Yes, HIP (the Healthy Indiana Plan) is Indiana’s version of Medicaid for adults. Rather than running a traditional Medicaid expansion, Indiana received federal approval to operate Medicaid through a customized program that includes personal health accounts and monthly contributions from members. If you live in Indiana and qualify for adult Medicaid, HIP is the program you’ll enroll in.
How HIP Works as Medicaid
HIP operates under what’s called a federal Medicaid waiver, meaning Indiana got permission from the Centers for Medicare and Medicaid Services to run its Medicaid program differently from most states. The program covers uninsured adults with family incomes up to 138% of the federal poverty level (with a 5% income disregard that effectively raises the ceiling). For a single person, that means a monthly income up to about $1,836. For a family of four, the limit is roughly $3,796.
HIP uses private insurance companies to deliver care. When you enroll, you choose one of three managed care plans: Anthem, CareSource, or Managed Health Services (MHS). These plans manage your benefits, provide a network of doctors and hospitals, and handle claims, similar to how employer-sponsored insurance works.
HIP Plus vs. HIP Basic
HIP has two tiers of coverage, and the one you get depends on your income and whether you make monthly contributions to a personal health account called a POWER account.
HIP Plus is the more comprehensive option. It includes vision, dental, and chiropractic services. Members pay no copays when visiting a doctor, going to the hospital, or filling prescriptions. You can also get 90-day prescription refills and order medications by mail.
HIP Basic covers all federally required essential health benefits but does not include vision, dental, or chiropractic care. Members on HIP Basic pay copays ranging from $4 to $8 per doctor visit or prescription, and up to $75 per hospital stay. Prescription refills are limited to a 30-day supply with no mail-order option.
Members with incomes above 100% of the federal poverty level are required to make POWER account contributions to stay enrolled in HIP Plus. Members below that threshold can choose to contribute and receive HIP Plus benefits, or skip contributions and receive HIP Basic instead.
POWER Account Contributions
The POWER account is a personal health account, somewhat like a health savings account. Your monthly contribution is set at roughly 2% of your family income, with a minimum of $1 per month. For a single person earning about $973 a month (100% of the poverty level), the contribution would be around $19.45. Someone earning less, say $486 a month, would pay closer to $10.
If you use tobacco, your contribution increases by about 50%. For example, a single person in the $15 per month contribution bracket would pay $22.50 instead. Indiana previously locked members out of coverage for not paying their POWER account contributions, but that policy was removed in 2021. Non-payment no longer results in losing coverage, though it may affect whether you receive HIP Plus or HIP Basic benefits.
Coverage for Pregnant Members
Pregnant members get enhanced benefits under HIP regardless of which tier they’re in. Once you notify your plan of the pregnancy, all cost-sharing is waived starting the first day of the following month. That means no monthly POWER account contributions, no copays for doctor visits or prescriptions, and no emergency room copays. These enhanced benefits continue throughout the pregnancy and for 12 months after the pregnancy ends.
The Medically Frail Category
Members with serious health conditions may qualify for a designation called “medically frail,” which provides access to a broader set of benefits through the HIP State Plan. Qualifying conditions include cancer, HIV/AIDS, cystic fibrosis, end-stage renal disease, muscular dystrophy, diabetes with serious complications (such as kidney damage or retinopathy), and paraplegia or quadriplegia, among others. Mental health conditions also qualify, including major depression, schizophrenia, bipolar disorder, PTSD, and substance use disorders. People who need help with daily activities like bathing, dressing, eating, or walking may also be classified as medically frail. Having one of these conditions doesn’t automatically guarantee the designation; the severity of your condition is also evaluated.
Who Is Eligible
HIP covers two main groups of adults: parents or caretakers of children on Medicaid or CHIP who don’t themselves qualify for traditional Medicaid, and adults without dependent children. You must be an Indiana resident and meet income requirements. Here are the monthly income limits by household size:
- 1 person: up to $1,836 for HIP Plus, up to $1,330 for HIP Basic only
- 2 people: up to $2,489 for HIP Plus, up to $1,804 for HIP Basic only
- 3 people: up to $3,142 for HIP Plus, up to $2,277 for HIP Basic only
- 4 people: up to $3,796 for HIP Plus, up to $2,750 for HIP Basic only
Children, pregnant women already eligible for traditional Medicaid, and certain other groups are covered through a separate Indiana program called Hoosier Healthwise, though it’s managed under the same umbrella.
How to Apply
You can apply for HIP online, by mail, or in person at a local Division of Family Resources office. The application process is the same as applying for Medicaid in Indiana. For help with the application or to find your nearest office, call 1-877-GET-HIP-9 (1-877-438-4479). Indiana is also planning to introduce new work requirements for HIP members starting January 1, 2027, though details on enforcement are still being finalized.