Medicaid is a state and federal program that provides free or low-cost health care coverage to eligible needy persons, including some low-income adults, children, pregnant women, elderly adults, and people with disabilities. Each state determines its own rules for what is covered under Medicaid, and copay amounts can differ significantly from one state to another. In this blog post, we’ll focus on understanding the copays associated with Medicaid in Indiana.


What is Covered by Indiana Medicaid?

Indiana Medicaid covers a wide range of health care services, including both generic and brand-name prescriptions, hospital stays, and emergency transportation.

Generic prescriptions have a copay of $3 per prescription, while brand-name prescriptions have a copay of $10 per prescription. Emergency transportation services come with a copay of $10.

HIP Basic Copayment Amounts

The Healthy Indiana Plan (HIP) is a part of Indiana’s Medicaid program. There are different costs and copayment amounts depending on the type of service provided.

For instance, inpatient services, which include hospital stays, come with a copay of $75. Preferred drugs have a copay of $4, while non-preferred drugs have a copay of $8. Non-emergency visits to the doctor or emergency room have a copay of $8.

Cost Sharing & Copays – Healthy Indiana Plan

One important thing to note about the Healthy Indiana Plan is that your family’s total cost sharing for healthcare can’t be more than 5% of your family’s household income per quarter (a three-month period).

Hoosier Healthwise – Premiums and Copays

Hoosier Healthwise is another program under Indiana Medicaid. Just like with the other programs, prescription drugs – generic, compound, and sole-source – have a copay of $3. Brand-name prescription drugs have a copay of $10, and emergency ambulance transportation comes with a copay of $10.

Changes to Copayment Amounts for Pharmacy Services

It’s important to keep in mind that copayment amounts can change. For instance, there have been modifications to the Indiana Medicaid copayment and payment methodology for pharmacy services.


Applying for Medicaid in Indiana

If you’re considering applying for Medicaid in Indiana, it is essential to know the eligibility criteria and the application process. To qualify, individuals must meet certain family income and residency requirements, among other conditions. Applications can be submitted online through the Indiana Family and Social Services Administration (FSSA) Benefits Portal, in person at your local Division of Family Resources (DFR) office, or by mail. For guidance through the application process or to see if you qualify for exemptions or reductions in copayments, it is recommended that you contact a Medicaid representative or a healthcare advisor.

In conclusion, understanding how copays work in the Indiana Medicaid program can help you plan your healthcare expenses better. Remember that these copays can change, so it’s essential to stay updated by visiting the official Indiana Medicaid website or speaking with a healthcare professional.