Cost-Share Restart
During the federal COVID-19 public health emergency, Indiana paused cost sharing to keep health coverage open for our members. This pause will end July 1, 2024, and Indiana will restart cost sharing for Medicaid, including the Healthy Indiana Plan (HIP); the Children’s Health Insurance Program (CHIP); and the MEDWorks program for employed individuals with a disability. This impacts approximately 1 million Medicaid members, the majority of which are on the Healthy Indiana Plan. CHIP and MEDWorks are also impacted.
HIP or CHIP members may owe copayments for certain services starting July 1. Most copayments are under $10. HIP members will receive invoices from their health plan for their POWER Account contributions. CHIP or MEDWorks will receive their invoices from the premium vendor. Benefits may be reduced or terminated if they are not paid.
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Who has to pay a cost share?
If you are a HIP member, you will receive an invoice from your health plan (Anthem, CareSource, MDwise, MHS). If you are or have a child in CHIP or if you receive MEDWorks coverage and are required to pay premiums, you will receive a bill from the premium vendor in July.
If you are in a health coverage category that has a cost sharing requirement, you will receive a letter from FSSA 60 days before you have to start paying. You will receive a post card from your health plan to remind you to look for an invoice around a month before you have to start paying, Then, you will receive an invoice in the month before your first payment is due.”
Medicaid members can check their status online in their benefits portal account (fssabenefits.in.gov) to determine if they are required to pay monthly contributions/premiums. Eligibility notices from FSSA and monthly invoices will also be provided by the member’s health plan (for HIP members) or the premium vendor (for CHIP and MEDWorks members) to keep members informed.
How do I pay my cost share?
To learn about the difference options available how to pay costs share please consider downloading the reference guide below or click on a specific health plan:
How much is my cost share?
The specific amount of the cost that members will need to contribute will vary as the amount is based on the members’ income.
Checking one's status online at fssabenefits.in.gov will provide personalized information about monthly contribution/premium amounts. Members can find more information on copay amounts by calling the “member services” number on the back of their Medicaid card.
Members may also review the charts below to see HIP Power Account and CHIP/MEDWorks Premium tiers by family size and dollar income.
2024 HIP POWER Account Contribution (PAC) Federal Poverty Level
| Each Unmarried HIP Member | $1 | $5 | $10 | $15 | $20 | ||||
|---|---|---|---|---|---|---|---|---|---|
| Household size | 22% or lower | 23% | 50% | 51% | 75% | 76% | 100% | 101% | *133% |
| 1 | $276.10 | $276.11 | $627.50 | $627.51 | $941.25 | $941.26 | $1,255.00 | $1,255.01 | $1,669.15 |
| 2 | $374.88 | $374.89 | $852.00 | $852.01 | $1,278.00 | $1,278.01 | $1704.00 | $1704.01 | $2,266.32 |
| 3 | $473.44 | $473.45 | $1,076.00 | $1,076.01 | $1,614.00 | $1,614.01 | $2,152.00 | $2,152.01 | $2,862.16 |
| 4 | $572.00 | $572.01 | $1,300.00 | $1,300.01 | $1,950.00 | $1,950.01 | $2,600.00 | $2,600.01 | $3,458.00 |
| 5 | $670.63 | $670.64 | $1,524.17 | $1,524.18 | $2,286.25 | $2,286.26 | $3,048.33 | $3,048.34 | $4,054.28 |
| 6 | $769.27 | $769.28 | $1,748.34 | $1,748.35 | $2,622.50 | $2,622.51 | $3,496.67 | $3,496.68 | $4650.57 |
| 7 | $867.90 | $867.91 | $1,972.50 | $1,972.51 | $2,958.75 | $2,958.76 | $3,945.00 | $3,945.01 | $5,246.85 |
| 8 | $966.53 | $966.54 | $2,196.67 | $2,196.68 | $3,295.00 | $3,295.01 | $4,393.33 | $4,393.34 | $5,843.13 |
| Married Couple Both on HIP | $.50 each | $2.50 each | $5 each | $7.50 each | $10 each | ||||
| Note: Married couples who are both on HIP share one PAC payment which is split in half. | |||||||||
2024 CHIP Premiums by Federal Poverty Level
| Single CHIP Child in Family | $22 | $33 | $42 | $53 | ||||
|---|---|---|---|---|---|---|---|---|
| Household Size | 151% | $175 | 176% | 200% | 201% | 225% | 226% | 250% |
| 1 | $1,895.05 | $2,196.25 | $2,196.26 | $2,510.00 | $2,510.01 | $2,823.75 | $2,823.76 | $3,137.50 |
| 2 | $2,573.04 | $2,982.00 | $2,982.01 | $3,408.00 | $3,408.01 | $3,834.00 | $3,834.01 | $4,260.00 |
| 3 | $3,249.52 | $3,766.00 | $3,766.01 | $4,304.00 | $4,304.01 | $4,842.00 | $4,842.01 | $5,380.00 |
| 4 | $3,926.00 | $4,550.00 | $4,550.01 | $5,200.00 | $5,200.01 | $5,850.00 | $5,850.01 | $6,500.00 |
| 5 | $4,602.98 | $5,334.58 | $5,334.59 | $6,096.66 | $6,096.67 | $6,858.74 | $6,858.75 | $7,620.83 |
| 6 | $5,279.97 | $6,119.17 | $6,119.18 | $6,993.34 | $6,993.35 | $7867.51 | $7,867.52 | $8,741.68 |
| 7 | $5,956.95 | $6,903.75 | $6,903.76 | $7,890.00 | $7,890.01 | $8,876.25 | $8,876.26 | $9,862.50 |
| 8 | $6,633.93 | $7,688.33 | $7,688.34 | $8,786.66 | $8,786.67 | $9,884.99 | $9,885.00 | $10,983.33 |
| Multiple CHIP Children in Family | $33 | $50 | $53 | $70 | ||||
2024 CHIP Premiums by Federal Poverty Level
| Single MEDWorks Member in Home | $48 | $69 | $107 | $134 | $161 | $187 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Household Size | 150% | 175% | 176% | 200% | 201% | 250% | 251% | 300% | 301% | 350% | 351% or higher | |
| 1 | $1,882.50 | $2,196.25 | $2,196.26 | $2,510.00 | $2,510.01 | $3,137.50 | $3,137.51 | $3,765.00 | $3,765.01 | $4,392.50 | $4,392.51 | |
| Married Couple Both on MEDWorks | $65 | $93 | $145 | $182 | $218 | $254 | ||||||
| Note: Only the income of the individual counts when determining MEDWorks eligibility; spouse income is added back in to determine premium amounts only; there is no income limit for spouse income when the spouse is not on MEDWorks. | ||||||||||||
Stakeholder meeting
- Apr. 4, 2024 - Webinar recording
Timeline/Key dates
- February 2024: An updated insert was included in eligibility notices
- April/May: 60-day notification to members of cost share restart
- June: MCEs send notice alerting HIP members to watch for invoice arriving in early July
- July: Invoices will be sent in the first half of July for HIP, CHIP and MEDWorks for the month of August
- July: Co-pays active in HIP and CHIP
Outreach
Indiana is duplicating its redetermination outreach strategy and outreach materials currently being developed include a media campaign, social media toolkits, specific outreach materials for our partners to help share the message.
Sample member communication