Health Indiana Plan HIP Medicaid Guide – The Healthy Indiana Plan (HIP) is Indiana’s flagship Medicaid program designed specifically for low-income adults. If you’re searching for clear, up-to-date information on the Health Indiana Plan HIP Medicaid guide, you’re in the right place. This comprehensive resource explains eligibility, benefits, costs, enrollment steps, and 2026 updates so Hoosiers can make informed decisions about their health coverage.
HIP combines essential medical coverage with a consumer-driven POWER Account model that rewards personal responsibility. Whether you’re new to Medicaid or transitioning plans, this guide covers everything you need to know.
What Is the Healthy Indiana Plan (HIP)?
The Healthy Indiana Plan (HIP) is a state-sponsored health insurance program under Indiana Medicaid for qualified adults ages 19 to 64. It pays for medical costs while encouraging healthy behaviors through its unique POWER Account system.
Unlike traditional Medicaid, HIP operates as a managed care program with three primary health plans: Anthem, CareSource, and Managed Health Services (MHS Indiana). It replaced traditional Medicaid for most non-disabled adults and remains active under a federal Section 1115 waiver extended through December 31, 2030.
HIP helps thousands of Hoosiers access doctor visits, hospital care, prescriptions, and more — with the option for enhanced benefits when you participate in the POWER Account.
Who Qualifies for HIP Medicaid in Indiana?
You may qualify for HIP Medicaid if you meet these criteria:
- Age 19 to 64 (not on Medicare)
- Indiana resident
- Not disabled (or meet specific medically frail exceptions)
- Not eligible for other Medicaid categories
- Household income at or below 138% of the Federal Poverty Level (FPL)
No asset test applies, making HIP accessible for many working adults. Parents and caretakers must ensure dependent children have minimum essential coverage. Pregnant individuals may qualify for enhanced HIP Maternity benefits with no POWER contributions or copays during pregnancy and 12 months postpartum.
2026 Income Limits for Healthy Indiana Plan
Income limits for HIP are updated annually based on the Federal Poverty Level. Here are the 2026 qualifying income limits:
- Individuals: up to $22,026 per year
- Couples: up to $29,870.40 per year
- Family of four: up to $45,546 per year
These amounts equal approximately 138% FPL. Use the official HIP Eligibility and Contribution Calculator on the FSSA website for your exact situation.
HIP Plus vs. HIP Basic: Understanding Your Options
HIP offers two main coverage levels:
HIP Plus (preferred plan)
- Requires a small monthly POWER Account Contribution (PAC)
- Includes full benefits: vision, dental, and chiropractic services
- No copays except $8 for non-emergency ER visits (in most plans)
- Higher therapy limits (75 combined physical/speech/occupational visits per year)
HIP Basic
- Available for members at or below 100% FPL who do not make POWER contributions
- Core medical benefits only — no routine vision, dental, or chiropractic
- Lower therapy limits (60 combined visits per year)
- May include copays for services
Your monthly PAC is modest and tiered by income (from $1 to $20 per person, or split for couples). The first $2,500 in medical expenses comes from the POWER Account (state contributes the majority), after which your health plan covers the rest.
What Benefits Does the Healthy Indiana Plan Cover?
HIP provides comprehensive coverage through your chosen managed care plan. Core benefits (available in both Plus and Basic) include:
- Doctor and specialist office visits
- Hospital care (inpatient and outpatient)
- Emergency and urgent care services
- Laboratory tests and X-rays
- Prescription drugs (via Preferred Drug List)
- Behavioral health and substance use treatment
- Maternity and postpartum care
- Non-emergency medical transportation
- Durable medical equipment and home health services
HIP Plus adds:
- Routine dental care (exams, cleanings, fillings, extractions)
- Vision exams and eyeglasses
- Chiropractic care (up to 6 visits per year)
- Expanded therapy services
Pregnant members receive HIP Maternity with enhanced benefits and zero cost-sharing.
Exact details and provider networks vary by health plan — always check your member handbook.
How Much Does HIP Cost? POWER Account Contributions and Copays?
Most members pay only a small monthly POWER Account Contribution (typically $1–$20) to unlock HIP Plus. Lower-income members (≤100% FPL) who skip payments default to HIP Basic without losing core coverage.
Copays are minimal or nonexistent in HIP Plus. Always verify current cost-sharing with your health plan, as rules can adjust.
Step-by-Step: How to Apply for HIP Medicaid?
Applying for HIP is straightforward and can be done anytime during the year:
- Gather income, household, and residency information.
- Submit an application online at fssabenefits.in.gov, by mail, or in person at your local Division of Family Resources (DFR) office.
- Processing usually takes up to 45 business days.
- Choose your managed care plan (Anthem, CareSource, or MHS Indiana) on the application.
- If approved, you’ll receive an invoice for your first POWER Account contribution.
- Pay the invoice (or Fast Track payment) to start HIP Plus coverage immediately.
Coverage begins the month your payment is processed (HIP Plus) or the following month (HIP Basic).
Call 1-877-GET-HIP-9 (1-877-438-4479) for free help or to locate a certified navigator.
Important 2026 Updates to Indiana’s HIP Program
- MDwise exited the program on December 31, 2025. Current MDwise members were automatically reassigned or given the chance to choose Anthem, CareSource, or MHS Indiana. Existing treatments and prescriptions remain honored for at least 90 days.
- HIP waiver extended through 2030.
- Income limits and contribution tiers updated for 2026.
Frequently Asked Questions About Healthy Indiana Plan HIP Medicaid
Can I keep my doctor?
Yes, if they are in-network with your new plan. Verify before switching.
What if my income changes?
Report changes immediately through the benefits portal to avoid coverage gaps.
Is HIP the same as traditional Medicaid?
No — HIP uses a POWER Account and managed care for non-disabled adults 19–64.
Do I lose coverage if I miss a POWER payment?
Only if your income is above 100% FPL and you miss the deadline; lower-income members move to HIP Basic.
How to Get Help and Contact HIP Support?
- General HIP questions: 1-877-438-4479
- Anthem Member Services: 866-408-6131
- CareSource Member Services: 844-607-2829
- MHS Indiana: 877-647-4848
- Official website: in.gov/fssa/hip
- Apply or check status: fssabenefits.in.gov
Don’t wait — apply today or re-evaluate your coverage if your situation has changed. The Healthy Indiana Plan makes quality health insurance affordable and accessible for eligible Hoosiers.
For the most current details, always visit the official Indiana Family and Social Services Administration (FSSA) HIP website or contact your chosen health plan directly. Your health coverage is just a few steps away.