What is Covered by Indiana Medicaid
Overview
This is a general description of the benefits available to members with Package A and Package C.
- Package A is a full-service plan for children and pregnant individuals. Members do not have any cost-sharing obligations.
- Package C is a full-service plan for children enrolled in Children's Health Insurance Program (CHIP). Members have a small monthly premium payment and co-pay for some services based on family income.
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 Primary Medical Provider (PMP) or call your health plan. Some specialized services require that you see or call your PMP before you receive them. Some services will require your PMP 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.
- If you would like more information about covered services under the Presumptive Eligibility for Pregnant Women Programs (PEPW), please go to the Presumptive Eligibility webpage.
- If you would like more information about covered services under the Healthy Indiana Plan (HIP), please see the HIP Health Plan Summary.
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-$2.00 (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 |