Healthy Indiana Plan coverage is available to Indiana residents ages 19 to 64 whose household income is at or below 138 percent of the federal poverty level, and it comes in two tiers: HIP Plus, which includes vision, dental, chiropractic, and a full prescription drug benefit for members who make a small monthly payment, and HIP Basic, a scaled-back version for members below the poverty line who don’t pay. For 2026, the income cutoff is $22,026 for an individual and $45,546 for a family of four.1FSSA: HIP – Healthy Indiana Plan. Healthy Indiana Plan
Who Qualifies
HIP is for Indiana adults between 19 and 64 who aren’t already eligible for Medicare or traditional Medicaid. Eligibility is based on household income relative to the federal poverty level. The 2026 thresholds are $22,026 for one person, $29,870.40 for a couple, and $45,546 for a family of four.1FSSA: HIP – Healthy Indiana Plan. Healthy Indiana Plan
Because HIP runs under a Medicaid waiver, there is no annual open enrollment window. You can apply any time of year online, by mail, or in person at a local Division of Family Resources office. Once the state has everything it needs, applications are processed within 45 business days.2FSSA. How to Enroll in HIP
HIP Plus and HIP Basic: What’s Different
The plan tier you end up with depends almost entirely on whether you make your monthly contribution.
HIP Plus is the better coverage. Members who pay their monthly POWER account amount get comprehensive medical coverage along with vision, dental, and chiropractic benefits and a full prescription drug benefit. Beyond those monthly payments, HIP Plus members pay nothing at the doctor or the pharmacy. The one exception is an $8 charge for non-emergency use of the emergency room.3FSSA. HIP POWER Accounts
HIP Basic is the fallback for members below the federal poverty level who don’t make their POWER account contribution. It covers core medical services and maternity care, but drops vision, dental, and chiropractic. The drug benefit is more limited, and members owe a copay every time they see a doctor, go to the hospital, or fill a prescription. Preventive care and family planning visits are excluded from copays.4FSSA. HIP Plan Comparison Chart
The gap is real. A HIP Plus member who needs glasses or a filling is covered. A HIP Basic member pays out of pocket. For most people, the monthly contribution is less than the cost of a single dental visit.
POWER Accounts and What You Pay Each Month
Every HIP member has a POWER account, a special savings account the state uses to pay the first $2,500 of annual healthcare costs. The state funds most of it. You contribute a fixed monthly amount between $1 and $20, scaled to your income.3FSSA. HIP POWER Accounts
For a single individual, the monthly contribution works out as:5FSSA. Am I Eligible
- Below 22% FPL: $1
- 23–50% FPL: $5
- 51–75% FPL: $10
- 76–100% FPL: $15
- 101–138% FPL: $20
Spouses who enroll together each pay half the single rate. Tobacco users can face a surcharge of up to 50 percent on their monthly amount, though the surcharge is waived during the first year of enrollment so members can use HIP’s tobacco cessation benefits.3FSSA. HIP POWER Accounts
Once annual healthcare costs exceed the $2,500 POWER account balance, additional covered services are fully paid by the plan for HIP Plus members. HIP Basic members can still owe copays past that point. Each calendar year the account resets to $2,500, and if your actual costs stayed below that, unused contributions roll over to reduce next year’s payments. Completing preventive services doubles the rollover reduction.3FSSA. HIP POWER Accounts
What HIP Covers
Both tiers cover a wide range of medical services: doctor visits, hospital stays, emergency care, maternity and newborn care, mental health and substance use treatment, lab work, rehabilitative services, and preventive care such as screenings and immunizations. Preventive services carry no copay under either plan.4FSSA. HIP Plan Comparison Chart
HIP Plus adds vision, dental, and chiropractic care, plus a broader drug benefit and higher service limits. HIP Basic sticks to the core medical package, with lower service limits and a restricted drug formulary.
Prescription Drugs
HIP covers prescription medications and certain over-the-counter drugs when they’re prescribed by an Indiana Medicaid-enrolled provider. The plan uses a Preferred Drug List that’s updated four times a year. Generic and preferred drugs must be used when available unless your doctor has a medical reason to prescribe something else.6MHS Indiana. Healthy Indiana Plan Pharmacy
HIP Plus members pay nothing at the pharmacy. HIP Basic members pay a copay for each prescription. Some medications require prior authorization, particularly non-preferred drugs, higher-than-usual quantities, or situations where the plan wants a lower-cost alternative tried first. Specialty medications must be filled at a designated specialty pharmacy.6MHS Indiana. Healthy Indiana Plan Pharmacy
If You Stop Paying Your POWER Account
The consequence depends on your income. Members below the federal poverty level who stop paying move from HIP Plus to HIP Basic. They lose vision, dental, and chiropractic benefits and start paying copays for services that were previously free. Members above the poverty level who stop paying are disenrolled from the program entirely.3FSSA. HIP POWER Accounts
Indiana’s waiver originally included a six-month lockout before a disenrolled member above the poverty line could re-enroll. That provision is currently inactive and cannot be enforced unless authorized by the U.S. Supreme Court.7MACPAC. Indiana Waiver – Healthy Indiana Plan 2.0 Even so, disenrollment creates a coverage gap that can get expensive if something comes up before you re-enroll.
Appealing a Denied Claim
When your managed care organization denies a claim or makes a coverage decision you disagree with, you have 60 calendar days from the date on the denial letter to file an appeal. Appeals can go in by phone, mail, fax, or email.8MHS Indiana. Filing an Appeal
The plan must acknowledge your appeal within three business days and resolve it within 30 calendar days. If waiting that long could cause serious harm, you can request expedited review, which must be completed within 48 hours.8MHS Indiana. Filing an Appeal
If the internal appeal doesn’t go your way, you can request external independent review. Under federal rules, the request must be filed within four months of the final internal denial.9eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes The external reviewer has no connection to your plan and issues a binding decision. Keep copies of denial letters, medical records, and correspondence with the plan at every stage.
If Your Income Goes Up or You Turn 65
Members whose income rises above 138 percent of the federal poverty level lose HIP eligibility. If you don’t have employer coverage waiting, you can apply through the federal marketplace at healthcare.gov. Losing Medicaid or HIP coverage triggers a special enrollment period that lasts 60 days.10HealthCare.gov. Get or Change Coverage Outside of Open Enrollment
HIP only covers adults up to age 64, so members approaching 65 need to transition to Medicare. Delaying Medicare enrollment without qualifying coverage from a current employer can trigger a late enrollment penalty that increases your Part B premium permanently.11Medicare.gov. Avoid Late Enrollment Penalties Apply during your initial Medicare enrollment period to avoid gaps.