The public health insurance program designed for uninsured Indiana adults, Healthy Indiana Plan is an outlet for affordable coverage. Established in 2007, HIP has since provided health insurance to Hoosiers between the ages of 19 and 64. Many parents of children in the Hoosier Healthwise program are typically eligible for HIP, as the income limit is 200 percent of the Federal Poverty Level (FPL). HIP offers these adults the opportunity to enjoy life by staying healthy and removing the worry that comes with the high cost of medical care.
The program covers a broad spectrum of health services, including physician and hospital services, prescription medications, and disease management. While there are fees for the program and certain services, they are structured around what your income will allow, and will never exceed a specific amount. When enrolled in HIP, you also have access to an account similar to an HSA with an allotted dollar amount to help pay for healthcare expenses. HIP provides adults with a public health program that extends over the Medicaid limits for adults in the state plan for a small fee.
To qualify for the Healthy Indiana Plan, adults must be residents of Indiana between ages 19 and 64, with earnings that do not exceed 200 percent of the poverty guideline. Individuals must also have been uninsured for at least the past six months, and not have access to insurance through an employer. Additionally, an individual applying may not be eligible for Medicaid or Medicare, and be a legal resident of the United States. Income levels for various family sizes are shown on the chart below. If your gross adjusted income is at this level or lower and the other criteria applies, you are likely eligible for HIP.
The Healthy Indiana Program provides coverage, in full and for a small copay, for medical care similar to a Medicaid plan. Most every service is available without a copay, with the exception of emergency care, which will never exceed $25 per visits. Emergency visit copays range based on a member’s income, typically from $3 – $25. Benefits through HIP include the following services:
- Preventive care
- Family planning
- Doctor’s office visits
- Diagnostic exams
- Emergency care
- Home health care
- Inpatient hospital services
- Outpatient hospital services
- Hospice care
- Disease management
- Case management
- Mental health care
- Substance abuse treatment
HIP Plan Details
Individual contributions for HIP are on a sliding scale, which is determined by your total household income. Parents and caretaker relatives in the highest income bracket (150 – 200% FPL) contribute 4.5%, while childless adults must pay 5%.
- o – 100% FPL: 2%
- 100 – 125% FPL: 3%
- 125 – 150% FPL: 4%
- 150 – 200% FPL: 4.5 – 5%
POWER Accounts provide HIP members with a bonus reserve of funds for medical care, valued at $1,100 each. These accounts are funded by the state, as well as the plan member on a sliding scale based on their ability to pay. No participant will pay more than 5 percent of his or her total family income on the plan. When your annual medical costs exceed the amount in the POWER Account, a basic commercial benefits package is provided.
POWER Accounts offer participants a financial reward for maintaining their health and therefore seeking a minimal number of medical services. If successful in staying healthy, plan members can find out how much their care will cost in advance, which allows them to plan according to their budget and remaining account funds. The account aims to give HIP members the reward of saving money by leading a healthy lifestyle and seeking preventive care. If all age and gender appropriate preventive services have been sought, all remaining funds in your POWER Account will rollover to offset the next year’s contribution. However, if all preventive services are not completed, only the member’s contribution, not the state’s, will rollover.
When you enroll in HIP, you must select a managed care organization, like any other public health program in Indiana. Through your health plan, you will also choose a primary care doctor to guide you in your medical care, all of which is performed within your health plan’s provider network. Each health plan offers a POWER Account option and different payment methods for contributions, as well as their own policies on emergency room copays. The three health plans offered for HIP are the same an Hoosier Healthwise, and include:
- Managed Health Services (MHS)
View a basic HIP Plan Summary.
1. FSSA. “HIP”. http://www.in.gov/fssa/hip/index.htm.