Healthy Indiana Plan
The Healthy Indiana Plan (or HIP 2.0) is an affordable health insurance program from the State of Indiana for uninsured adult Hoosiers. The Healthy Indiana Plan pays for medical expenses and provides incentives for members to be more health conscious.
What are the eligibility guidelines?
The Healthy Indiana Plan (HIP) covers Indiana residents between the ages of 19 and 64 whose family incomes are less than approximately 138% of the federal poverty level and who aren’t eligible for Medicare or another Medicaid category.
To find out if you are financially eligible for HIP, go to http://www.in.gov/fssa/hip/2352.htm to access a calculator that estimates household income eligibility.
What are the different HIP plans?
The Healthy Indiana Plan has three ways for members to get coverage.
- HIP Plus
The initial plan selection is HIP Plus which offers the best value for members.In the HIP program, the first $2,500 of medical expenses for covered benefits are paid with a special savings account called a Personal Wellness and Responsibility (POWER) account.The state will pay most of this amount, but members will also be responsible for paying a small portion of their health care costs.The member’s portion is an affordable, monthly contribution to their POWER account based on their income.
There is no copayment required every time a member seeks health care such as visits to a doctor or filling a prescription with one exception:using the emergency room where there is no true emergency.The HIP Plus program provides health care benefits such as doctor, prescription, or hospital stays and includes vision and dental services for a low, predictable monthly cost.
- HIP Basic
HIP Basic is the fallback option for members with household income less than or equal to 100% of federal poverty level who don’t make their POWER account contributions.HIP Basic pays for essential health care services but not vision or dental services.The member is required to pay a copayment each time he or she receives a health care service, such as going to the doctor, filling a prescription, or staying in the hospital.
HIP Basic can be much more expensive than HIP Plus.Copayments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay.
- HIP Link
HIP Link is an option for eligible members who work and have access to their employer’s health plan.HIP Link members will also have a POWER account and contribute to their coverage like other HIP members.But with Link, the POWER account can be used to pay the insurance premiums and out-of-pocket medical expenses connected with the member’s employer-sponsored plan.
The employer must choose to participate in HIP Link and be registered with the state.Employers also must contribute 50% of the member’s premium.Members can receive counseling from a Navigator on whether their employer plan would be best suited for them.To schedule an appointment with a Columbus Regional Health Navigator call 800-699-1521 or a list of Indiana navigators can be found at http://www.in.gov/healthcarereform/2468.htm.
How to Apply
Applications are available online at http://www.in.gov/fssa/hip/index.htm or by mail, or can be picked up at any Division of Family Resources (DFR) office.Call 1-877-GET-HIP-9 to learn more about the application process or find your local DFR office at http://www.in.gov/fssa/hip/index.htm.
How do I find a provider?Can I keep my doctor?
Anthem Blue Cross and Blue Shield, MDwise, and Managed Health Services (MHS) are the three Managed Care Entities (MCE) selected by the State of Indiana to administer the Healthy Indiana Plan (HIP).
Enrolled HIP program members should call their assigned health plan (Anthem, MDwise, or MHS) or go online to their website to research which providers are in that health plan’s network.Members can also call 1-877-GET-HIP-9 and ask.
Individuals who are just joining HIP and want to make sure they choose a health plan that includes their doctor can call 1-877-GET HIP-9 to discuss their options.
- How do members pay for care?
HIP members use their POWER account to pay for the first $2,500 of covered services in any coverage year.Each member receives a POWER account debit card to use at their doctor’s office, pharmacy, hospital, or anywhere else they make a purchase that’s covered under HIP.The card is also the member’s ID card.The POWER account debit card cannot be used to pay for copayments, such as with the HIP Basic program.Members must make copayments out of pocket.
If annual expenses are more than $2,500, the first $2,500 is covered by the member’s POWER account, and expenses for additional health services over $2,500 are fully covered at no additional cost to the member.
- How does the POWER account work?
In the HIP program, the first $2500 of covered medical expenses is paid for out of a special savings account called a Personal Wellness and Responsibility (POWER) account.The State will pay most of this amount, but each month, members are also required to make a small contribution.HIP members will have the opportunity to choose a health plan (Anthem, MDwise, or MHS) that will manage and track the POWER account and collect the member’s portion each month.
Members who manage their account well and get preventive care can reduce their future costs.In HIP 2.0, if a member’s annual health care expenses are less than $2,500 per year they may rollover their remaining contributions to reduce their monthly payment for the next year.Members can also double their reduction if they complete preventive services.
- What are the contribution amounts?
Monthly POWER contributions are determined by income and family size and are approximately 2% of annual family income.
As long as members make their required monthly POWER account contributions, they will have no other costs.Each month, the member’s health plan will send a monthly statement showing how much is left in their POWER account.
- Why is it important to make POWER account contributions?
POWER account contributions are a key part of the Healthy Indiana Plan.Members who make POWER account contributions on-time each month participate in HIP Plus where they have better health benefits and predictable costs.
If members choose not to pay their POWER contributions, they will be removed from the HIP Plus program and will not be allowed to re-enroll for 6 months.Members will be moved to the HIP Basic plan.HIP Basic does not pay for dental and vision and members will be required to make copayments each time they go to the doctor or hospital or have a prescription filled.
Gateway to Work
Gateway to Work is a new feature of the Healthy Indiana Plan that helps to connect HIP members to Indiana’s workforce training programs, work search resources and potential employers.HIP members who are unemployed or working less than 20 hours a week will be referred to available employment, work search and job training programs that will assist them in securing new or potentially better employment.
Gateway to Work is a voluntary program.HIP members will be notified if they have been referred to the program.Eligibility for HIP coverage will not be affected if a member chooses not to participate.
Those interested in participating in Gateway to Work can call 1-800-403-0864 and select Option 1 for the health coverage menu and then Option 6 for Gateway to Work.
Written by kprather on Sunday December 6, 2015