HIP Basic Option
HIP Basic Provides Essential But Limited Health Benefits
It doesn’t offer vision or dental services, bariatric surgery or temporomandibular joint disorders (TMJ). Unlike HIP Plus, you only get a 30-day supply of medications and cannot order them by mail.
How HIP Basic Works
Copayment And Contribution Collections Are Currently Stopped
During the COVID-19 public health emergency, Medicaid members do not need to make copays for health services.
HIP Basic requires members to make a payment each time they receive a health care service. These are called copays.
- Inpatient: $75
- Outpatient/office visits: $4
- Preferred drugs: $4
- Nonpreferred drugs: $8
- Nonemergency ER visit: $8 — Members are not charged if they call the 24/7 NurseLine at 1-866-408-6131 (TTY 711) first and are told to go to the ER.
HIP Plus members don’t have copays, except for nonemergency ER visits as described above.
Copays can add up quickly, making it more costly than the HIP Plus Plan. If you moved to the HIP Basic plan due to nonpayment, you’ll have to wait for the next benefit year to switch to the HIP Plus Plan.
Pregnant members and American Indians/Alaska Natives are not required to pay copays. There are also no copays for members who’ve already paid 5% of their income for medical care in the past quarter.
POWER Account Contribution Collections Are Currently Stopped
During the COVID-19 public health emergency, HIP Plus members do not need to make POWER Account contributions.
In HIP, the first $2,500 of medical expenses for approved benefits are paid with a special savings account called a Personal Wellness and Responsibility (POWER) Account.
For HIP Basic members, HIP POWER Accounts do not pay for copays.
When you manage your account well and get preventive care, you can lower your future costs. HIP Basic members who get wellness checkups can qualify for a reduced HIP Plus contribution, if you choose to move to HIP Plus. This is called rollover credit.
Eligibility And Renewal
When you enroll in HIP, you’re eligible for 12 months. About three months before your benefits end, you'll get a renewal letter from the state. This letter will tell you when your current benefit period ends and to renew before this date. At this time, HIP Basic members can choose HIP Plus by paying the monthly contribution.
Page Last Updated: 3/3/2023