In Indiana, Traditional Medicaid and the Healthy Indiana Plan (HIP) are both state-run health insurance programs, but they serve different populations and offer different benefits. Here’s how they compare:
1. Eligibility
Traditional Medicaid: Covers low-income individuals who meet specific eligibility criteria, including:
- Children under 19 years old
- Pregnant women
- Elderly individuals (65+ years old)
- People with disabilities
- Certain parents or caretakers of children
Healthy Indiana Plan (HIP): Covers low-income adults (19-64 years old) who do not qualify for traditional Medicaid and earn up to 138% of the Federal Poverty Level (FPL). It is Indiana’s version of Medicaid expansion under the Affordable Care Act (ACA).
2. Cost & Contributions
Traditional Medicaid: Usually free or very low-cost for members. There are no monthly premiums or required payments for most services.
HIP:
- HIP Plus members pay monthly POWER Account contributions (similar to premiums) based on income.
- HIP Basic members (who don’t make contributions) receive fewer benefits and may have copays for services. Only limited emergency dental care is covered.
3. Dental & Vision Coverage
Traditional Medicaid:
- Covers both dental and vision care for children and adults.
- Includes routine exams, cleanings, fillings, and extractions for dental.
- Vision benefits include eye exams and glasses.
HIP:
- HIP Plus includes dental and vision coverage.
- HIP Basic only covers limited emergency dental care.
4. Benefits & Coverage Differences
Traditional Medicaid: Comprehensive coverage, including hospital visits, doctor visits, dental care, prescriptions, mental health services, long-term care, and home health services.
HIP: Covers preventive care, hospital visits, doctor visits, dental care, prescriptions, and mental health, but long-term care and home health services are NOT covered.
5. Long-Term Care & Disability Services
- Traditional Medicaid: Provides coverage for nursing homes, home-based services, and disability-related care.
- HIP: Does not cover long-term care or disability-related services. If a HIP member becomes disabled or needs nursing home care, they must switch to Traditional Medicaid.
6. Managed Care vs. Fee-for-Service
- Traditional Medicaid: Uses both fee-for-service (direct billing) and managed care (insurance-like plans), depending on the program.
- HIP: Operates as a managed care program, meaning members choose from insurance providers (MHS, Anthem, or UnitedHealthcare) that manage their benefits.
Summary Table
| Feature | Traditional Medicaid | HIP (Healthy Indiana Plan) |
|---|---|---|
| Eligibility | Children, pregnant women, elderly, disabled, low-income parents | Low-income adults (19-64), up to 138% FPL |
| Cost | Mostly free, little to no copays | Monthly contributions (HIP Plus) or copays (HIP Basic) |
| Dental & Vision | Yes (for all) | Yes (only in HIP Plus) |
| Long-Term Care & Disability Services | Yes | No |
| Plan Type | Fee-for-service & managed care | Managed care only |
| Hospital & Doctor Visits | Yes | Yes |
| Prescription Drugs | Yes | Yes |
Final Takeaway
- If you are elderly, disabled, or need long-term care, Traditional Medicaid is the better option.
- If you are a low-income adult without disabilities, HIP is designed for you, but HIP Plus offers the best benefits.
- If Indiana moves forward with capping HIP enrollment, thousands may have to look for other coverage, possibly switching to Traditional Medicaid (if eligible) or the federal marketplace (if they qualify for subsidies).
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