Plus Doctor
Hetty Calin
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HHSC has contracted with different STAR+PLUS plans effective Sept. 1, 2024. Some service areas will have health plan changes. If you are a STAR+PLUS member or provider, you may be impacted. Read important information below.
STAR+PLUS is a Texas Medicaid-managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid healthcare and long-term services and support through a health plan that they choose.
Another feature of STAR+PLUS is service coordination. A STAR+PLUS managed care organization (MCO) staff member works with the member, the member's family and the member's doctors and other providers to help the member get the medical and long-term services and supports they need.
Once you are approved for STAR+PLUS, you will get a packet in the mail that tells you about the program and how to choose a health plan. If you don't have Medicare, you will also need to select a primary care doctor.
Regular health care and long-term services and supports are part of a service plan created by you, your family, your doctor, other healthcare providers, and your health plan. Other people who are important in your life can also participate in your service planning if you want to invite them.
The following is an overview of the services STAR+PLUS offers.
Health plans must have a service coordinator visit with the member within 30 days of enrolling in the program. The service coordinator must find out the member's goals, interests, and needs, and help the member develop a service plan.
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.
Applications are available online or by mail, or can be picked up at any Division of Family Resources office. Call 877-GET-HIP-9 to learn more about the application process or click here to find your local DFR office.
If you are an enrolled HIP member, you should call your health plan (Anthem, CareSource, MDwise or MHS) or go online to their website to research which providers are in that health plan's network. Members can also call 877-GET-HIP-9 and ask.
The Healthy Indiana Plan empowers members to make important decisions about the cost and quality of their health care. As an incentive, members who remain in the HIP Plus program can reduce their POWER account contribution amounts after a year in the program based on the amount remaining in their accounts. If they receive recommended preventive care services throughout the year, the discount will be doubled. Members in the HIP Basic plan also have a POWER account, but since they are not making contributions to the potential amount of their discount for receiving preventive care is lower.
HIP Plus
The initial plan selection for all members is HIP Plus which offers the best value for members. HIP Plus has comprehensive benefits including vision, dental and chiropractic services. The member pays an affordable monthly POWER account contribution based on income. There is no copayment required for receiving services with one exception: using the emergency room where there is no true emergency.
HIP Basic
HIP Basic is the fallback option for members with household income less than or equal to 100 percent of the federal poverty level who don't make their POWER account contributions. The benefits are reduced. The essential health benefits are covered but not vision, dental or chiropractic services. The member is also required to make a copayment each time he or she receives a health care service, such as going to the doctor, filling a prescription or staying in the hospital. These payments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay. HIP Basic can be much more expensive than HIP Plus.
Members in the HIP Basic plan will still use the POWER account to cover their $2,500 annual deductible, but the funds in the account will be contributed entirely by the State. HIP Basic plan members will still receive POWER account statements to assist them in managing the account and to increase their awareness of the cost of the health care services they receive.
A key principle of the Healthy Indiana Plan is that it gives members the opportunity to participate in HIP Plus. HIP Plus is the initial, preferred plan selection for all members and offers the best value. To participate in HIP Plus, members make affordable monthly contributions into their POWER account based on income. In the HIP Plus program, members do not pay copayments when they go to the doctor or hospital or fill a prescription. The only exception to this is a copayment for going to the emergency room for care when there is not a true emergency.
HIP Plus provides MORE benefits than the HIP Basic program, including vision, dental and chiropractic services. It also allows more visits for physical, speech and occupational therapy, and covers additional services like bariatric surgery and Temporomandibular Joint Disorders treatment. With HIP Plus, members can get 90-day refills on prescriptions and receive medication by mail order. Members also receive medication therapy management services that are designed to work closely with their doctors and pharmacies to provide additional assurances that prescription therapies are safe and effective.
HIP Basic is the fallback option that is available only to members with household incomes less than or equal to the federal poverty level. In HIP Basic, members make a payment every time they receive a health care service, such as going to the doctor, filling a prescription or staying in the hospital. These payments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay. HIP Basic can be more expensive than HIP Plus.
HIP Basic includes all the federally required essential health benefits, but does not provide coverage for vision, dental or chiropractic services, bariatric surgery or Temporomandibular Joint Disorders. HIP Basic benefits also allow fewer visits to physical, speech and occupational therapists. Unlike HIP Plus, HIP Basic has more limited options for getting medication. Members are limited to 30-day prescription supply and cannot order medications by mail.
Members can select their health plan when they apply. There are four health plans that serve Healthy Indiana Plan members (Anthem, CareSource, MDwise, MHS). Click here for a comparison of the available health plans. Click here for the health plan comparison in Spanish. Once a member is approved for HIP, he or she will be assigned to the health plan selected on the application. If no plan is choose a health plan, one will be assigned.
On an annual basis, HIP members have the opportunity to switch to another health plan for the following year. A member wishing to change health plans may do so by calling 877-GET-HIP-9 between November 1 and December 15. All changes will be effective January 1 and stay in effect for the next calendar year. If a member does not wish to change health plans, they do not need to take any action and will automatically stay with their current health plan for the new year.
HIP members who are pregnant may keep their HIP coverage for the duration of their pregnancy. Pregnant members will have all cost sharing eliminated and will receive additional benefits during their pregnancy including non-emergency transportation.
A pregnant HIP member must promptly report her pregnancy. After reporting a pregnancy, pregnant mothers will become HIP Maternity members. The member will continue to have a POWER account but will not be required to make payments. Pregnant members are eligible to receive incentives for completing preventive care like all other HIP members. HIP Maternity members will receive vision, dental, chiropractic coverage, non-emergency transportation and access to additional smoking cessation services designed specifically for pregnant women.
At the end of her pregnancy, additional pregnancy benefits will continue for another 12 month post-partum period. Pregnant members will continue to not have any cost sharing responsibilities during this period.
After the 12 month period members will transfer from HIP Maternity to HIP Basic to get HIP Plus benefits the member will need to make a POWER account contribution. Members will have 60 days to make their POWER account contribution from the start of the HIP Basic benefits. Members with income over the federal poverty level who do not pay for Plus will lose eligibility for HIP Basic after 60 days.
Pregnant women enrolled in Hoosier Healthwise will not be affected by changes to the Healthy Indiana Plan and will continue to receive coverage through Hoosier Healthwise. Pregnant women who would otherwise be eligible for HIP but are not enrolled may receive a new member card indicating they are enrolled in HIP Maternity.
The state of Indiana pays for most of the $2,500 in the POWER account, but the member is responsible for a fixed monthly payment depending on income. The member contribution amounts are between $1 and $20, but may be higher for members that smoke. When a member makes a POWER account payment, they become enrolled in HIP Plus, which offers better health coverage, including vision, dental and chiropractic benefits.
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