What’s Covered?
Indiana Medicaid covers a wide range of health services. What is covered depends on which program you are in.
Always Covered
All Indiana Medicaid programs
- Doctor visits (primary care and specialists)
- Hospital stays and surgery
- Emergency room care
- Prescription drugs (with some restrictions)
- Lab tests and X-rays
- Preventive care (annual checkups, screenings, immunizations)
- Prenatal and maternity care
- Mental health and substance use treatment
- Home health care
- Medical equipment (wheelchairs, walkers, etc.)
- Transportation to appointments (NEMT)
HIP Plus Only
Not covered by HIP Basic
- Dental care — cleanings, fillings, extractions, dentures
- Vision care — eye exams and eyeglasses (one pair per year)
If you are on HIP Basic and want these benefits, contact FSSA about moving to HIP Plus.
Children — Hoosier Healthwise
More comprehensive for kids
- All services above, plus:
- Well-child visits and developmental screenings
- Dental care (cleanings, sealants, fillings)
- Vision care and eyeglasses
- Hearing tests and hearing aids
- Speech, occupational, and physical therapy
Prescriptions
Indiana Medicaid covers most generic and brand-name medications on the preferred drug list (PDL). Your MCO may require prior authorization for some drugs. Ask your doctor or pharmacist if your medication is covered.
What Is Not Covered
- Cosmetic procedures
- Most over-the-counter medications (unless prescribed)
- Experimental treatments
- Services not deemed medically necessary
If a service is denied, you can appeal through your MCO or request a State Fair Hearing.