The HIPP program is particularly beneficial to families with multiple children because the premium will usually cover all of them, not just the child with a disability. In addition to providing coverage for family members who might be uninsured otherwise, it allows individuals on Medicaid to pick from more doctors and have more choices.
“HIPP is very simple to use and we were able to enroll very easily,” said Jillana Holt-Reuter, whose whole family of five benefits from the program. “We actually qualify to have all of our health insurance premiums reimbursed. This includes medical, dental, vision, prescription and mental health.” For them, it covers Jillana, her husband, Kevin Reuter who works for Lowe’s, and their three adult children who are under age 26, Michael, Kenneth and Caitlin Caulfield.
Before you can qualify for HIPP, Medicaid has to determine that it is more cost effective to reimburse your family for health insurance premiums than to pay the medical bills for a family member(s) on Medicaid. This saves the state money while helping families obtain health care. It does this by making private insurance the main payer and Medicaid the second payer for individuals on it. Based on individual circumstances, HIPP might not cover insurance costs for everyone in a family and some families may have to pay a percentage of the cost.
“We were able to enroll right away,” Jillana recalled. “We just had to fill out a few very easy pieces of paper, similar to information we’d have to provide to a doctor’s office, such as listing your insurance.” You also have to provide a summary of insurance benefits and cost sheet that you can obtain from your employer, plus a copy of your insurance card.
“If you collect your insurance information before you submit your application and keep it together, you are prepared if they call with any questions and it can go much faster,” she advised. “Once you are on HIPP, the only thing you have to do is fax in a copy of the paystub showing that the premium has been taken out once a month. We get reimbursed in a week or two via direct deposit,” Jillana said. “For 15 minutes of work each month, we get $386 back. That’s phenomenal!”
The Reuter family has been on HIPP about three years, and even moved from northeast Texas to San Marcos recently without any changes in the program, since Kevin still works for the same company. They also changed insurance companies this year. “It was easy,” she revealed. “We did not miss one payment. It is direct deposited, which makes it very easy to maintain.”
Family members who have both HIPP and Medicaid get more services paid for by using doctors that accept both plans; however, HIPP also allows them more choices. “I feel that we can access better doctors and specialists,” Jillana said.
If they choose to use a doctor who is not on Medicaid, an office visit for their daughter is only a $35 co-pay under their insurance, as opposed to having to pay for the whole visit if they go outside the Medicaid system without having HIPP. “That gives me more choices in my daughter’s care to maintain a higher quality and consistency of care,” she explained. “Whether providers are on Medicaid or not, I can choose who is best for her.”
When services are provided by a doctor who accepts both plans, individuals on Medicaid get their insurance co-payments and deductibles paid by Medicaid, as well as Medicaid services that are not covered by their private plan. Family members who do not get Medicaid must pay their own co-pays and deductibles.
Jillana’s family has experienced some complications with HIPP because Caitlin is on STAR+PLUS, which includes long-term services, and it adds another layer to the payment process. It is also harder to find doctors that accept both their private insurance and STAR+PLUS, Jillana observed. Caitlin qualified for Medicaid through the Supplemental Security Income program, and she is on the Deaf Blind Multiple Disabilities waiver.
“Most people do not believe it when I tell them there’s a Medicaid program that will pay for their health insurance premiums,” Jillana remarked. Families should apply for it now, she stressed. “I think it is important to show the need for this program by enrolling. At least try. And if your situation changes, try again.”