Medicaid is a health care program for low-income families, individuals, and children. Medicaid is very different from Medicare, which is another federal health care program designed for seniors and some disabled people. While Medicaid is a federal health care program, each state does have some ability to customize the Medicaid program to the needs of its residents. This guide will explain the Illinois Medicaid program, also referred to as Health Choice Illinois.
Of the 12.6 million people who live in Illinois, over two million are covered by Medicaid. That equates to about one out of every seven adults, three out of every eight kids, four out of every seven nursing home residents, and four out of every nine disabled people. If you are eligible for Medicaid, you are not alone. Take advantage of the benefits available to you.
In 2019, you may be eligible for an Illinois Medicaid program if:
Your kids (up to age 19) can qualify for the Children's Health Insurance Program if your household income falls at or below 318% of the Federal Poverty Level.
If you make too much money to qualify for Illinois Medicaid but your medical spending puts you below the eligibility numbers, you may still be able to qualify for Medicaid reimbursements. This is called the “Pay-in Spenddown.” Those who qualify will receive notice. To get your reimbursements, be sure to keep track of all your medical spending each month. You’ll need to submit proof of your medical spending to the Medicaid program. You can do this through your local Department of Human Services office.
Generally, Illinois Medicaid covers:
Generally, Health Choice Illinois Medicaid dental coverage for adults includes x-rays, restorative services (like crowns), root canals, dentures and prosthetics, extractions, jaw restructuring, and related drugs. Kids get the added benefits of 6-month oral exams, cleanings, fluoride, sealants, space maintenance, bridges, orthodontics, and some other additional services.
Your Health Choice Illinois dental coverage will depend largely on your managed care plan, if you have one. If you are not enrolled in a Medicaid Managed Care plan, you’ll receive your Medicaid-covered dental care through DentaQuest. To find a dentist who accepts DentaQuest and Illinois Medicaid, visit the DentaQuest website or call 1-888-286-2447.
Health Choice Illinois includes coverage for one routine eye exam each year, as well as medically required eyeglasses. Kids generally have fewer restrictions when it comes to eyeglasses and prescriptions, but adults must medically require new lenses before Medicaid will cover a new pair.
Health Choice Illinois covers prescription drugs and some select over-the-counter products. Some drugs and products will require prior approval. It’s best to follow (and make sure your doctor follows) the Illinois Medicaid preferred drug list. For the most part, preferred drugs will not require prior authorization. If you need to request a non-preferred drug, call 1-800-252-8942 or fax your request to 217-524-7264. Sometimes, the prescribing doctor can submit the request for you.
Most Illinois Medicaid beneficiaries have coverage for ambulance transportation, but disabled adults can also receive non-ambulance transportation when necessary.
If you need non-emergency medical transportation and do not qualify for disabled non-emergency transportation, you may qualify for NETSPAP. NETSPAP is specifically for people with Health Choice Illinois who do not have a reliable and affordable means of transportation or cannot travel easily due to a health condition. NETSPAP provides non-emergency transportation through First Transit. You can get a ride to a medical appointment by calling (in advance): 877-725-0569.
To find Illinois doctors, hospitals, and specialists who accept Illinois Medicaid, click here. You’ll need to start by selecting a Primary Care Provider if you do not have one already. This will be the primary doctor that you go to for your preventative care and most of your health care needs. The search results will tell you which Managed Care Plans the doctors work with, what ages they serve, whether or not they are accepting new patients, and what hours the office is open. It will also provide a number so you can call and schedule your first appointment.
There are 13 Health Choice Illinois Managed Care Plans in 2018. Not every plan is available in every county and zip code, but most people will have at least five plans to choose from. Be careful when you make your selection, because they are not all the same. Not every doctor will accept every plan available in your area, so be sure to find out which plans your favorite doctors accept before making your decision.
There are five All Kids Illinois programs: FamilyCare/All Kids Assist, All Kids Share, All Kids Premium Level 1, All Kids Premium Level 2, and Moms and Babies:
It’s easy to apply for Illinois Medicaid online! Click here to apply for Medicaid, SNAP, Cash Assistance, and/or a Medicare Savings Program. If you need to, you can create an account, start your application, then save it and come back to it later. You can also select the “Spanish” option if Spanish is your primary language.
If you prefer, you can download the Illinois Medicaid Application form. You can type in your responses, or print and complete it. Then, you can either mail it to your local DHS (Department of Human Services) office or bring it into the office. To find your local DHS office, click here and search for “administrative office” in your county.
When you first select your Health Choice Illinois Managed Care plan, you have 90 days to make a change. After that, like any other medical plan, you can change your Health Choice Illinois plan once per year during the Open Enrollment Period (November 1 through December 15). If you have Medicare, your Annual Enrollment Period is October 15 through December 7, instead.
To set up an appointment with a licensed health insurance agent in the state of Illinois, complete this form or call us directly at 833-438-3676.
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