To Join A Different Medicare
If you want to keep getting your Medicare and Medicaid benefits together from a single plan, you can join a different Medicare-Medicaid plan.
- Call Illinois Client Enrollment Services at 877-912-8880 , Monday Friday, 8 a.m. 6 p.m., and Saturday, 9 a.m. 3 p.m., Central time.
- Tell them that you want to leave Humana Gold Plus Integrated and join a different Medicare-Medicaid plan. If you are not sure what plan you want to join, they can tell you about other plans in your area.
- If you request to change plans before the 18th of the month, your membership will end on the last day of that same month. Your new coverage will begin the first day of the next month. For example, if Illinois Client Enrollment Services gets your request on August 6, your coverage in the new plan will begin September 1.
- If you request to change plans after the 18th of the month, your membership will end on the last day of the following month. Your new coverage will begin the first day of the month after that. For example, if Illinois Client Enrollment Services gets your request on August 24, your coverage in the new plan will begin October 1.
Illinois Has Accepted Federal Medicaid Expansion
- 3,342,166 Number of Illinoisans covered by Medicaid/CHIP as of June 2021
- 715,223 Increase in the number of Illinoisans covered by Medicaid/CHIP fall 2013 to May 2021
- 46% Reduction in the uninsured rate from 2010 to 2019
- 27% Increase in total Medicaid/CHIP enrollment in Illinois since Medicaid expansion took effect
Centers For Medicare & Medicaid Services
Medicare is the federal health insurance program for people 65 years of age or older, some people under age 65 with disabilities, and people with end-stage kidney disease . The federal agency in charge of Medicare is the Centers for Medicare & Medicaid Services, or CMS.
800-MEDICARE , 24 hours a day, 7even days a week
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I Was Approved For Medicaid Whats Next
Congratulations! This is an important first step to better health and well-being. Coverage isnt only important when you are sick, its helpful when you dont feel sick. Now that you have Medicaid coverage, you can use your insurance to:
-Visit your doctor
-Get preventive care
-Get prescription medicines that you need
Follow the links on the right side of this page to learn what you need to do next, how to stay covered, and how to get the most out of your Medicaid coverage.
How You Will Get Medicare Services
Original Medicarewitha separate Medicare prescription drug plan
Original Medicarewithouta separate Medicare prescription drug plan
NOTE: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you tell Medicare you don’t want to join.
You should only drop prescription drug coverage if you get drug coverage from an employer, union, or other source. If you have questions about whether you need drug coverage, call your Senior Health Insurance Program at 800-548-9034.
Call Medicare at 800-MEDICARE , 24 hours a day, 7 days a week, to enroll in the new Medicare-only health plan.
If you need help or more information:
- Call the Senior Health Insurance Program at 800-548-9034.
You will automatically be disenrolled from Humana Gold Plus Integrated when your new plan’s coverage begins.
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Illinois Home Care Ombudsman Program
The Illinois Home Care Ombudsman Program works as an advocate on your behalf. Program employees can:
- Answer questions if you have a problem or complaint
- Help you understand what to do
- Help you file a complaint or an appeal with our plan
The Illinois Home Care Ombudsman Program is not affiliated with Humana Gold Plus Integrated or with any other insurance company or health plan.
800-252-8966 , Monday Friday, from 8:30 a.m. 5 p.m., Central time
Who Is This Program For
The MMAI is for people who meet all of the following requirements:
- Live in Adams, Alexander, Bond, Boone, Brown, Bureau, Calhoun, Carroll, Cass, Christian, Clark, Clay, Clinton, Coles, Cook, Crawford, Cumberland, DeKalb, De Witt, Douglas, DuPage, Edgar, Edwards, Fayette, Ford, Franklin, Fulton, Gallatin, Greene, Grundy, Hancock, Hamilton, Hardin, Henderson, Henry, Iroquois, Jackson, Jasper, Jefferson, Jersey, Jo Daviess, Johnson, Kane, Kankakee, Kendall, Knox, Lake, La Salle, Lawrence, Lee, Livingston, Logan, Macon, Madison, Marion, Marshall, McDonough, McHenry, McLean, Macoupin, Mason, Menard, Mercer, Monroe, Montgomery, Morgan, Moultrie, Ogle, Peoria, Perry, Piatt, Pike, Pope, Pulaski, Putnam, Randolph, Richland, Rock Island, Saline, Sangamon, Schuyler, Scott, Shelby, Stark, St. Clair, Stephenson, Tazewell, Union, Vermilion, Wabash, Warren, Washington, Wayne, White, Whiteside, Will, Williamson, Woodford, or Winnebago county, and
- Have both Medicare Part A and Medicare Part B, and
- Are eligible for Medicaid, and
- Are a United States citizen or are lawfully present in the United States, and
- Are age 21 and older when you enroll, and
- Are enrolled in the Medicaid Aid to the Aged, Blind and Disabled category of assistance, and
- If you meet all other Demonstration criteria and are in one of these Medicaid 1915 waivers:
- Persons who are Elderly
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Who Is Eligible For Medicaid In Illinois
Federal law specifies mandatory and optional coverage groups for Medicaid. States must cover the mandatory groups to receive federal Medicaid funding, and they qualify for additional funding if they cover optional groups.
The federal government specifies minimum thresholds for eligibility for the various groups, and states can set their requirements at or above the minimum threshold. Illinois has established requirements that are near national averages.
Humana Gold Plus Integrated Disenrollment
You can request to end your membership in Humana Gold Plus Integrated at any time.
If you want to go back to getting your Medicare and Medicaid services separately:
- Your membership will end on the last day of the month that we get your request to change your plan. Your new coverage will begin the first day of the next month. For example, if we get your request on January 18, your new coverage will begin February 1.
If you want to switch to a different Medicare-Medicaid plan:
- If you request to change plans before the 18th of the month, your membership will end on the last day of that same month. Your new coverage will begin the first day of the next month. For example, if Illinois Client Enrollment Services gets your request on August 6, your coverage in the new plan will begin September 1.
- If you request to change plans after the 18th of the month, your membership will end on the last day of the following month. Your new coverage will begin the first day of the month after that. For example, if Illinois Client Enrollment Services gets your request on August 24, your coverage in the new plan will begin October 1.
For more information about when you can end enrollment in Humana Gold Plus Integrated, call:
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We Cannot Disenroll You From Our Plan For Any Of The Following Reasons
- Because of an adverse change in a members health status
- Because of the members utilization of covered services
- Because of diminished mental capacity or uncooperative or disruptive behavior resulting from such members special needs
- Because the member attempts to exercise, or is exercising, his or her appeal or grievance rights
We may, however, submit a written request, accompanied by supporting documentation, to the department and CMS to disenroll a member, for cause, if:
The members continued enrollment seriously impairs the contractors ability to furnish covered services to either this member or other members, provided the members behavior is determined to be unrelated to an adverse change in the members health status, or because of the members utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs.
For More Information About Ending Your Enrollment
For more information about ending your enrollment:
- Call Customer Care at 800-787-3311 , Monday Friday, 8 a.m. 8 p.m., Central time
Please note that our automated phone system may answer your call during weekends and holidays. You may leave your name and telephone number, and well call you back by the end of the next business day.
- Call Illinois Client Enrollment Services at 877-912-8880 , Monday Friday, 8 a.m. 6 p.m., and Saturday, 9 a.m. 3 p.m., Central time
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Humana Gold Plus Integrated Eligibility
You are eligible to enroll in Humana Gold Plus Integrated as long as you:
- Live in our service area, and
- Have Medicare Part A and Medicare Part B, and
- Are eligible for Medicare, and
- Are a U.S. citizen or are lawfully present in the U.S., and
- Are at least 21 years of age or older at the time of enrollment, and
- Are enrolled in the Medicaid Aid to the Aged, Blind, and Disabled category of assistance, and
- Meet all other Demonstration criteria and are in one of the following Medicaid 1915 waivers:
- Persons who are elderly
- Persons with brain injuries
- Persons residing in supportive living facilities
Individuals enrolled in home- and community-based services or waiver, and/or those residing in a nursing facility or long-term care facility, also may be eligible.
Joining is risk free. You can go back to your original Medicare-Medicaid plan, switch to another carrier, or even opt out completely. You have the power to choose.
Until Your Membership Ends You Will Keep Getting Your Medical Services And Drugs Through Our Plan
If you leave Humana Gold Plus Integrated, it may take time before your membership ends and your new Medicare and Medicaid coverage begins. During this time, you will keep getting your healthcare and drugs through our plan.
- You should use our network pharmacies to get your prescriptions filled. Usually, your prescription drugs are covered only if they are filled at a network pharmacy including through our mail-order pharmacy services.
- If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged. This will happen even if your new health coverage begins before you are discharged.
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How You Will Get Medicaid Services
If you leave Humana Gold Plus Integrated, you will either get your Medicaid services through fee-for-service or be required to enroll in the HealthChoice Illinois Managed Long-Term Services and Supports program to get your Medicaid services.
If you are in a nursing facility or are enrolled in a home- and community-based service waiver, you will be required to enroll in the HealthChoice Illinois MLTSS program to get your Medicaid services.
To choose a HealthChoice Illinois MLTSS health plan:
- Call Illinois Client Enrollment Services at 877-912-8880 , Monday Friday, from 8 a.m. 6 p.m., and
- Tell them that you want to leave our plan and join a HealthChoice Illinois MLTSS health plan
If you are not in a nursing facility or enrolled in an HCBS waiver, you will be in Medicaid fee-for-service. This is how you received your Medicaid services before joining our plan. You can see any provider that accepts Medicaid and new patients.
Upon enrollment in a new plan, you will get a new member ID card, Member Handbook, and Provider and Pharmacy Directory from that plan.
To Disenroll From Humana Gold Plus Integrated And Still Get Medicare And Medicaid Benefits Without Enrolling In A New Medicare
If you do not want to enroll in a different Medicare-Medicaid plan after you leave Humana Gold Plus Integrated, you will go back to getting your Medicare and Medicaid services separately.
You have 3 options for getting your Medicare services. By choosing 1 of these options, you will automatically end your membership in our plan.
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Hepatitis C Drug Coverage Expanded In Stages Now Available To Anyone With The Disease
In the past few years, drugs that can cure Hepatitis C have burst onto the medical scene, heralded as miracles. But they can also be a strain on budgets, as the pill initially could cost more than $1,000 per day, and the treatment course lasts 12 weeks. Medicaid programs across the country have been grappled with how to handle the situation, and Illinois announced in September 2016 that they would loosen their guidelines in terms of when Hepatitis C drugs would be covered.
Rather than restricting coverage only to the sickest patients, Illinois Medicaid began to cover Hepatitis C drugs for people with stage 3 and 4 liver scarring, rather than just 4. Advocates cheered the new rules, but cautioned that there was still no coverage for treatment in people with chronic Hepatitis C that hadnt progressed as far as stage 3 liver scarring, and urged the state to continue to consider the issue.
By 2018, the price of Hepatitis C medications had declined, and a generic version was set to hit the market in early 2019, priced at $24,000 for the full treatment course . And in October 2018, the state eliminated the restrictions on access to Hepatitis C drugs, allowing several thousand Illinois residents to obtain Hepatitis C medication through Medicaid, regardless of the stage of their disease and without having to prove sobriety.
Medicaid Funding For Enhanced Mental Health Care
In September 2016, Illinois officials requested permission from the federal government to use existing Medicaid funds to test different approaches to treating Medicaid enrollees who need mental health and/or substance abuse treatment. The state had planned to implement the changes in July 2017, but CMS didnt approve the waiver proposal until May 2018.
The idea is to focus more on preventive care, supportive housing services, and community-based care, rather than institutional care. The state notes that while 25% of Illinois Medicaid enrollees have mental health and/or substance abuse diagnoses, their treatment accounts for 56% of the Medicaid programs total cost.
Under the terms of the approved waiver, Illinois is running ten pilot projects that provide coverage for services that werent previously covered by Medicaid, including short-term inpatient substance abuse treatment, services to help people manage withdrawals during substance abuse recovery, home health visits for new babies and for children born to opioid-addicted mothers, and job coaching and transportation services designed to help people obtain and keep employment.
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What Is Redetermination
Redetermination is a review of a recipients eligibility for Medicaid and All Kids. Redetermination requires you to return a renew annually online or by returning the renewal form to see if you still qualify for a medical card.
You will receive an initial letter from the State telling you that your redetermination form is on the way. Then, about two weeks later, you will receive the actual redetermination form in the mail. Please pay close attention to the due date, and make sure you return it on time.
If you don’t return the renewal form by the due date, your child’s medical card will be canceled.
Do You Need More Help
If you arent sure if your Medicaid coverage has been approved yet or if it is still active, you can check Manage My Case or call the states Automated Voice Recognition System at 1-855-828-4995 with your Recipient Identification Number .
If you have an urgent medical need and need Medicaid quickly, call the DHS Helpline at 1-800-843-6150.
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Behavioral Health Crisis Line
855-371-9234 , Monday Friday, 24 hours a day, 7 days a week
Qualified mental health professionals can answer questions, assess your mental health, and provide and coordinate services as needed.
In the event of a life-threatening emergency or an emergency that poses a threat to the lives of others or property, call 911 or go directly to the nearest emergency room .
What Should I Do If I Am Already Enrolled In A Medicaid Plan And I Received A Letter From The State Asking If I Want To Change My Plan
The Illinois Department of Healthcare and Family Services will send letters once a year, giving those insured by Medicaid the option to change plans. This is called your annual open enrollment period.
If you are enrolled in a plan that is meeting your needs, you do not have to do anything. You will remain in that Medicaid plan for another year.
If you want to change plans, you should call the State’s Client Enrollment Services at or visit their enrollment website.
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What To Do If Your Child’s Medical Card Has Been Canceled
If your child’s medical card has been canceled, it is possible that:
Depending on what caused your child’s medical card to be canceled, there may be ways to restore it or find alternative forms of health insurance. To learn what you should do next, find the scenario below that matches your situation.
