In some situations, an individual’s Medicare coverage may temporarily overlap with Healthy Indiana Plan (HIP) coverage. Some members may gain Medicare coverage while on HIP by turning the age of 65 or by qualifying for Medicare based on a Social Security Administration (SSA) determination.

Sometimes, Medicare benefits may be approved with a retroactive effective date, leading to an overlap in HIP and Medicare coverage. The process to terminate the member’s HIP benefits begins after notice of the dual coverage is received by the IHCP. Federal policy requires that a member be notified prior to the termination of any benefits. Accordingly, Web interChange may correctly reflect that a member is eligible for both HIP and Medicare benefits. If a member has dual coverage, HIP is the secondary payer. Medicaid, as always, is the payer of last resort, including for those insured under Medicare.

As with all third-party liability, Medicare must be billed first, and a copy of the Medicare explanation of benefits (EOB) must be submitted with the HIP claim to the appropriate managed care entity (MCE).

Please read the full IHCP banner here.