Frequently Asked Questions (FAQs)
What is HealthChoice Illinois and what does it mean for me?
HealthChoice Illinois is the name of the statewide Medicaid managed care program in Illinois. Most Medicaid clients are required to pick a primary care provider (PCP) and a managed care health plan for their Medicaid services.
What is a health plan?
A health plan is a managed care organization with a network of 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 your 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?
If you already have a primary care provider (PCP) and you want to continue see that doctor, contact the office to find out which health plans your PCP accepts before you enroll. You should do the same thing with any specialists you want to continue seeing.
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?
Go to abe.illinois.gov and click on “Manage My Case”. Create a new ABE user ID and password or login using your existing user ID and password. You can also call the HFS Health Benefits Hotline at 1-866-468-7543.
What is open enrollment?
Open enrollment is the one time each year when you can change your HealthChoice Illinois health plan. It is only once a year. When it is time for open enrollment, we will send you a letter.
Will I lose any services?
You will not lose any services you are receiving under regular Medicaid. All managed care health plans cover the same services Medicaid covers. Some plans have extra services.
What is a co-pay?
A co-pay is the money you pay at the time of services. HealthChoice Illinois health plans cover all co-pays. You will not have to pay any co-pays while you are enrolled with a HealthChoice Illinois health plan.
What happens if I don’t choose a health plan and PCP?
If you don’t go online or call Client Enrollment Services to pick a health plan, our system 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?
You can change your PCP once a month. To change your PCP, call your health plan.
How will I get medical services?
When you or a family member need medical help, call your doctor to make an appointment. If you need help making an appointment, call your health plan and ask for your care coordinator. Your care coordinator can help you. 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 a referral from your doctor.
An emergency is a health problem that is life threatening or one that will cause serious health problems 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 program covers all your Medicare and Medicaid benefits, including prescription drug benefits (Medicare Part D) under one health plan.
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?
None of the MMAI health plans have co-pays for medical services. Some of the MMAI plans have co-pays for Part D covered prescriptions. 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 (private 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?
We will educate you on all your plan options and look up which plans your current providers accept, but 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. If you receive long term care or waiver services, you will still need to enroll in an LTSS health plan for those services only.
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.
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.