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What Is Covered by Indiana Medicaid?

This is a general description of the benefits available through Indiana Medicaid (other than the Healthy Indiana Plan) based upon a member's eligibility.

  • If you would like more information about covered services under PEPW (also known as the Presumptive Eligibility for Pregnant Women Program), please go to the Presumptive Eligibility webpage.
  • If you would like more information about covered services under the Healthy Indiana Plan (HIP), please go to the Healthy Indiana Plan webpage.

Please remember that your health plan may offer additional services.

Benefit

Package A

(for Hoosier Healthwise, Hoosier Care Connect, and Traditional Medicaid)

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 Transportation Yes Yes

Non- Emergency Transportation

Yes

 

No

Family Planning Services

Yes

Yes

Routine Foot Care

Yes

No

Surgical Foot Care Yes Yes

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 doctor or call your health plan.  Some specialized services require that you see or call your doctor before you receive them. Some services will require your doctor 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.

Copays

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

Traditional Medicaid

Hoosier Care Connect

Hoosier Healthwise (Package C-only)

Non-Emergency Transportation

$0.50-$3.00 (based on service)

$1 (each way)

Non-covered

Emergency Transportation

No copay

No copay

$10.00

Pharmacy (Generic)

$3.00 (per prescription)

$3.00 (per prescription)

$3.00 (per prescription)

Pharmacy (Brand Name)

$3.00 (per prescription)

$3.00 (per prescription)

$10.00 (per prescription)

Non-emergency usage of the ER

No copay

$3.00

No copay