Medicaid Costs and Coverage in Indiana

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Medicaid coverage in Indiana is geared toward low-income families and applicants seeking affordable insurance options. “What services are covered by Medicaid?” and “What does Medicaid not cover” are common questions of interested applicants and approved beneficiaries. While there may be different types of Medicaid insurance available based on eligibility and other qualifying factors, there are still basic medical services covered entirely for approved applicants. It is important for all applicants to find out Medicaid cost estimates for their types of insurance, so they can prepare for any financial or medical issues that may occur. In Indiana, Medicaid coverage types can vary from traditional Medicaid coverage to Emergency Services Only to Family Planning Eligibility and more. An applicant will be eligible for certain health coverage depending on his or her application and overall qualifications for Medicaid. It is worth noting that depending on the type of Medicaid insurance offered to an applicant, the Medicaid cost estimates can change. While a majority of coverage for Medicaid is paid through government funding, there may be extra fees associated with services and treatments, such as deductibles, copayments and premiums. For instance, traditional Medicaid coverage in IN, which is the most basic healthcare option, provides coverage for healthcare that involves more fundamental needs. Continue below to learn more about the services covered by Medicaid in Indiana, along with answers to questions like, “How much does Medicaid cost?”

What services are covered by Medicaid in Indiana?

Medicaid coverage in Indiana can be determined through an applicant’s eligibility. The Medicaid benefits covered can range in terms of services and treatments, and can fluctuate, depending on a petitioner’s age, income and medical needs. It is important for new applicants to understand what services are covered by Medicaid, and which services may require extra fees or out-of-pocket expenses. Preparation for medical emergencies can be as easy as learning the types of Medicaid insurance benefits that are offered. For example, this can make the difference in choosing an ambulance during an emergency situation, because an applicant understood the IN Medicaid coverage offered ahead of time. More basic coverage for Medicaid offered in Indiana includes, but is not limited to:

  • Hospital inpatient care.
  • Doctor visits.
  • Wellness visits.
  • Prescription drugs.
  • Laboratory services.
  • X-ray services.
  • Medical supplies and equipment.
  • Vision care.
  • Dental care.
  • Hospice care.
  • Emergency transportation.
  • Podiatry services.

For specific Medicaid coverages and services, an applicant can contact his or her local health plan provider for verification. For more specialized Medicaid coverage, an applicant may need to contact his or her doctor in advance for prior authorization. For more general information about what is covered by Medicaid, download our guide.

What services are not covered by Medicaid in Indiana?

All prospective applicants should learn what Medicaid does not cover in Indiana in order to be prepared financially. Any sort of financial surprises regarding types of Medicaid insurance or Medicaid coverage can be avoided with just a bit of understanding and further knowledge about the program. A quick way to determine if a service or treatment is covered by Medicaid is by finding out if the doctor or medical specialist is a Medicaid provider. If not, then the service will not be covered by Medicaid. Indiana Medicaid coverage is gauged by medical necessity, and any services or treatments that are not deemed medically necessary will not be covered by Medicaid. Other services Medicaid will not cover in Indiana include, but are not limited to:

  • Experimental services and treatments.
  • Health services provided by relatives or friends.
  • Cosmetic surgeries and services.
  • Private nursing duties.
  • Reconstructive services and surgeries.
  • Acupuncture.
  • Weight-loss surgery without prior approval.
How much does Medicaid cost in Indiana?

Determining the costs for Medicaid coverage in Indiana can depend on a few different factors, most notably due to the type of Medicaid insurance an applicant receives. So, exactly how much is Medicaid in Indiana? There are different kinds of Medicaid insurance options, all of which have their own sets of copayments, premiums and deductibles attached. For some Medicaid coverage services, a copayment will need to be paid in order for the applicant to receive care. For example, traditional Medicaid coverage in Indiana might have zero copayments for emergency transportation services, as well as non-emergency usage of the emergency room. Yet, another type of Medicaid insurance option called Hoosier Care Connect will require a copayment for non-emergency usage of the emergency room, although very minimal. Different costs associated with Medicaid coverage can vary greatly, depending on the insurance eligibility offered to each applicant.

Other factors that can directly influence Medicaid coverage in Indiana involve income requirements. Medicaid is a government-funded program, which means that out-of-pocket expenses tend to be minimal for approved applicants. However, the copayments and premiums that might be attached to certain services can be higher or lower depending on eligibility. The way that income requirements work to establish Medicaid coverage is through use of the Federal Poverty Level, or FPL. An applicant must earn less than a specific percentage below the FPL in order to be approved for Medicaid. However, those applicants who find themselves well below the FPL may have less in the way of copayments due. Applicants who find themselves earning more than most, but are still eligible to be covered for Medicaid, may have more copayments for services due. An applicant will be advised of exact coverages for Medicaid and Medicaid cost estimates once approved by the program. If an applicant is attempting to determine exact costs for Medicaid prior to submitting an application, he or she can reach out to a local Medicaid provider for more information.

Download our free guide to learn more about Medicaid and what it covers.