FAQ

What is a health plan?
The group of doctors, hospitals, and other providers who work together to give you the healthcare you need.

What is a Primary Care Provider (PCP)?
A primary care provider (PCP) is the doctor or clinic you go to when you are sick or need a checkup.

Can I keep my doctor as my PCP?
Yes, if your doctor is in the health plan you choose.

When can I start making appointments with my PCP?
After you enroll, your health plan will send you a Welcome Packet in the mail. At that time you can begin making appointments to see your PCP (doctor or clinic).

Will I lose any services?
No. You will not lose any services. Some plans have extra services.

What is a co-pay?
A co-pay is the money you pay at the time of services.

Will I have a co-pay?
If you have a co-pay now, you may still have one.

How do I change my address?
Please call your caseworker at your local Department of Human Services (DHS) office or call the Change Report Hotline at 1-800-720-4166 (TTY: 1-800-447-6404). To find your local DHS office, use the DHS Office Locator. You may also change your address online.

What happens if I don’t choose a health plan and PCP?
If you don’t choose, we will choose a health plan and PCP for you. It is better if you choose because you know your healthcare needs best.

Can I change my PCP?
Yes. You can change your PCP once a month. To change your PCP, call your health plan.

What if I have more questions?
If you have questions or need more information, you can call Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576). The call is free.

How will I get medical services?
When you or a family member needs medical help, you will first call your doctor for an appointment. If needed, your doctor will refer you to a specialist for additional services. If you have an emergency, you should go to the closest emergency room or call 911 (if available in your area). You may go to any emergency room. You do not need to ask your doctor.

An emergency is a health problem that is life threatening or one that will seriously hurt your health if it is not treated right away. Go to the emergency room only if your problem is serious. If it is not serious, make an appointment to see your doctor.

Here are some emergencies:
• Chest pains
• High fever
• Bleeding that won't stop
• Passing out
• Seizures
• A broken bone
• Trouble breathing
• Serious burns
• Serious stomach pains
• Damage to the eyes
• Any medical problem you think is serious

Medicare-Medicaid Alignment Initiative (MMAI) 

What is MMAI and why do I need to enroll?

The Medicare-Medicaid Alignment Initiative (MMAI) is for seniors and persons with disabilities who are enrolled in both Medicare and Medicaid. This new program covers all your Medicare and Medicaid benefits, including prescription drug benefits (Medicare Part D).

Enrolling with an MMAI plan will ensure you receive better coordination of care and will eliminate the need for you to have to worry about two sets of healthcare benefits.

Is this a new Medicare program under the Affordable Care Act (ACA)?

No. This is a special program being operated by Medicare (the federal government) and Medicaid (state government).

Will I have to pay a co-pay in the MMAI program?

Please, go to the Compare Plans page to find out if you have a co-pay or call Illinois Client Enrollment Services for co-pay information, at 1-877-912-8880

Can I enroll online for this new program (MMAI)?

No, online enrollment is not available. However, if you are ready to enroll, we can help you enroll; we can help you enroll today. Or, you can call us at a later date when you are ready to enroll.

I have insurance currently; do I need to enroll with this new program?

If you have high-level third party insurance, you will not be able to enroll in MMAI. If your insurance is not considered high-level, you can enroll in MMAI if otherwise eligible.

Can you tell me what plan is best for me?

No, but I can educate you on all your plan options and look up which plans your current providers are participating in. You will need to decide which plan is best for you once you have all the necessary information. Once you have picked a plan and provider, we can help you enroll.

How can I opt out of MMAI?

If you do not want to be in the Medicare-Medicaid Alignment Initiative, you can opt out (decide not to enroll) by calling Illinois Client Enrollment Services at 1-877-912-8880

What is Medicare’s number and/or website address?

If you have questions about Medicare, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week or visit www.medicare.gov. TTY users should call 1-877-486-2048.

Long-Term Services & Supports

What is MLTSS?
Medicaid Managed Long Term Services and Supports (MLTSS) is a program that covers long term care or waiver services for people who qualify.
To make sure you get better care coordination, MLTSS covers your services through a Managed Care Organization, also called an HMO or health plan. When you enroll in MLTSS, you will choose an MLTSS health plan.
Who qualifies for MLTSS?
To qualify for MLTSS, you must:
  • Live in the Greater Chicago Region, including Cook, DuPage, Kane, Kankakee, Lake and Will Counties
  • Get both full Medicaid and Medicare benefits (be “dual eligible”)
  • Get long term care services in a nursing facility or  waiver services in your home
How do I enroll in MLTSS?
Call us at 1-877-912-8880 (TTY 1-866-565-8576). Call Monday to Friday, 8 a.m. to 7 p.m. The call is free.
We do not have online enrollment at this time.
Do I have to enroll in MLTSS?
You must enroll if you:
  • Get full Medicaid and Medicare benefits
  • Opt out of MMAI
  • Live in the Greater Chicago Region, and
  • Live in a nursing home or get services from one of these five waiver programs:
    • Persons with Disabilities
    • Persons with Traumatic Brain Injuries
    • Persons with HIV/AIDs (these first 3 programs are part of the Home Services Program)
    • Persons who are Elderly/Aging (also called the Community Care Program)
    • Supportive Living Facilities
Who cannot enroll in MLTSS?
You cannot enroll in the MLTSS program if you:
  • Do not meet the requirements listed above
  • Get long term services and supports from the Developmental Disabilities Support or Residential waivers
What services does MLTSS cover?
MLTSS covers:
  • Nursing Home Care
  • Supportive Living Care
  • Home and Community Services you have qualified for that help you stay in your home, such as homemaker services, personal assistant services, emergency home response system, adult day services, and home delivered meals
  • Care management
  • Mental health services
  • Substance abuse services
  • Some non-emergency transportation
Some MLTSS health plans offer extra benefits at no cost to you.
 
What if I want to change my health plan after I enroll?
You can change your MLTSS health plan during the first 90 days. To change your health plan, call us at 1-877-912-8880 (TTY 1-866-565-8576). Call Monday to Friday, 8 a.m. to 7 p.m. The call is free.
After the first 90 days, you cannot change your health plan for one year. Once each year, you can change your health plan during the time called “Open Enrollment.” 
 
What if I want to switch to MMAI after I enroll in MLTSS?
You can choose to enroll in MMAI instead of MLTSS at any time. You do not need to wait for Open Enrollment to join MMAI. To enroll in MMAI, call us at 1-877-912-8880 (TTY 1-866-565-8576). Call Monday to Friday, 8 a.m. to 7 p.m. The call is free.
 
What if I want to get all of my Medicare and Medicaid benefits from one health plan?
Enroll in MMAI if you want to get all your benefits in one health plan. MMAI brings together all of your Medicare, Medicaid, and prescription drug benefits into one MMAI health plan.
Most MMAI health plans also offer extra benefits such as more dental care and lower prescription co-pays. All MMAI health plans have a care coordinator to help you manage all of your health care and long term services and supports.
You can choose to enroll in MMAI instead of the MLTSS program at any time. To enroll in MMAI, call us at 1-877-912-8880 (TTY: 1-866-565-8576). Call Monday to Friday, 8 a.m. to 7 p.m. The call is free.
 
 

 

Contact Us

Questions?

Call us for more information.
The call is free.

1-877-912-8880
(TTY: 1-866-565-8576)

Hours

Monday to Friday
8 a.m. to 7 p.m.

Free interpretation services.