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.

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.

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