Caresource HIP Dental Coverage | HIP Dental Coverage Breakdown

 What is HIP?

The Healthy Indiana Plan is the state of Indiana’s signature, consumer-driven health coverage program for non-disabled Hoosiers ages 19-64. HIP continues to build on the successes of the original design and lessons learned since initial implementation in 2008. HIP provides incentives for members to take personal responsibility for their health.

Through HIP, Indiana works to:

• Provide quality coverage choices for Hoosiers
• Provide additional substance use disorder services to address the opioid crisis
• Improve the health status of Hoosiers
• Provide health coverage to low-income Hoosiers and ensure an adequate provider network for both HIP and Medicaid enrollees
• Empower participants to make cost- and quality-conscious health care decisions
• Create pathways to jobs that promote independence from public assistance
• Ensure that HIP is fiscally sustainable

How does HIP coverage work?

In the HIP program, in each calendar year the first $2,500 of a member’s medical expenses for covered benefits are paid with a special savings account called a Personal Wellness and Responsibility (POWER) account. The state will pay most of this amount, but the member is also responsible for paying a small portion of their initial health care costs. The member’s portion is an affordable, monthly contribution based on income. The contribution that will be one of five affordable amounts between $1 and $20.

Managing your account well and getting preventive care can reduce your future costs. If your annual health care expenses are less than $2,500 per year, you may rollover your remaining contributions to reduce your monthly payment for the next year. You can also have the amount of your reduction doubled if you complete preventive services. If your annual health care expenses are more than $2,500, the first $2,500 is covered by your POWER account, and expenses for additional health services are fully covered at no additional cost to you.

In HIP, your contributions to your POWER account will be yours. If you choose to leave the program early, your contributions not spent on health care costs will be returned to you. A penalty is deducted if an individual is disenrolled due to non-payment or withdrawing from the program without having other coverage.

Who is eligible for the Healthy Indiana Plan?

The Healthy Indiana Plan covers Indiana residents between the ages of 19 and 64 whose family incomes are less than approximately 138 percent of the federal poverty level and who aren’t eligible for Medicare or another Medicaid category. Click here to access a calculator that will help you determine if you are eligible for HIP and will estimate your monthly POWER account contribution.

What are the benefits of HIP Plus?

The HIP Plus program provides comprehensive benefits including vision, dental and chiropractic services for a low, predictable monthly cost. With HIP Plus, members do not pay every time they visit a doctor or fill a prescription. HIP Plus allows members to make a monthly contribution to your POWER account based on income. This contribution can be split when spouses are both enrolled in HIP. Contribution amounts may be higher for smokers. The only other cost you may have for health care in HIP Plus is a payment of $8 if you visit the emergency room when you don’t have an emergency health condition. Click here to find monthly contribution amounts.

1. HIP Plus

• HIP Plus is the preferred plan. It covers all the key health benefits for a low monthly cost.
• It includes vision, dental and chiropractic services.
• It offers more physical, speech, and occupational therapy visits than HIP Basic. There are extra services like bariatric surgery and jaw care (temporomandibular joint dysfunction or TMJ).

2. HIP Maternity

Let us know if you become pregnant to get HIP Maternity benefits.

• Pregnant members do not have copays or monthly payments.
• HIP Maternity offers current benefits plus additional benefits during the HIP member’s pregnancy, and for an extra 12 months starting the last day of pregnancy. It includes vision, dental, and chiropractic services at no cost.
• It covers non-emergency rides.
• HIP Maternity can help you find ways to stop tobacco use.

HIP State Plans

HIP State Plan includes HIP State Plan Plus and HIP State Plan Basic. It is for those who need enhanced benefits. These benefits are available to those with certain medical conditions that need additional care or otherwise determined eligible by the State.

HIP Benefit Summary

Below is a list of common services under each HIP Package. Please call Member Services if you do not see the service you need. With the exception of family planning or emergency services, out-of-network health care providers need prior authorization.  

Dental Benefits
	HIP Plus	HIP Basic Copays may apply	HIP Maternity	HIP State Plus	HIP State Basic Copays may apply	Prior Authorization Needed?
Oral Exams and X-Rays	Yes	No HIP Basic members age 19- 20 are eligible for (EPSDT) services and some limited enhanced preventive and diagnostic dental services.	Yes	Yes	Yes	Oral exams, x-rays and preventive services do not need prior authorization. Many of these other services do require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more.
Dental Cleanings	Yes		Yes	Yes	Yes
Other Preventive Services	Yes		Yes	Yes	Yes
Minor Restorative Services (ex: Fillings)	Yes		Yes	Yes	Yes
Major Restorative Services (ex: Dentures)	Yes		Yes	Yes	Yes
Periodontal Services	Yes		Yes	Yes	Yes
Extractions and Oral Surgery	Yes		Yes	Yes	Yes
Accident or Injury Related Dental Services	Yes	Yes	Yes	Yes	Yes