Overview
This is a general description of the benefits available through Indiana Medicaid (other than the Healthy Indiana Plan) based upon a member's eligibility.
- If you would like more information about covered services under PEPW (also known as the Presumptive Eligibility for Pregnant Women Program), please go to the Presumptive Eligibility webpage.
- If you would like more information about covered services under the Healthy Indiana Plan (HIP), please go to the Healthy Indiana Plan webpage.
Please remember that your health plan may offer additional services.
|
Benefit |
Package A (for Hoosier Healthwise, Hoosier Care Connect, and Traditional Medicaid) |
Package C (For Hoosier Healthwise) |
|
Hospital Care |
Yes |
Yes |
|
Doctor Visits |
Yes |
Yes |
|
Wellness Visit |
Yes |
Yes |
|
Well-child Visits |
Yes |
Yes |
|
Clinic Services |
Yes |
Yes |
|
Prescription Drugs |
Yes |
Yes |
|
Over-the-Counter Drugs |
Yes |
Yes |
|
Lab and X-ray Services |
Yes |
Yes |
|
Mental Health Care |
Yes |
Yes |
|
Substance Abuse Services |
Yes |
Yes |
|
Medical Supplies and Equipment |
Yes |
Yes |
|
Home Health Care |
Yes |
Yes |
|
Nursing Facility Services |
Yes |
No |
|
Dental Care |
Yes |
Yes |
|
Vision Care |
Yes |
Yes |
|
Physical, Occupational, and Speech Therapy |
Yes |
Yes |
|
Hospice Care |
Yes |
No |
| Emergency Transportation | Yes | Yes |
|
Non- Emergency Transportation |
Yes |
No |
|
Family Planning Services |
Yes |
Yes |
|
Routine Foot Care |
Yes |
No |
| Surgical Foot Care | Yes | Yes |
|
Chiropractic Services |
Yes |
Yes |
Note: There are some benefit limits for Hoosier Healthwise Package C members.
If you need to know if a specific procedure or service is covered, ask your doctor or call your health plan. Some specialized services require that you see or call your doctor before you receive them. Some services will require your doctor to request a prior authorization (PA) before the service can be delivered. It is up to the provider to request the PA on your behalf.
Copays
For some services, you will have a copay in order to receive the services. The table below summarizes these services and copay amounts, by program.
|
Traditional Medicaid |
Hoosier Care Connect |
Hoosier Healthwise (Package C-only) |
|
|
Non-Emergency Transportation |
$0.50-$3.00 (based on service) |
$1 (each way) |
Non-covered |
|
Emergency Transportation |
No copay |
No copay |
$10.00 |
|
Pharmacy (Generic) |
$3.00 (per prescription) |
$3.00 (per prescription) |
$3.00 (per prescription) |
|
Pharmacy (Brand Name) |
$3.00 (per prescription) |
$3.00 (per prescription) |
$10.00 (per prescription) |
|
Non-emergency usage of the ER |
No copay |
$3.00 |
No copay |