is covered by your POWER account, and expenses for additional health services are fully covered at no additional cost to you.
In HIP, your contributions to your POWER account will be yours. If you choose to leave the program early, your contributions not spent on health care costs will be returned to you. Since your contributions are based on a projected annual amount, early exit from the program may require you to pay the contributions for the remaining months of the enrollment period. This may occur if you had significant health care expenses before leaving the program.
Who is eligible for the Healthy Indiana Plan?
The Healthy Indiana Plan (HIP) covers Indiana residents between the ages of 19 and 64 who’s family incomes are less than approximately 138 percent of the federal poverty level and who aren’t eligible for Medicare or another Medicaid category. Click here to access a calculator that will help you determine if you are eligible for HIP and will estimate your monthly POWER account contribution.
How many people will be eligible for HIP 2.0?
In total, HIP 2.0 will provide a coverage option for an estimated 334,000 to 598,334 Hoosiers who have incomes under 138 percent FPL.
What are the benefits of HIP Plus?
The HIP Plus program provides comprehensive benefits including vision and dental services for a low, predictable monthly cost. With HIP Plus, you won’t have to pay every time you visit a doctor or fill a prescription. HIP Plus allows you to make a monthly contribution to your POWER account based on your income. If both you and your spouse are enrolled in HIP Plus, the monthly contribution amount will be split between you and your spouse. The only other cost you may have for health care in HIP Plus is a payment of $8 to $25 if you visit the Emergency Room when you don’t have an emergency health condition. Click here to find monthly contribution amounts.
What are the differences between the original Healthy Indiana Plan and HIP 2.0?
From 2008-2014, the State of Indiana operated the original Healthy Indiana Plan. Analysis of program data and member feedback were taken into consideration during the design of HIP 2.0. HIP 2.0 preserves the core principles of the original Healthy Indiana Plan, but does make several changes:
How much will HIP 2.0 cost and how will this program be funded?
HIP 2.0 will not raise taxes for Hoosiers. The federal government contributes to the program costs, and the state cost of expanding HIP between 2015 and 2020 is $1.5B. The State cost will be fully funded through Indiana’s existing cigarette tax revenue, and through support from Indiana’s hospitals, Hoosier taxpayers are further protected by annual contributions into the HIP trust fund to ensure appropriate reserves.
What will happen if federal funding is reduced?
The waiver submission is conditioned on the availability of enhanced federal matching funds and the continuation of hospital support for the program. If either funding source is reduced at any point during the five-year waiver period, the HIP 2.0 will automatically terminate for the new expansion population.
Legislation passed in 2015 by the Indiana General Assembly indicates that if the federal funding changes for the coverage expansion, HIP 2.0 would revert to the original program. However, Governor Pence’s deal with the Indiana hospitals would ensure at least a year of funding for the transition from HIP 2.0 back to the original HIP program.
Does HIP cost more than traditional Medicaid?
HIP’s program design bends the cost curve, and the state’s actuaries indicate that the cost is lower than a traditional Medicaid expansion.
How do I apply?
Applications are available online or by mail, or can be picked up at any Division of Family Resources (DFR) office. Call 1-877-GET-HIP-9 to learn more about the application process or click here to find your local DFR office.
Can the member receive help paying for their required contribution?
HIP 2.0 will retain the HIP program policy to allow employers and non-profit organizations to contribute to the individual’s required monthly contribution. In HIP 2.0, employers and non-profits can contribute any amount up to the full contribution amount. In addition, the health plans may implement a rewards program that allows members to "earn" additional dollars in their POWER account. Total contributions may not exceed the members required contribution to their POWER account.
How do I find a provider? Can I keep my doctor?
If you are an enrolled HIP member, you should call your health plan (Anthem, MDwise or MHS) or go online to their website to research which providers are in that health plans' network. Members can also call 1-877-GET-HIP-9 and ask.
If you are just joining HIP and want to make sure you choose a health plan that includes your doctor, call 1-877-GET-HIP-9 to discuss your options.
What are the incentives for managing costs and receiving preventive care?
The Healthy Indiana Plan empowers members to make important decisions about the cost and quality of their health care. As an incentive, members who remain in the HIP Plus program can reduce their POWER account contribution amounts after a year in the program based on the amount remaining in their accounts. If they receive recommended preventive care services throughout the year, the discount will be doubled. Members in the HIP Basic plan also have a POWER account, but since they are not making contributions the potential amount of their discount for receiving preventive care is lower.
What are the different plans?
The Healthy Indiana Plan (HIP) has three pathways to coverage HIP Plus, HIP Basic and HIP Link.
The initial plan selection for all members is HIP Plus which offers the best value for members. HIP Plus has comprehensive benefits including vision and dental. The member pays an affordable monthly POWER account contribution based on income. There is no copayment required for receiving services with one exception: using the emergency room where there is no true emergency.
HIP Basic is the fallback option for members with household income less than or equal to 100 percent of the federal poverty level (FPL) who don't make their POWER account contributions. The benefits are reduced. The essential health benefits are covered but not vision or dental services. The member is also required to make a copayment each time he or she receives a health care service, such as going to the doctor, filling a prescription or staying in the hospital. These payments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay. HIP Basic can be much more expensive than HIP Plus.
What happens to the POWER account in the Basic Plan?
Members in the HIP Basic plan will still use the POWER account to cover their $2,500 annual deductible, but the funds in the account will be contributed entirely by the State. HIP Basic plan members will still receive POWER account statements to assist them in managing the account and to increase their awareness of the cost of the health care services they receive.
HIP Link will be an option for eligible members who work and have access to their employer's health plan. HIP Link members will also have a POWER account and contribute to their coverage like other HIP members. But with HIP Link, the POWER account can be used to pay the insurance premiums and out-of-pocket medical expenses associated with the member's employer-sponsored plan.
The employer must choose to participate in HIP Link and be registered with the state. Employers also must contribute 50 percent of the member's premium. Members can receive counseling on whether their employer plan would be best suited for them.
What's the difference between HIP Plus and HIP Basic?
A key principle of the new Healthy Indiana Plan is that it gives members the opportunity to participate in HIP Plus. HIP Plus is the initial, preferred plan selection for all members and offers the best value. To participate in HIP Plus, members make affordable monthly contributions into their POWER account based on income. In the HIP Plus program, members do not pay copayments when they go to the doctor or hospital or fill a prescription. The only exception to this is a copayment for going to the emergency room for care when there is not a true emergency.
HIP Plus provides MORE benefits than the HIP Basic program, including vision and dental services. It also allows more visits for physical, speech and occupational therapy, and covers additional services like bariatric surgery and Temporomandibular Joint Disorders (TMJ) treatment. With HIP Plus, members can get 90-day refills on prescriptions and receive medication by mail order. Members also receive medication therapy management services that are designed to work closely with their doctors and pharmacies to provide additional assurances that prescription therapies are safe and effective.
HIP Basic is the fallback option that is available only to members with household incomes less than or equal to the federal poverty level (FPL). In HIP Basic, members make a payment every time they receive a health care service, such as going to the doctor, filling a prescription or staying in the hospital. These payments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay. HIP Basic can be more expensive than HIP Plus.
HIP Basic includes all the federally required essential health benefits, but does not provide coverage for vision or dental services, bariatric surgery or Temporomandibular Joint Disorders (TMJ). HIP Basic benefits also allow fewer visits to physical, speech and occupational therapists. Unlike HIP Plus, HIP Basic has more limited options for getting medication. Members are limited to 30-day prescription supply and cannot order medications by mail. HIP Basic also does not provide medication therapy management services.
What happens if a HIP member becomes pregnant?
In the original HIP program, members were required to leave HIP and transfer Medicaid when they became pregnant. Under the new HIP program, maternity services are covered. HIP members who are pregnant may keep their HIP coverage for the duration of their pregnancy or until their annual redetermination (whichever comes first). Pregnant members who stay in HIP will have all cost sharing eliminated and will receive additional benefits during their pregnancy including non-emergency transportation.
A pregnant HIP member must promptly report her pregnancy. After reporting a pregnancy, pregnant mothers will initially have a choice to stay in their HIP Basic/HIP Plus plan OR transfer to HIP Maternity. HIP Maternity is more like a traditional Medicaid program. The member will not have a POWER account or receive monthly statements to track health care costs. Neither choice will result in a noticeable difference in benefits. All pregnant women will receive additional benefits such as vision, dental, non-emergency transportation and access to additional smoking cessation services designed specifically for them.
For pregnant members: Before deciding which pregnancy coverage option is best for you, you should talk to your doctor and make sure he or she is in your health plan's network.
IMPORTANT: If your annual redetermination occurs during your pregnancy, federal guidelines require you to be moved to HIP Maternity. Again, you won't notice any changes in your benefits or cost sharing.
At the end of your pregnancy, your additional pregnancy benefits will continue for another 60 day post-partum period. You will continue to not have any cost sharing responsibilities during this period. However you should promptly report that your pregnancy has ended to the state as soon as possible to prevent any breaks in coverage. At the end of your post-partum period, your cost-sharing will resume. You must begin paying your POWER account contribution at this time to maintain HIP Plus benefits. If you fail to report the end of your pregnancy promptly and/or pay your POWER account contribution, you could face a gap in coverage.
Pregnant women enrolled in Hoosier Healthwise will not be affected by changes to the Healthy Indiana Plan and will continue to receive coverage through Hoosier Healthwise. Pregnant women who would otherwise be eligible for HIP but are not enrolled may receive a new member card indicating they are enrolled in HIP Maternity.
How will I pay for care?
Healthy Indiana Plan members use their POWER accounts to pay for the first $2,500 of covered services in any coverage year. Each member receives a POWER account debit card to use at their doctor's office, pharmacy, hospital or anywhere else they make a purchase that's covered under HIP. The card is also the member's insurance ID card. The POWER account debit card cannot be used for copayments. Members must make copayments out of pocket.
If annual health care expenses are more than $2,500, the first $2,500 is covered by the member's POWER account, and expenses for additional health services over $2,500 are fully covered at no additional cost to the member (except in the HIP Basic program where the member is responsible for any required copayments).
How does the POWER account work?
In the HIP program, the first $2,500 of covered medical expenses is paid for out of a special savings account called a Personal Wellness and Responsibility (POWER) account. The State will pay most of this amount, but each month, members are also required to make a small contribution. These POWER account contributions can be made by the member’s employer and/or a not-for-profit organization. HIP members will have the opportunity to choose a health plan that will manage and track the POWER account and collect the member’s portion each month. This POWER account infographic provides a good summary.
The contributions you make to your new POWER account will be yours. If you choose to leave the program early, your contributions not spent on health care costs may be returned to you. Since your contributions are based on a projected annual amount, leaving the program early may also result in you being required to pay the contributions for the remaining months of the enrollment period. This may occur if you had significant health care expenses before leaving the program.
Managing your account well and getting preventive care can reduce your future costs. In HIP 2.0, if your annual health care expenses are less than $2,500 per year you may rollover your remaining contributions to reduce your monthly payment for the next year. You can also double your reduction if you complete preventive services.
What are the contribution amounts?
Monthly POWER account contributions are determined by income and family size and are approximately 2 percent of annual family income. Income ranges and contribution amounts for all family sizes can be calculated using this tool
As long as members make their required monthly POWER account contributions, they will have no other costs. The only exception to this is a charge of up to $25 if a member goes to the hospital emergency room for a non-emergency. Each month, the member’s health plan will send a monthly statement showing how much is left in their POWER account.
There are two distinct levels of coverage in HIP 2.0: HIP Plus and HIP Basic. Each covers medical expenses such as doctor visits, hospital care, therapies, medications, prescriptions and medical equipment. HIP Plus offers members the best value and, unlike HIP Basic, also covers vision and dental care, and even bariatric surgery.
Why is it important to make POWER account contributions?
POWER account contributions are a key part of the Healthy Indiana Plan. Members who make POWER account contributions on-time each month participate in HIP Plus where they have better benefits and predictable costs. Members with incomes above the poverty level, for example $11,670 a year for an individual, $15,730 for a couple or $23,850 for a family of four, that choose not to make their POWER account contributions will be removed from the program and not be allowed to re-enroll for six months. This enrollment lockout will not apply if the member is medically frail or residing in a domestic violence shelter or in a state-declared disaster area.
Members who have incomes below the federal poverty level who do not make their contributions will be moved to the HIP Basic plan. HIP Basic does not cover vision and dental coverage and could be more expensive. The Basic plan requires members to make a small payment, called a copayment, each time they go to the doctor or hospital except for preventive care or family planning services.
The HIP Basic plan will charge copayments for health care services. Again, members only pay these copayments if they do not make their POWER account contributions on-time.
Unlike POWER account contributions, which belong to the member and could be returned if the member leaves the program early, copays cannot be returned to the member.
HIP Basic members will be given the opportunity to reenroll in HIP Plus at the end of their annual cycle, or plan year, defined by their enrollment date.
Where and how can you pay your POWER account contribution?
POWER account contributions are paid directly to the member's health plan (Anthem, MDwise or MHS). Members will receive information from their health plans about the various ways POWER account contributions can be paid. These include by mail, over the phone, online and via payroll deduction through the member's employer. Each health plan also has designated retail locations around the state where you can make your payment in person. Call your health plan for details about these options and locations.
How do I monitor my POWER account?
Members receive monthly statements that show how much money is remaining in the POWER account. Members who manage their health and POWER accounts wisely could still have money in their accounts after a year of coverage. These remaining funds can be used to lower POWER account contributions for the next year of coverage. Every 12 months, members get a new $2,500 POWER account amount to pay for HIP covered medical expenses.
What can I buy with my POWER account card?
POWER accounts can only be used for covered services provided by your physician or a hospital or other health care service provider, or for covered prescriptions or medical supplies.
What is Fast Track?
Fast Track is a payment option that allows eligible Hoosiers to expedite the start of their coverage in the HIP Plus program. Fast Track allows you to make a $10 payment while your application is being processed. The $10 payment goes toward your first POWER account contribution. If you make a Fast Track payment and are eligible for HIP, your HIP Plus coverage will begin the first of the month in which you made your Fast Track payment. To learn more about Fast Track payments, click here.
Will my health condition(s) affect the coverage I receive?
Enhanced benefits are available to individuals whose health status qualifies them as medically frail. As defined by the Centers for Medicare and Medicaid Services (CMS), an individual will be considered medically frail if he or she has one or more of the following:
If you have a condition, disorder or disability, as described above, you receive additional benefits called the ‘HIP State Plan’ benefits. The HIP State Plan benefits grant you comprehensive coverage including vision, dental, non-emergency transportation, chiropractic services and Medicaid Rehabilitation Option services. These HIP State Plan benefits will continue as long as your health condition, disorder or disability status continues to qualify you as medically frail. Your health plan (Anthem, MDwise, MHS) may contact you annually to review your health condition. It is important to answer their questions to maintain HIP State Plan benefits. If you fail to verify your condition at the request of your health plan, you could still have access to comprehensive coverage including vision and dental, by participating in HIP Plus, but you would lose access to the additional HIP State Plan benefits including coverage for non-emergency transportation and chiropractic services. If you have questions about or changes in your health condition, please contact your health plan directly.
How does HIP Link help members enroll in their employer’s plans?
HIP Link is an exciting new Healthy Indiana Plan option for eligible members who work and have access to their employer’s health plan. HIP Link members will also have a POWER account and contribute to their coverage like other HIP members. But with HIP Link, the POWER account can be used to pay the insurance premiums and out-of-pocket medical expenses associated with the member’s employer-sponsored plan.
The employer must choose to participate in HIP Link and be registered with the state. Employers also must contribute 50 percent of the member’s premium. Members can receive counseling on whether their employer plan would be best suited for them.
Do individuals with access to employer-sponsored health insurance have to use their employer’s plan?
No. Enrollment in the employer-sponsored coverage is not mandatory, and eligible individuals will be given the option to choose based on which plan is best for their individual health care needs. All HIP-eligible adults with access to employer-sponsored insurance will receive options counseling through an enrollment broker regarding whether enrollment in HIP or their employer plan would be best suited to their individual needs and situation.
Do individuals who choose to enroll in employer-sponsored insurance still have a POWER account?
Yes. Individuals who choose to enroll in employer-sponsored insurance will still have a POWER account and will be required to make monthly contributions. The State will provide a defined contribution to the POWER account that can be used to cover the cost of the individual’s premium and to pay for any required cost sharing under the employer plan, including the deductible and copayments.
The State will fund the POWER account to the average amount that an individual covered by an employer-sponsored plan may be expected to spend for premium and other out-of-pocket expenses.
What is Gateway to Work?
Gateway to Work is a new feature of the Healthy Indiana Plan that helps connect HIP members to Indiana’s workforce training programs, work search resources and potential employers. HIP members who are unemployed or working less than 20 hours a week will be referred to available employment, work search and job training programs that will assist them in securing new or potentially better employment.
Gateway to Work is a voluntary program. HIP members will be notified if they have been referred to the program. Eligibility for HIP coverage is not affected if a member chooses to not participate.
Those interested in participating in Gateway to Work should call 1-800-403-0864 and select Option 1 for the health coverage menu and then Option 6 for Gateway to Work.
Once engaged in the Gateway to Work program, members may receive case management services, participate in a structured job readiness program and receive help with their job search. Additional training, volunteer work experiences and/or education may be provided, as appropriate. Gateway to Work participants will also be invited to attend hiring events with employers.