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What is Covered by Indiana Medicaid

Overview

This is a general description of the benefits available to members with Package A (Standard Plan or Full Medicaid) and Package C.

  • Package A is a full-service plan for children and pregnant individuals. Members do not have any cost-sharing obligations.
  • Package C is a full-service plan for children enrolled in Children's Health Insurance Program (CHIP). Members have a small monthly premium payment and co-pay for some services based on family income.

Benefit

Package A  (Standard Plan or Full Medicaid)

(for Hoosier Healthwise, Hoosier Care Connect, Traditional Medicaid, and Indiana PathWays for Aging)

Package C

(For Hoosier Healthwise)

Hospital Care

Yes

Yes

Doctor Visits

Yes

Yes

Wellness Visit

Yes

Yes

Well-child Visits

Yes

Yes

Clinic Services

Yes

Yes

Prescription Drugs

Yes

Yes

Over-the-Counter Drugs

Yes

Yes

Lab and X-ray Services

Yes

Yes

Mental Health Care

Yes

Yes

Substance Abuse Services

Yes

Yes

Medical Supplies and Equipment

Yes

Yes

Home Health Care

Yes

Yes

Nursing Facility Services

Yes

No

Dental Care

Yes

Yes

Vision Care

Yes

Yes

Physical, Occupational, and Speech Therapy

Yes

Yes

Hospice Care

Yes

No

Emergency TransportationYesYes

Non- Emergency Transportation

Yes

No

Family Planning Services

Yes

Yes

Routine Foot Care

Yes

No

Surgical Foot CareYesYes

Chiropractic Services

Yes

Yes

Note: There are some benefit limits for Hoosier Healthwise Package C members.

If you need to know if a specific procedure or service is covered, ask your Primary Medical Provider (PMP) or call your health plan. Some specialized services require that you see or call your PMP before you receive them. Some services will require your PMP to request a prior authorization (PA) before the service can be delivered. It is up to the provider to request the PA on your behalf.

  • If you would like more information about covered services under the Presumptive Eligibility for Pregnant Women Programs (PEPW), please go to the Presumptive Eligibility webpage.
  • If you would like more information about covered services under the Healthy Indiana Plan (HIP), please see the HIP Health Plan Summary.

Copays

For some services, you will have a copay in order to receive the services. The table below summarizes these services and copay amounts.

Hoosier Healthwise (Package C Only) 

Emergency Transportation

$10.00

Pharmacy (Generic)

$3.00 (per prescription)

Pharmacy (Brand Name)

$10.00 (per prescription)

Note: HIP also requires copayments and POWER accounts. Please see HIP Basic Copayment Amounts page and POWER Accounts page for more information.

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