How is HealthChoice Illinois different than regular Medicaid?
HealthChoice Illinois is health coverage specially built to serve Medicaid members. Without managed care, most Medicaid members were given medical cards, and then it was up to them to find doctors and other medical providers. You may have heard of these cards as “Public Aid” cards too.
Now with HealthChoice Illinois, you can get the same services and options as under regular Medicaid – and even more.
With HealthChoice Illinois managed care, a health plan organization is there to help you find the right care at the right time and place.
What exactly are health plans?
They are the organizations you get to choose from. They offer you a network of doctors, hospitals, specialists, providers and other services. Their job is to make sure you are getting the health care that is available to you. The health plans are chosen to be part of HealthChoice Illinois only after they meet standards to show they can provide the right kind of care.
Helpful hint: If you already have a primary care provider or other medical professionals you trust, ask them which HealthChoice Illinois health plans they are signed up with and you can join that plan yourself.
How do I become a member of HealthChoice Illinois?
Check out “How to join” to find out if HealthChoice Illinois coverage might be available to you.
How do I find out which health plans I can choose from in my area?
There are several health plans you can pick from once you become part of HealthChoice Illinois:
Blue Cross Community Family Health Plan
CountyCare Health Plan (in Cook County only)
Merdian Health Plan
NextLevel Health (in Cook County only)
For more information, visit https://enrollhfs.illinois.gov/enroll
Can I change my health plan if I want to?
If you’re new to HealthChoice Illinois, you can change your health plan one time in your first 90 days. After that, you can change health plan once each year during your “open enrollment” period. This takes place one year after joining HealthChoice Illinois. You will be informed when this time is coming. (Please note that if you’re in the Medicare Medicaid Alignment Initiative (MMAI), you can change your health plan at any time.)
Can I keep my doctor as my Primary Care Provider (PCP)?
Yes, if you pick a health plan that your PCP is in. Your PCP is the doctor or clinic you go to when you are sick or need a checkup. To make sure you keep yours, contact your PCP to see which health plans they are part of.
What happens if I don’t choose a health plan during my choice period?
If you don’t choose a health plan by the deadline listed in your enrollment letter, a health plan and a PCP will be picked for you. That’s why it is so important to get informed and pick the plan that’s right for you.
Can I change my Primary Care Provider (PCP)?
Yes. You can change your PCP once a month. To change your PCP, call your health plan.
If my PCP leaves my health plan’s network, what do I do?
Contact your health plan as soon as possible. They will help you find a different provider who can meet your needs.
What if I have a treatment plan when I first enroll in a health plan?
If you are in a current, ongoing course of treatment, you can continue with your provider for 90 days when first enrolling in a health plan - whether that provider is in the plan’s network or not. You can then work with your health plan for future treatment.
Will I have co-pays?
If you have co-pays now, you may still have them. Some plans have no co-pays. Go to EnrollHFS.illinois.gov and click on “Compare Plans” to see which plans have co-pays.
I recently moved. Does this affect my health plan enrollment?
If your current health plan is also available in your new county, it will not make a difference to your coverage. But if current your plan is not available in your new county, make sure your Department of Human Services caseworker has your new address. You will be able to pick a new health plan after your address is updated. Until then, you’ll need to use your HFS Medical Card to receive benefits.
I recently had a baby. How can I enroll my newborn in a health plan?
Ask the hospital to help you add your baby to your medical case right away. If you do not have a medical case, you can apply for an HFS Medical card for your baby by calling 1-800-843-6154 or online at https://ABE.illinois.gov. You will receive an enrollment packet for your baby in the mail. The enrollment packet will give you your baby’s health plan options and a date for when you must decide.
What additional services does HealthChoice Illinois managed care offer?
Visit “The HealthChoice Illinois advantage” webpage to learn about added benefits that might be available to you above and beyond the services offered with regular, traditional Medicaid.
How can I contact my health plan?
For a list of member services and answers to other questions, check out the contact information on the medical card that your health plan gave you. If you do not have that, you can call their member services department.