What is HIP?
The Healthy Indiana Plan is the state of Indiana’s signature, consumer-driven health coverage program for non-disabled Hoosiers ages 19-64. HIP continues to build on the successes of the original design and lessons learned since initial implementation in 2008. HIP provides incentives for members to take personal responsibility for their health.
Through HIP, Indiana works to:
- Provide quality coverage choices for Hoosiers
- Provide additional substance use disorder services to address the opioid crisis
- Improve the health status of Hoosiers
- Provide health coverage to low-income Hoosiers and ensure an adequate provider network for both HIP and Medicaid enrollees
- Empower participants to make cost- and quality-conscious health care decisions
- Create pathways to jobs that promote independence from public assistance
- Ensure that HIP is fiscally sustainable
How does HIP coverage work?
In the HIP program, in each calendar year the first $2,500 of a member’s 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 the member is also responsible for paying a small portion of their initial health care costs. The member’s portion is an affordable, monthly contribution based on income. The contribution that will be one of five affordable amounts between $1 and $20.
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. A penalty is deducted if an individual is disenrolled due to non-payment or withdrawing from the program without having other coverage.
Who is eligible for the Healthy Indiana Plan?
The Healthy Indiana Plan covers Indiana residents between the ages of 19 and 64 whose 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.
What are the benefits of HIP Plus?
The HIP Plus program provides comprehensive benefits including vision, dental and chiropractic services for a low, predictable monthly cost. With HIP Plus, members do not pay every time they visit a doctor or fill a prescription. HIP Plus allows members to make a monthly contribution to your POWER account based on income. This contribution can be split when spouses are both enrolled in HIP. Contribution amounts may be higher for smokers. The only other cost you may have for health care in HIP Plus is a payment of $8 if you visit the Emergency Room when you don’t have an emergency health condition. Click here to find monthly contribution amounts.
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?
Employers and non-profit organizations can contribute to the individual’s required monthly contribution up to the full contribution amount. Total contributions may not exceed the member’s projected required annual 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, CareSource, MDwise or MHS) or go online to their website to research which providers are in that health plan's 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 two pathways to coverage HIP Plus and HIP Basic.
The initial plan selection for all members is HIP Plus which offers the best value for members. HIP Plus has comprehensive benefits including vision, dental and chiropractic services. 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, dental or chiropractic 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.
What's the difference between HIP Plus and HIP Basic?
A key principle of the 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, dental and chiropractic 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, dental or chiropractic 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.
When do HIP members select their health plan?
Members can select their health plan when they apply. There are four health plans that serve Healthy Indiana Plan members (Anthem, CareSource, MDwise, MHS). Click here for a comparison of the available health plans. Once a member is approved for HIP, he or she will be assigned to the health plan selected on the application. If no plan is choose a health plan, one will be assigned.
On an annual basis, HIP members have the opportunity to switch to another health plan for the following year. A member wishing to change health plans may do so by calling 877-GET-HIP-9 between November 1 and December 15. All changes will be effective January 1st and stay in effect for the next calendar year. If a member does not wish to change health plans, they do not need to take any action and will automatically stay with their current health plan for the new year.
What happens if a HIP member becomes pregnant?
HIP members who are pregnant may keep their HIP coverage for the duration of their pregnancy. Pregnant members 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 become HIP Maternity members. The member will continue to have a POWER account but will not be required to make payments. Pregnant members are eligible to receive incentives for completing preventive care like all other HIP members. HIP Maternity members will receive vision, dental, chiropractic coverage, non-emergency transportation and access to additional smoking cessation services designed specifically for pregnant women.
At the end of her pregnancy, additional pregnancy benefits will continue for another 60-day post-partum period. Pregnant members will continue to not have any cost sharing responsibilities during this period.
After the 60-day period members will transfer from HIP Maternity to HIP Basic to get HIP Plus benefits the member will need to make a POWER account contribution. Members will have 60 days to make their POWER account contribution from the start of the HIP Basic benefits. Members with income over the federal poverty level who do not pay for Plus will lose eligibility for HIP Basic after 60 days.
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.
What are POWER Accounts?
A POWER Account is a special savings account that members use to pay for health care. Every HIP member has a POWER Account. The POWER Account is used to pay for the first $2,500 in health care costs.
The state of Indiana pays for most of the $2,500 in the POWER account, but the member is responsible for a fixed monthly payment depending on income. The member contribution amounts are between $1 and $20, but may be higher for members that smoke. When a member makes a POWER account payment, they become enrolled in HIP Plus, which offers better health coverage, including vision, dental and chiropractic benefits.
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).
Some members can have HIP Basic coverage even if they don’t make their monthly payment, but in HIP Basic they will have to pay a fee every time they go to the doctor or fill a prescription. In HIP Plus, monthly POWER account payments are members’ only health care costs outside of any non-emergency visits to the emergency room.
Members who leave HIP and return in the same calendar year will still have their same POWER account and health plan.
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.
Managing your account well and getting preventive care can reduce your future costs. In HIP, 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 family income compared to the federal poverty level as shown below. Members who indicate that they are tobacco users during the plan selection period in the fall, may be subject to an increased contribution amount in the following year if they are still smoking.
|FPL||Monthly PAC Single Individual||Monthly PAC Spouses||PAC with Tobacco Surcharge||Spouse PAC when one has tobacco surcharge||Spouse PAC when both have tobacco surcharge (each)|
|<22%||$1.00||$1.00||$1.50||$1.00 & $1.50||$1.50|
|23-50%||$5.00||$2.50||$7.50||$2.50 & $3.75||$3.75|
|51-75%||$10.00||$5.00||$15.00||$5.00 & $7.50||$7.50|
|76-100%||$15.00||$7.50||$22.5||$7.50 & $11.25||$11.25|
|101-138%||$20.00||$10.00||$30.00||$10.00 & $15.00||$15.00|
Federal poverty levels are based on income and family size 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 $8 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.
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 $12,140 a year for an individual, $16,460 for a couple or $25,100 for a family of four in 2018, 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, dental or chiropractic services and could be more expensive. HIP Basic 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.
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. HIP Basic members also receive an opportunity to move to HIP Plus if they earned rollover in the prior calendar year.
Where and how can you pay your POWER account contribution?
POWER account contributions are paid directly to the member's health plan (Anthem, MDwise, CareSource 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 calendar year, members get a new $2,500 POWER account amount to pay for HIP covered medical expenses.
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 members to make a $10 payment while their application is being processed. The $10 payment goes toward the member’s first POWER account contribution. If a member makes a Fast Track payment and is eligible for HIP, their HIP Plus coverage will begin the first of the month in which they made the 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:
- Disabling mental disorder;
- A chronic substance abuse disorder;
- Serious and complex medical conditions;
- Physical, intellectual or developmental disability that significantly impair the individual’s ability to perform one or more activities of daily living; or
- A disability determination based on Social Security Administration criteria.
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, CareSource, 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. If you have questions about or changes in your health condition, please contact your health plan directly.
What is Gateway to Work?
Gateway to Work helps connect HIP members with job training and search assistance, or other education, community engagement or work opportunities. To help ensure Indiana has a healthy workforce, starting in 2019 participation in the Gateway to Work program will be required for some HIP members. Unless they fall into one of several exempt categories, such as being medically frail, pregnant, in treatment for substance use or having a child younger than school age to take care of, HIP members will be required to work, go to school, volunteer or participate in other qualifying activities up to 20 hours a week. Members required to participate will need to meet these requirements for at least 8 out 12 months of the year. There are 12 exemptions and 16 qualifying activities. More information will be posted to the Gateway to Work page in the coming months.