Indiana Medicaid Dental Benefits | '25 Healthy Indiana Plan Overview

 As of March 2025, Indiana's Medicaid program continues to provide comprehensive dental benefits through various plans, including the Healthy Indiana Plan (HIP) Plus. Recent developments and upcoming changes in 2025 are noteworthy for current and prospective members.

Current Dental Benefits under Indiana Medicaid and HIP Plus

Indiana Medicaid offers dental services across its programs, ensuring members have access to necessary oral health care. The Healthy Indiana Plan (HIP), targeting adults aged 19 to 64, provides two main coverage options: HIP Basic and HIP Plus.

• HIP Dental: This plan covers essential dental services, including:

  • Two oral exams every 12 months
  • One cleaning every six months
  • Emergency oral exams
  • One complete bitewing x-ray series per member every 12 months
  • Full-mouth radiograph series or panoramic x-rays once every three years

• HIP State Plan: For a minimal monthly contribution, HIP Plus members receive enhanced dental benefits, which include all services under HIP Basic, plus:

  • Restorative services (fillings) and extractions (up to four per benefit year)
  • Crowns (one per benefit year)
  • Periodontal services, such as scaling and root planing
  • Dentures, partials, and repairs (with certain limitations)

These benefits are designed to promote preventive care and address more extensive dental needs.

Upcoming Changes and Considerations for 2025

Several significant updates are on the horizon for Indiana Medicaid's dental programs in 2025:

• Partnership with Delta Dental: Effective January 1, 2025, Delta Dental of Indiana has partnered with MDwise to administer dental benefits for members enrolled in the Hoosier Healthwise and Healthy Indiana Plan programs. This collaboration aims to enhance access to quality dental care through Delta Dental's extensive provider network.

• State Budget Considerations: Indiana, like many states, is evaluating Medicaid funding due to potential federal spending adjustments. Proposed measures include implementing work requirements and capping enrollment in the state's Medicaid expansion program. While these proposals aim to manage costs, they could impact coverage and benefits for some members.

What to Watch for in 2025

As these changes unfold, members should stay informed to maximize their dental benefits:

• Monitor Eligibility Criteria: Be aware of any new eligibility requirements, such as work mandates or enrollment caps, that could affect your coverage.

• Understand Benefit Modifications: Stay updated on any changes to dental benefits, including coverage limits or service modifications, to ensure you receive appropriate care.

• Engage with Your Dental Provider: Regular communication with your dentist can help you navigate any changes and maintain your oral health effectively.

• Utilize Available Resources: Leverage member services and online portals provided by your health plan to access up-to-date information and support.

By staying informed and proactive, Indiana Medicaid and HIP Plus members can continue to access comprehensive dental care throughout 2025.