Common Questions about the Healthy Indiana Plan (HIP)

As a HIP member, is important to understand your Benefit Year and Eligibility Period (also known as Redetermination Period). Benefit Year starts January 1 and ends December 31 each calendar year. Eligibility Period (Redetermination Period) is 12 months from when you are approved for coverage. This can be different for each person.

Benefit Year:

  • Your Benefit Year does not change if you leave the HIP program and return during the year.
  • Benefit limits and POWER Account reset each January
  • November 1 – December 15 you will have a chance to stay with your current health plan or change your health plan for the next Benefit Year. NOTE: If you like MDwise you will need to do nothing and MDwise will automatically carry over to the next Benefit Year. MDwise is committed to serve our members health care needs.        
  • If you want to change your health plan you can contact the enrollment broker 1-877-438-4479 during the annual Health Plan Selection Period which is November 1 – December 15 of every year.
  • See more information on this period below under “How do I change my health plan”
  • You must get your preventive services within the Benefit Year to qualify for rollover of any funds left in your POWER account.  See page 20 of the member handbook for detailed POWER Account information.


Eligibility (also known as Redetermination) Period:

  • Members can buy-in to HIP pay for Plus during the Eligibility Period
  • IMPORTANT: Members must participate in the annual Eligibility (Redetermination) process.
  • If member does not participate in the annual Eligibility (Redetermination) process the member may be locked out of the HIP program for up to 6 months.
  • Letters for your eligibility will come from the Department of Family Resources (DFR).


Who is MDwise?

MDwise is an Indiana-based, nonprofit health plan. MDwise signs a contract with the State of Indiana to offer health coverage to Healthy Indiana Plan (HIP) members. The State of Indiana decides who gets health coverage. Once the State decides a member gets health coverage they will assign a Healthy Indiana Plan member to a health plan like MDwise. MDwise provides the doctors and medical services to Healthy Indiana Plan (HIP) members who choose or are assigned to MDwise as their health plan. 

What is the Healthy Indiana Plan (HIP)? 

The Healthy Indiana Plan (HIP) is the name of the State of Indiana’s health insurance program. It is one of the Medicaid programs available to Indiana residents between 19 and 64 years old that are eligible. The Healthy Indiana Plan states what benefits are covered and what the costs are associated with getting these benefits. MDwise is a company that helps members in getting those benefits and handles the administration of the Healthy Indiana Plan for the state of Indiana. MDwise is called your “health plan” for the Healthy Indiana Plan.

How do I change my health plan?

HIP members will pick their health plan (MDwise) once per year and you will keep that health plan all year, January through December. This is called your Benefit Year. Even if you leave the HIP program due to eligibility or other reasons and you return to the HIP program during the year, MDwise will be your health plan.
Each fall, November 1 through December 15 you will have the chance to change your health plan for the next Benefit Year. We call this the Health Plan Selection Period. You can do this by calling 1-877-438-4479 and letting them know you want to change your health plan for the next year. If you like MDwise, you don’t have to do anything, you will stay a MDwise member for the next benefit year.
If you would like to change your health plan outside of the Health Plan Selection Period (November 1 through December 15), you may do so for “just cause” reasons. These are listed below:

  1. You transitioned from other Indiana Health Coverage Program (IHCP) to HIP.
  2. You went through redetermination in the fall and were in a lockout period during the Health Plan Selection Period. Then returned to the program via a reauthorized case, not a new application.
  3. You were not fully eligible during the Health Plan Selection Period (i.e. you applied in the fall and did not pick a health plan on application and was then authorized for coverage in November or December so you were not fully eligible in time to participate in the Health Plan Selection Period.

This opportunity to change your health plan doesn’t affect your eligibility period (redetermination) for the HIP program. You will still have to go through the redetermination process every 12 months to make sure you are still eligible for HIP. Your redetermination depends on what month you entered the HIP program. You will get a reminder in the mail when it is time for your redetermination.

Why must I make a Personal Wellness and Responsibility (POWER) Account Contribution?

Your covered medical expenses are paid with a special savings account called a Personal Wellness and Responsibility (POWER) Account. The state contributes most of the funds, but you are asked to also contribute each month. Your contribution amount is based upon your income and will not be more than two percent of your household income. Contribution payments should be made to be eligible for the Healthy Indiana Plan Plus (HIP Plus) coverage and Healthy Indiana Plan State Plus (HIP State Plus) coverage. Healthy Indiana Plan Basic (HIP Basic) members and Healthy Indiana Plan State Basic members (HIP State Basic) make no contribution to their POWER Account.  


Changing Your Doctor

If you are not happy with your health care or your doctor, please call MDwise. We will work with you to fix any problems you have. 
We can also help you change doctors, such as when: 
  • You have moved. 
  • Your doctor has moved or no longer belongs to MDwise. 
  • Your doctor does not return your calls. 
  • You have trouble getting the care you want or your doctor says you need. 
  • Your doctor was assigned by MDwise before you had the chance to choose a doctor for yourself. 
  • Other reasons—call for more information. 

To change your doctor or to ask for a list of doctors in your area, please call MDwise customer service. You can also get a list of MDwise doctors here on our website.

How do I change my HIP plan to HIP Plus?

You can enroll in HIP Plus: 
  • By making your initial POWER Account contribution. 
  • When you renew your HIP coverage every year. 


Do I have to renew my Healthy Indiana Plan (HIP) coverage?

This is a determination that the State makes each year. The State may send you paperwork when it is time for you to renew that you have to send in to make sure you keep your HIP coverage. Follow the instructions in the letter you receive. It will tell you what steps you need to take to keep Healthy Indiana Plan (HIP) coverage. If you don't follow the instructions, you may lose your health coverage. The State may also send you a letter that tells you that you have coverage for another year and you don’t need to do anything. It is always very important to carefully read all paperwork you get from the state of Indiana and MDwise. 

MDwise will also send you communication when it’s time to renew your HIP coverage. Click here to learn more about renewing your HIP coverage.


What if I called to choose a doctor but did not get the doctor I chose?

There are many reasons why a doctor selection may not have been approved. It is important to watch for a letter confirming your choice. If you do not get one within 14 calendar days of making a selection, call MDwise to be sure you get the doctor you chose. 


Why did my doctor get changed?

There are many reasons why your doctor may change. MDwise will always try to send you a letter before your doctor is changed. If you find that your doctor is changed and you want a different doctor, call MDwise right away. We may be able to help you understand what happened. We can help you choose a doctor you want.  


How soon can I get an appointment to my doctor?

It is very important to see your doctor in the first 90 days of joining MDwise. For your first appointment you may have to wait up to two months if you are not sick. If you are sick with something like a fever or earache, you should be able to get an urgent care appointment within one day. If you are not feeling well or have a non-urgent care issue, you should be able to see your doctor within three days. The most important thing to do is to call your doctor’s office. Tell them who you are. Then tell the appointment person that you have been assigned to your doctor. Let them know why you need to see the doctor. 


How do I find a dentist, eye doctor, foot doctor or chiropractor?

Dental, vision, podiatry (foot doctor), family planning and chiropractic care are self-referral services for eligible Healthy Indiana Plan (HIP) members. This means that you can go to any dentist or other provider that accepts Medicaid/Healthy Indiana Plan. Your MDwise doctor can often help by suggesting a doctor for you. Some services you get from these providers will need an okay (or authorization) from MDwise. The doctor you select should know what to do to get an okay for the services that you need. For a list of these types of doctors, search our Find a Doctor directory. Or you can call MDwise customer service at 1-800-356-1204 for assistance with locating Healthy Indiana Plan providers. 


How can I see a specialist?

Your doctor or primary care provider (PMP) manages all of your medical care. You must see your doctor before he/she can refer you to a specialist. He/she can refer you to a specialist if there is a medical reason. Your doctor will be able to tell you which specialist you can see. MDwise can help your doctor find a specialist if he/she does not know of one for you. 


How do I get my baby on the Healthy Indiana Plan (HIP)?

The Presumptive Eligibility for Pregnant Women (PEPW) program offers prenatal care services to low-income pregnant women who do not receive Medicaid or Healthy Indiana Plan (HIP). If you are pregnant and need health coverage, contact a qualified provider and ask for help applying for Presumptive Eligibility for Pregnant Women and Healthy Indiana Plan. 

You must be a U.S. citizen and live in Indiana to participate. Certain legal immigrants can participate too. Also, your family income must be below a certain amount. 

If you are already on Healthy Indiana Plan (HIP) while you are pregnant, your new baby will be eligible for the Hoosier Healthwise (HHW) plan, another Medicaid program. You must report your baby’s birth to your caseworker. At birth your baby will be assigned to MDwise if you are a MDwise member. It is important to choose a MDwise doctor for your baby before you deliver. Your baby will be covered for one year.


Why can’t I get my prescription filled?

There can be several reasons why your prescription may not get filled right away at your pharmacy. If you are having a problem, you can call 1-844-336-2677. If you still need help you can call MDwise customer service at 1-800-356-1204. We can tell the pharmacy where to call for help. Even after hours, MDwise has a process in place to direct the pharmacy to the right place for help to fill prescriptions for emergencies.


How do I get my member ID card?

All MDwise Healthy Indiana Plan members will receive a member ID card from MDwise. If you have lost or misplaced your ID card, you can go to the MDwise web site and print one if you have set up a myMDwise account. You can also request a new one by calling MDwise customer service at 1-800-356-1204 or 317-630-2831 in the Indianapolis area. You can also go on your myMDwise account and print a temporary ID card or request a new one.


Who should I call when I change my address and/or phone number?

This is very important. MDwise mails important information to members all the time. If we do not have your address, the important information will not get to you. Also, there are times that MDwise or your doctor’s office or nurses need to call you. If we do not have a current phone number, you may miss important phone calls about your health. If you do not update your address when you move, you could miss important notices about renewing your health coverage/benefits. You must contact your local Division of Family Resources (DFR) at 1-800-403-0864. They will send your new address and phone number to us. 


Why did I get a bill when I have MDwise coverage?

There are several reasons why you may get a bill from a doctor or medical provider, even though you are on the MDwise plan. It is important to call the billing agency on your bill right away. Please make sure to give them your Healthy Indiana Plan (HIP) number. If the agency already has that information, call MDwise. Your representative will need to ask you for some information. MDwise will then call the billing agency and help get the bill paid. If you are responsible for paying the bill, MDwise can let you know. 


Resources Regarding Privacy and Security—Interoperability Frequently Asked Questions


Tips for Healthy Indiana Plan members