Healthy Indiana Plan to Medicare: What Happens When You Turn 65

HIP Doesn't Convert to Medicare

The Healthy Indiana Plan (HIP) covers low-income adults aged 19 to 64. On your 65th birthday, HIP ends by operation of law. It does not automatically convert into Medicare coverage, full Medicaid, or a Medicare Savings Program. You have to take specific steps to avoid a gap.

This catches families off guard every time. They assume the state will seamlessly transition coverage. Instead, you're looking at a mandatory data-gathering interview with DFR and a new application through a completely different eligibility pathway.

The Timeline You're Working With

DFR cannot schedule the transition interview until roughly 45 days before the 65th birthday. If Medicare Part A kicks in on December 1, the interview typically can't happen until the second half of October. That's a tight window.

Here's what needs to happen:

1. Apply for Medicare through Social Security — Do this during your Initial Enrollment Period, which starts three months before you turn 65. Sign up for Part A (and Part B if you don't have employer coverage). Apply at ssa.gov or your local SSA office.

2. Contact DFR for the transition interview — Call 1-800-403-0864 or visit fssabenefits.in.gov to request the data-gathering interview. This is a new application — your HIP history doesn't carry over.

3. Gather verification documents — DFR will need income verification, asset documentation, Medicare entitlement proof, and identity/residency documents. The requirements are stricter than HIP's income-only evaluation because you're moving from MAGI-based eligibility to non-MAGI aged/disabled Medicaid rules.

4. DFR determines your new category — Based on your income and assets, DFR places you in one of several possible categories: QMB (at or below $2,015/month single), SLMB (at or below $2,281), QI (at or below $2,481), Traditional Aged Medicaid (at or below $1,330 with different asset rules), or PathWays for Aging (if long-term care needs exist).

The Coverage Gap Risk

The danger point is the period between HIP ending and your new coverage starting. If DFR hasn't completed the eligibility determination before HIP terminates, you could face a month or more without Medicaid coverage. During that gap:

• Medicare Part B premiums come out of your Social Security check at $202.90/month
• You're responsible for Medicare deductibles and coinsurance
• Prescription drug costs aren't buffered by Extra Help until MSP approval triggers it

The best way to minimize this gap is to start the process early. Contact DFR as soon as you receive your Medicare enrollment confirmation, even if it feels premature. The data-gathering interview can be scheduled before coverage actually starts.

What Changes With MSP vs. HIP

HIP covered a broad range of services — primary care, hospital, prescriptions, mental health. Medicare Savings Programs are narrower: they pay Medicare premiums and (for QMB) cost-sharing. They don't cover services Medicare doesn't cover.

If you need long-term care services, home health aides, or other supports beyond what Medicare provides, DFR evaluates you separately for PathWays for Aging or waiver programs. You can hold QMB status alongside these programs — that's called "QMB Plus."

The Indiana Medicare Savings Programs Guide walks through the full HIP-to-Medicare transition, including the DFR interview checklist and how to prevent a coverage gap.

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