When Is Open Enrollment For Illinois Medicaid

Illinois Requires More Robust Coverage Of Mammograms On State

Illinois enacted legislation in 2019 to expand on the scope of mammography coverage that must be offered at no cost to residents enrolled in state-regulated plans .

The new law took effect in January 2020. It requires health plans to go beyond the federal preventive care mandate for mammography, which only requires insurers to coverwith no cost-sharing for the patientscreening mammograms .

Under the new law in Illinois, insurers have to continue to fully cover screening mammograms, but also have to cover breast ultrasounds and MRIs for women with dense breast tissue or women whose doctor believes the ultrasound or MRI is medically necessary. In addition, insurers will have to fully cover diagnostic mammograms, which are used when an abnormality is detected in the breast, either during a screening mammogram or otherwise.

The Illinois law does include an exception for plans that are HSA-qualified and would lose their HSA-qualified status if they provided pre-deductible coverage for anything beyond what the federal government considers preventive care. And as is the case with any insurance mandates, it only applies to state-regulated plans .

How Much Does Health Insurance Cost In Illinois

The Health Insurance Marketplace uses metal names to classify on-exchange health plans. Checking a plans tier makes it easier to estimate your total out-of-pocket costs for health coverage.

Plan details are prominent when you shop for a plan via the Health Insurance Marketplace. You can estimate your total out-of-pocket costs just by glancing at the plan summary. You can also download plan documents with more detailed information inside.

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.

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Looking For Plans Through Your Employer

This page features plans you can buy for yourself and your family. If you are looking for plans you might get through your employer, we can help get you there.

Find plans through your employer

Plans are insured by Cigna Health and Life Insurance Company or its affiliates: For Arizona residents, health plans are offered by Cigna HealthCare of Arizona, Inc. For Georgia residents, health plans are offered by Cigna HealthCare of Georgia, Inc. For Illinois residents, health plans are offered by Cigna HealthCare of Illinois, Inc. For North Carolina residents, health plans are offered by Cigna HealthCare of North Carolina, Inc. For South Carolina residents, health plans are offered by Cigna HealthCare of South Carolina, Inc. For Texas residents, health plans are offered by Cigna HealthCare of Texas, Inc.

1 $0 premium plans based on internal data for 2022. Final premium amount is after any applicable subsidy, based on household size and income, from the Federal government is applied. $0 deductible and $0 copay are available on select Cigna individual and family health care plans. Reference plan documents for more information.

3 Availability of $0 preventive care by plan may vary. Includes eligible in-network preventive care services. Some preventive care services may not be covered, including most immunizations for travel. Reference plan documents for a list of covered and non-covered preventive care services.

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Coverage For Young Adults

Under the Affordable Care Act, individual and group health plans that offer dependent benefits must allow parents to keep their children up to age 26 on their plan. Illinois law goes further than this by allowing certain dependent adults from age 26 up to their 30th birthday to remain on their parent’s insurance if it is a state-regulated plan that insures dependent children. These dependents must:

• Be an Illinois resident
• Be unmarried and
• Have served as a member of the active or reserve components of any branch of the U.S. Armed Forces and received a release or discharge other than a dishonorable discharge.

Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

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Medicare Initial Enrollment Period

The earliest time you can enroll in Original Medicare, a Medicare Advantage plan or a Medicare Part D prescription drug plan is during your Medicare Initial Enrollment Period .

Your Initial Enrollment period lasts for seven months:

• It begins three months before you turn 65
• It includes your birth month
• It extends for another three months after your birth month

If you are under 65 and qualify for Medicare due to disability, the 7-month period is based around your 25th month of disability benefits.

Frequently Asked Questions About Illinoiss Aca Marketplace

Illinois operates a partnership exchange with the federal government the state department of insurance runs Get Covered Illinois, including a website, in-person assistance, and a help desk, and the federal government provides the IT platform Healthcare.gov that Illinois residents use to enroll in coverage or make changes to their plan.

Former Gov. Pat Quinns administration announced in July 2012 that the Illinois marketplace would operate as a state-federal partnership. Quinn had hoped to leverage the partnership model as an interim step toward a state-run marketplace for the 2015 coverage year. However, a state exchange bill passed in the Senate in 2013 didnt get a vote in the House. There was some hope that exchange legislation would be considered during the fall 2014 session. However, the House did not take up the issue, and Illinois continues to have a partnership exchange .

Rep. Robyn Gabel had hoped the issue would gain traction in 2015, given that the U.S. Supreme Court was considering whether premium subsidies could be lawfully provided in states that dont run their own health insurance exchange. By transitioning to a state-run exchange, Illinois would have secured ongoing subsidies for its residents regardless of how the Court ruled. But the Court ultimately deemed subsidies to be legal in every state, regardless of whether the federal government is running the exchange or not.

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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 Does Illinois Medicaid Cover

Illinois’ Medicaid program provides coverage for necessary health care services, including preventative care. Its intention is to help seniors, children, pregnant women and families access quality medical services they’re not able to afford on their own. Services covered by basic Medicaid include:

• Mental health and substance abuse services
• Prescription medications
• Necessary medical equipment

On top of the traditional Medicaid program, Illinois also offers several other Medicaid program options for older adults that include varying other services.

HealthChoice is a managed care program that provides all the benefits of regular Medicaid, in addition to some of the following added benefits:

• 24-hour nursing helpline
• Transportation to and from appointments
• Transitional care

In addition to added health-related services, care coordinators also connect beneficiaries with resources such as nutritional assistance programs, energy assistance and support groups as needed.

The MMAI program helps older adults who receive Medicare and Medicaid benefits to coordinate their coverage and care. With this streamlined coverage, seniors are able to access extra supports, including:

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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

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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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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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.

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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.

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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Medicare Part D Prescription Drug Plan Enrollment

When youre eligible to enroll in Original Medicare, you also become eligible to enroll in a Medicare Part D prescription drug plan.

If you want Medicare prescription drug coverage, you typically have two options:

• Enroll in a Medicare Advantage plan that includes Part D prescription drug coverage, Medicare Part A hospital insurance and Part B medical insurance combined into a single plan
• Enroll in a Medicare Part D standalone prescription drug plan that can be paired with other insurance such as Original Medicare , Medicare Supplement plans or Medicare Advantage plans that don’t include drug coverage

In 2022, 23.1 million Medicare beneficiaries were enrolled in a standalone Part D Medicare drug plan.3

Learn more about Part D drug coverage. You can also enroll in a prescription drug plan online when you visit MyRxPlans.com.

Use Our Plan Finder Tool

You can compare your coverage options using eHealths online search tool and find affordable individual and family health insurance. We make it easy to find health plans that fit your needs and budget. Simply answer a few questions about your coverage needs, and well show you ACA plans in your state with a range of benefits and costs. If you want expert advice or assistance, you can speak with one of eHealths trusted licensed insurance agents. Our services are free of charge, and youre under no obligation to buy insurance to receive our help finding affordable medical coverage that meets your needs.

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How Do I Keep My Blue Cross Community Health Planssm Benefits

BCCHP knows your health is important to you. Once annually, you may have to complete a renewal process to keep your benefits. You can also decide to change your health care plan and choose BCCHP. The good news is both are easy to do!

Don’t risk losing your health insurance. Please update your address with Illinois Medicaid.

Illinois Medicaid needs to send you paperwork. To keep your health insurance, use an address where mail can always reach you. It’s easy, fast, and free.

When Can I Join Switch Or Drop A Plan

You can join, switch, or drop a

with or without drug coverage during these times:

• Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
• Open Enrollment Period. From October 15 December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 .
• Medicare Advantage Open Enrollment Period. From January 1 March 31 each year, if youre enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare once during this time. Note: You can only switch plans once during this period.

Learn more below about enrollment periods below.

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