FAQ
What is HealthChoice Illinois and what does it mean for me?
HealthChoice Illinois is the name of the newly expanded Medicaid managed care program in Illinois. Beginning January 1, 2018, all counties will be part of HealthChoice Illinois. Most clients will be required to pick a managed care health plan for their Medicaid services.
What is a health plan?
The group of doctors, hospitals, and other providers who work together to give you the healthcare you need. You can decide which of the available health plans is best for you and your family. Once you are a member of a health plan, you will see doctors and other providers that are in the health plan’s network.
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. Your PCP will send you (give you a referral) to specialists or other providers when needed.
Can I keep my doctor as my PCP?
Yes, if your doctor is in the health plan that you choose. Ask your doctor what health plans he or she accepts.
When can I start making appointments with my PCP?
When you enroll by phone or online, you will be given an estimated start date for your health plan. After you enroll, your health plan will send you a Welcome Packet in the mail. It will include your member ID card, a Member Handbook and your health plan start date. You can begin making appointments to see your PCP on the start date.
How do I change my address?
Please call the Health Benefits Hotline at 866-468-7543. You may also request a change of address online.
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.
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.
Emergencies include:
• 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.
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
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 we 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.