The Hoosier Healthwise program is designed for low income families, pregnant women, and children. Those who are enrolled have access to medical care such as doctor’s office visits prescription medications, dental care, hospital services, family planning, and surgery for minimal fees or no cost at all. Uninsured Indiana children up to age 19 are eligible, as well as pregnant women, and the parents or guardians of children under the age of 18.
Hoosier Healthwise provides coverage for both Medicaid-eligible children and families and those with higher incomes eligible for the Children’s Health Insurance Program (CHIP). CHIP coverage is offered to children under age 19 for a monthly premium, referred to as Hoosier Healthwsie Package C. Four different benefit packages are available through Hoosier Healthwise, and placement within these coverage levels depends on your income and other eligibility criteria. The state will choose the benefit set that corresponds with your eligibility.
Hoosier Healthwise Benefit Packages
Package A: Standard Plan
This plan offers full Medicaid coverage on all types of medical services for children, pregnant women, and families. Members do not have to pay a premium, though certain services such as prescriptions, transportation, and emergency care may be accompanied by a $0.50 to $3.00 copay. Hoosier Healthwise Package A is open to children with income at or below 150% of FPL, and parents with a maximum income of 24% FPL.
Package B: Pregnancy Coverage
Specific to maternity care exclusively, pregnant women using Package B are not required to pay a premium. Prescriptions, emergency care, and transportation may charge a copay of $0.50 to $3.00 for the service, but otherwise the program covers all maternity and medical care throughout a woman’s pregnancy in full. This program is open to women with income up to 200% of FPL, which is $2522 per month for a family of 2.
Package C: CHIP
A full-benefit source of medical coverage for children only, this package charges a monthly premium due to the higher income of the applicant. Some services will require patients to provide a copay, while others are included in coverage for no cost. Dental care, vision, hospital services, prescriptions, and other medical care is covered. Applicants may not have any other source of coverage in order to qualify for Package C, and have been uninsured for at least 6 months. Children with income between 150 and 250% of FPL, or a maximum of $2,328 per month for an individual.
Package E: Emergency Care Only
Covering emergency services only for immigrants who do not meet the residency requirements for full Medicaid coverage, this package provides an outlet for serious medical needs. Those who are Indiana residents and have not yet become legal residents can seek emergency care, including emergency labor and delivery.
Benefits covered by Hoosier Healthwise include preventive care, such as well-baby and well-child exams, immunizations, and regular checkups, in addition to many other medical services. Package A and C are the only full-benefit options for Hoosier Healthwise, and both cover nearly all the same services, though Package C may be more limited or have a copayment attached. To make sure certain specialized services that are not listed in the general benefit outline are covered, call your doctor or health plan beforehand.
You may need a referral from your doctor prior to receiving some types of care. Dental care, foot care, chiropractic, vision services (except surgery), transportation, mental health, and substance abuse services do not require a referral. If you are in need of a particular service or wish to see a specialist or other type of health care professional, it is necessary to first consult your doctor. Some types of care also ask for prior authorization from your doctor before the service can be performed.
Hoosier Healthwise coverage is available through three managed care organizations, one of which you will select to receive all of your health care services. Through your health plan’s providers, you will be able to access all of the care you need, select a primary care doctor, and use many other services within the network. Your doctor is assigned to one Hoosier Healthwise health plan, therefore it is important to select both a plan and a doctor that works well. The majority of medical services will be offered through your provider network alone, which makes it especially important to know which doctors are included and how many there are available. Managed care options include:
- Managed Health Services (MHS)
Contact Hoosier Healthwise
www.mdwise.org (317) 630-2831 or 800-356-1204
Managed Health Services (MHS)
1. Indiana Medicaid. “Hoosier Healthwise”. http://member.indianamedicaid.com/programs–benefits/medicaid-programs/hoosier-healthwise.aspx.