Jane Dotson
Illinois' Medicaid program is a federal-state initiative that offers health insurance to 3.3 million residents who meet specific eligibility requirements. The Illinois Department of Healthcare and Family Services (HFS) gives Medicaid recipients the option to change their plans annually during the open enrollment period. If you wish to change your insurance through Illinois Medicaid, you can do so by contacting the State's Client Enrollment Services via phone or their website. Additionally, you can apply for Illinois Medicaid benefits online, through an application form, or by visiting your local Family Community Resource Center.
| Characteristics | Values |
|---|---|
| How to change insurance through Illinois Medicaid | The Illinois Department of Healthcare and Family Services (HFS) will send letters once a year, giving those insured by Medicaid the option to change plans during the annual open enrollment period. |
| How often can you change plans? | Once a year during the annual open enrollment period. New enrollees can change their health plan once in the first 90 days. After that, they cannot change health plans for one year. |
| How to change plans | Call the State's Client Enrollment Services at 877.912.8880 or visit their enrollment website. |
| How to apply for Illinois Medicaid benefits | Apply online, complete an application form, or visit your local Family Community Resource Center. |
| How to find a center near you | Use the DHS Office Locator. |
| How to choose a plan | Call Illinois HFS Client Enrollment Services at 877.912.8880. |
| How to change your PCP | Call your health plan. You can change your PCP once a month. |
| How to report changes to your health insurance, assets, dependents, etc. | Call the DHS helpline at 1-800-843-6154. You can also report a change of address through the DHS website. |
| How often to renew your Medicaid | Every year through a process called redetermination. |
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What You'll Learn
Annual open enrollment period
In Illinois, the Illinois Department of Healthcare and Family Services (HFS) will send letters once a year, giving those insured by Medicaid the option to change plans. This is called the annual open enrollment period. If you are happy with your current plan, you don't need to do anything, and you will remain enrolled for another year. However, if you want to change plans, you can call the State's Client Enrollment Services at 877.912.8880 or visit their enrollment website. You can also apply online for Illinois Medicaid benefits or by completing an application form or visiting your local Family Community Resource Center.
The annual open enrollment period is a time when eligible Illinois residents who do not have health insurance can enroll in a health plan. It is also when consumers currently enrolled in a health plan can renew or change their plan. The next Open Enrollment Period will begin on November 1, 2025.
There is also a special enrollment period during which people can transition from Medicaid to Medicare without late enrollment penalties if they become eligible for Medicare. Additionally, there are certain life events that may qualify for a Special Enrollment Period throughout the year.
If you miss the deadline to submit the form, you may have to reapply for coverage. You may also need to reapply for yourself or other family members. To reapply, you can visit abe.illinois.gov/access/ or contact your HFS caseworker.
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Changing your Primary Care Provider (PCP)
If you're enrolled in an Illinois Medicaid health plan and want to change your Primary Care Provider (PCP), there are a few things you need to do. Firstly, it's important to note that you can only change your PCP once per month. So, if you've already made a change this month, you'll have to wait until the next month begins.
To initiate the change, you must contact your health plan. They will guide you through the process and help you choose a new PCP that suits your needs. You can find the contact information for your health plan by referring to the health plan member handbook or member ID card that you received upon enrollment. If you cannot locate this information, you can call the Department of Healthcare and Family Services Client Hotline at 1-800-226-0768, and they will provide you with the necessary details.
If you're adding a new baby to your medical case, you have the option to switch their PCP at any time. Your baby will initially be enrolled in your health plan, but you can choose to switch their health plan for any reason during the first 90 days. After that, they will remain enrolled in the same plan for the next 12 months.
Remember, if you're undergoing a specific treatment, you can continue with your current provider for 90 days, even if they are out of your health plan's network. This allows for continuity of care during the transition period.
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Adding a baby to your health plan
If your baby is added to your medical case within the first 90 days, they will be automatically enrolled in your health plan. You can keep your baby on your health plan, or you can switch their health plan for any reason during these first 90 days. After this period, your baby will remain enrolled in that health plan for 12 months. However, you can work with your health plan to change your baby's PCP at any time. If you are not enrolled in a health plan at the time of the baby's birth, you will receive an enrollment packet for your baby in the mail.
If you are pregnant, you may be eligible for Medicaid Presumptive Eligibility (MPE), which offers immediate, temporary coverage for outpatient healthcare. MPE is a program for pregnant women who meet certain income requirements. There are no co-payments or premiums in MPE. You must go to an MPE provider, who will decide if you can get MPE. You must tell the provider your family's gross monthly income. If you have a doctor or clinic, ask the office staff if they are an MPE provider. If not, or if you do not have a doctor or clinic, call the All Kids Hotline at 1-866-255-5437 to find a doctor or clinic.
With MPE, you can get outpatient services like prenatal checkups, doctor visits, lab tests, prenatal vitamins, medicine, specialty medical care, eye care, dental care, emergency room care, mental health and substance abuse services, transportation to get medical care, and other services. However, MPE does not cover hospital services, like labor and delivery. To get hospital services, you must apply for the Moms & Babies program. Moms & Babies covers healthcare for women while they are pregnant and for up to 12 months after the baby is born. It is the full Medicaid benefit package, including inpatient hospital care, primary and specialty care, and prescription drugs.
Remember, as a new enrollee, you can change your health plan once in the first 90 days. After that, you cannot change health plans for one year. Once each year, during the open enrollment period, you can change health plans.
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Changing your address
To change your address with Illinois Medicaid, you can use one of the following methods:
Online
Visit the website abe.illinois.gov/access/ to renew or update your address details.
By Phone
Call Illinois Medicaid at 800.843.6154 and ask for a new form to update your address.
By Mail
You can also receive an enrollment packet for your baby in the mail if you do not have a medical case or are not enrolled in a health plan at the time of the baby's birth.
In-Person
You can apply for Illinois Medicaid benefits in person by visiting your local Family Community Resource Center. You can find a center near you using the DHS Office Locator.
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Losing your health insurance
Secondly, your income may impact your eligibility for Medicaid. If your income increases, you may no longer qualify for Medicaid and will need to explore alternative insurance options. This can be a challenging transition, especially if your employer's insurance plan is too expensive. In such cases, you may need to consider purchasing private insurance, which can be costly, or exploring other low-cost insurance options.
Additionally, it's important to be aware of age-related restrictions. In Illinois, individuals aged 26 and above cannot remain on their parents' insurance plan and must apply for their own coverage. This transition can be challenging, and it's essential to plan ahead to ensure continuous coverage.
To avoid losing your health insurance, it's crucial to stay informed about any changes in eligibility requirements and to actively manage your coverage. Keep track of deadlines, submit any necessary forms or applications, and don't hesitate to reach out to the relevant state departments or insurance providers for clarification or assistance. By staying proactive and informed, you can help minimize the risk of losing your health insurance coverage.
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Frequently asked questions
The Illinois Department of Healthcare and Family Services (HFS) will send letters once a year, giving those insured by Medicaid the option to change plans. This is called the annual open enrollment period. If you want to change plans, you should call the State's Client Enrollment Services at 877.912.8880 or visit their enrollment website.
Call Illinois Medicaid at 800.843.6154 and ask for a new form.
You may have to re-apply for coverage. You may also need to re-apply for yourself or other family members. To re-apply, visit abe.illinois.gov/access/ or contact your HFS caseworker.
