Here’s the latest on Indiana's Healthy Indiana Plan (HIP) dental coverage for children and adults, with differences by HIP dental plan type. If something is unclear or if you have a specific county or provider, I can check more precisely.
Key Terminology
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HIP Plus – more comprehensive plan, includes dental, vision, etc.
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HIP Basic – more limited plan; fewer extras, especially for adults.
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HIP State Plan Plus / Basic – for individuals with more complex needs; enhanced benefits.
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HIP Maternity – for pregnant members; tends to have better coverage.
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EPSDT – Early & Periodic Screening, Diagnostic & Treatment services; ensures children under 21 in Medicaid get necessary preventive and treatment services.
What Children (Under Age 21) Get under HIP
Children under 21 generally have full dental benefits under HIP (regardless of whether HIP Plus or Basic), due to EPSDT rules. Some details:
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Preventive care:
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Oral exams twice a year.
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Cleanings every 6 months.
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Fluoride treatments: typically two per year.
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Diagnostic X-rays:
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One full set or bitewing series per 12 months (or full-mouth/panoramic every 3 years, depending on plan).
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Restorative services: fillings, extractions when medically necessary.
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Major restorative / other services: crowns, dentures/partials, orthodontia (when medically necessary) are covered with some limits.
So for kids, HIP offers fairly robust dental coverage.
What Adults (Age 19-64+) Get under HIP
Adult dental coverage depends heavily on which HIP plan the person is enrolled in. Here are the main distinctions:
| Plan | Dental Coverage for Adults (19-64) |
|---|---|
| HIP Plus | Full dental benefits. Includes preventive (exams, cleanings), diagnostic (x-rays), minor restorations (fillings), extractions, crowns and more. |
| HIP Basic | Very limited or no dental benefits for adults 21 and older; except emergency dental, or limited preventive for age 19-20 under EPSDT. |
| HIP State Plan Plus / Basic | Usually enhanced dental benefits; more services (similar to HIP Plus) due to more complex medical needs; more likely to include restorative and possibly major services. |
| HIP Maternity | Dental is included as part of pregnancy benefits. Pregnant members get dental coverage. |
Some Specific Notes & Caveats
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For HIP Basic, adults 21+ typically do not get routine dental (non-emergency), so preventive or restorative services might not be covered unless emergency.
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There are prior authorization requirements for certain dental services (e.g. dentures, dental surgery) in many plans. Dentists usually help process these.
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Coverage limits / frequency restrictions: e.g. crowns “one per benefit year” in many plans; extractions / number of fillings might be limited.
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Copays or cost sharing may apply in some plans, especially HIP Basic or for State Plan Basic, though many dental/preventive services for kids are exempt.
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