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

• 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

• 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

• Do not meet the requirements listed above
• Get long term services and supports from the Developmental Disabilities Support or Residential waivers

• 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