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Managed Care Health Plans

If you are a member of the Healthy Indiana Plan, Hoosier Healthwise, or Hoosier Care Connect, you will need to choose a health plan, also known as a managed care entity (MCE). A health plan, or MCE, is a health insurance company.

Choosing the Right Health Plan for You

Choosing a health plan is a personal choice. We are confident each health plan will meet your needs. Here are some things to think about when choosing a plan:

Provider Networks: Each health plan includes a group of health care providers (doctors, specialists, home health care providers, pharmacies, therapists, and more). This is called a "network" of providers. For most health care services, you must use the health care providers who are in your health plan's network.

Primary or Specialty Medical Providers: When you are enrolled in a managed care program, you will choose a doctor to be your Primary Medical Provider, often called a PMP. Your PMP will work with you and be your primary contact when making medical decisions. Your PMP will also make referrals and help you with prior authorizations for services that are not always covered by Medicaid.

If you already have a doctor or other primary or specialty medical provider, when choosing your health plan, you will want to make sure that provider is part of the health plan's network. If you do not have a current provider, your health plan will work with you to find one. To find out if your doctor or other primary medical provider is part of the health plan's network, you should call the help line listed below.

Locations: You may want to make sure that the plan you choose has providers that are conveniently located for you. This may mean they are near your work or your child's school, or they may be on a bus line.

Special Programs: Each health plan has various educational programs and enhanced services. You may want to select the health plan that offers special disease management for a chronic condition or an educational program that applies to you. Plan summaries for each program are listed below.

Health Plan Choices

Healthy Indiana Plan

  • Anthem
  • CareSource
  • MDwise
  • Managed Health Services

Health plan summary

Health plan summary (Spanish)

Helpline: 877-GET-HIP9 (877-438-4479)

Hoosier Healthwise

  • Anthem
  • CareSource
  • MDwise
  • Managed Health Services

Health plan summary

Health plan summary (Spanish)

Helpline: 800-889-9949

Hoosier Care Connect

  • Anthem
  • Managed Health Services
  • UnitedHealthcare

Health plan summary

Health plan summary (Spanish)

Helpline: 866-963-7383

Open Enrollment Period

With the Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect programs, you must remain enrolled in your chosen health plan for a one-year period so long as you remain eligible. This gives your health plan an opportunity to improve the care it provides. You may only change your health plan during open enrollment periods or if your change reason falls under the one of the "just cause" reasons outlined below:

Open Enrollment Periods:

  • Anytime during your first 90 days with a new health plan.
  • Annually during your open enrollment period.

"Just Cause":

Anytime you file a grievance with your health plan and the state finds that you have a good reason to change health plans you may change health plans based on "just cause." This is when you have concerns over the quality of care being provided by your health plan. You must first contact your health plan so they can attempt to resolve your concern. If you are still unhappy after contacting your health plan, you can call the helpline of the program in which the member is enrolled, and they will review your request.

The following are the "just cause" reasons for switching health plans during the year for the Hoosier Healthwise and Hoosier Care Connect programs:

  • Receiving poor quality of care
  • Failure of the health plan to provide covered services
  • Failure of the health plan to comply with established standards of medical care administration
  • Significant language or cultural barriers
  • Corrective action levied against the health plan by the Family and Social Services Administration (FSSA)
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence
  • A determination that another health plan's formulary is more consistent with a new member's existing health care needs
  • Lack of access to medically necessary services covered under the health plan's contract with the state
  • A service is not covered by the health plan for moral or religious objections
  • Related services are required to be performed at the same time and not all related services are available within the health plan's network, and the member's provider determines that receiving the services separately will subject the member to unnecessary risk
  • Lack of access to providers experienced in dealing with the member's healthcare needs
  • The member's primary healthcare provider disenrolls from the member's current health plan and re-enrolls with another health plan
  • Other circumstances determined by FSSA or its designee to constitute poor quality of health care coverage

The following are the "just cause" reasons for switching health plans during the year for the Healthy Indiana Plan (HIP) program:

  • Receiving poor quality care
  • Failure of the health plan to provide covered services
  • Failure of the health plan to comply with established standards of medical care administration
  • Lack of access to providers experienced in dealing with the member's health care needs
  • Significant language or cultural barriers
  • Corrective action levied against the health plan by the FSSA
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence
  • A determination that another health plan's formulary is more consistent with a new member's existing health care needs
  • Other circumstances determined by the FSSA or its designee to constitute poor quality of health care coverage

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