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Using your new coverage

Congratulations on getting covered.

Working with your new health coverage can be confusing, but Get Covered Illinois has resources that can help.

You can also use this information if you want to learn more about your coverage options before you apply or enroll.

You’ve Chosen a Health Plan through the Marketplace. Now What?
Congratulations on choosing a health plan. Your enrollment is not complete until you make your first payment to your insurance company. In order to finish enrollment, you need to pay your premium by the end of the month before your coverage start date. Some companies may have other payment deadlines, so please check with your insurance company as soon as possible to make sure you secure coverage. You will be contacted about making your first premium payment by your insurance company. After you make the first monthly payment, be sure to verify that your insurance company received it. That way, you’ll know that you are covered and can use your insurance. You should also contact your insurance company if you do not receive information about making a payment within a few days of selecting your plan on HealthCare.gov

The insurance company phone numbers are below for you to call:

Aetna – 1-877-302-3862
Blue Cross Blue Shield of Illinois –  1-800-538-8833
Coventry – 1-877-849-9690
Health Alliance – 1-866-247-3296 Ext. 1425
Humana – 1-888-543-2058
Land of Lincoln – 1-877-371-6155
What should I do if I have already enrolled in a health plan but my doctor is not in my plan’s network?
If you enroll in a Marketplace plan, you can switch to any other Marketplace plan until the date your coverage is effective. Once your coverage is effective, you won’t be able to change your plan until the next Open Enrollment Period begins in November 2014 unless you qualify for a Special Enrollment Period. You may be eligible for a Special Enrollment Period if you have experienced a Qualifying Life Event, such as giving birth to a child or loss of job–based coverage. If your insurance company or the Marketplace displayed incorrect information that affected your plan choice, you may also qualify for a Special Enrollment Period. Call the Get Covered Illinois Help Desk at (866) 311-1119 to speak with a trained representative.
How do I use my new plan to visit the doctor?
Before you visit a doctor, it’s important that you make sure they are in your new health plan’s provider network. You can get this information by calling your insurer or checking their website. Below are resources for each insurance company in Illinois. Be sure to check the network for your specific plan and confirm with your insurance company that the doctor you are visiting is in-network for your plan.

Insurance Company Phone Number Doctors Covered
Aetna (877) 302-3862 Click here for a list of doctors covered by Aetna plans.
Blue Cross Blue Shield of Illinois (800) 538-8833 Click here for a list of doctors covered by Blue Cross Blue Shield of Illinois plans.
Coventry (877) 849-9690 Click here for a list of doctors covered by Coventry plans.
Health Alliance (866)247-3296 Ext. 1425 Click here for a list of doctors covered by Health Alliance plans.
Humana (888) 543-2058 Call Humana to determine which network your plan uses.
Land of Lincoln (877) 371-6155 Click here for a list of doctors covered by Land of Lincoln plans.

After you select a doctor who is in your plan’s network, you can call the office and schedule your visit.

Make sure that you bring your insurance card or plan information and ID to your appointment. Confirm with your doctor that they don’t need any other information for your first visit.

How can I see if my current doctor is in-network?
It is important to check to see whether a doctor is covered by your plan before you make an appointment. Listed below are a few steps to make sure your doctor is in-network.

  1. Make a list of all the providers you use. Providers are health care professionals, like doctors, psychologists and therapists. Providers can also be health care facilities, like hospitals, urgent care clinics and pharmacies.
  2. Look at a list of providers in your plan’s network by visiting your insurance company’s website. A list of websites is provided below.
  3. Confirm with your insurance company that you are searching the provider network of the specific plan that you have. This is important because insurers may have a specific provider listed as in-network for some plans and out-of-network for other plans. You can call your insurance carrier directly or call the Get Covered Illinois Help Desk at (866) 311-1119 for help.
Insurance Company Phone Number Directory of Doctors
Aetna (877) 302-3862 Click here for a list of doctors covered by Aetna.
Blue Cross Blue Shield of Illinois (800) 538-8833 Click here for a list of doctors covered by Blue Cross Blue Shield of Illinois.
Coventry (877) 849-9690 Click here for a list of doctors covered by Coventry.
Health Alliance (866)247-3296 Ext. 1425 Click here for a list of doctors covered by Health Alliance.
Humana (888) 543-2058 Call Humana to determine which network your plan uses.
Land of Lincoln (877) 371-6155 Click here for a list of doctors covered by Land of Lincoln.
Will my new health plan cover my prescription medications?
Health plans will help pay the cost of certain prescription medications. To find out which prescriptions are covered through your new Marketplace plan, you can:

  • Visit your insurer’s website to see a list of prescriptions your plan covers, also called a formulary.
  • Call your insurer directly to find out what is covered, and have your plan information available.
  • Review any coverage materials that your insurance company mailed to you, including what pharmacies are in-network.

Just like different health plans cover different medications, different health plans allow you to get your medications from different pharmacies called in-network pharmacies.

Call your insurer or visit their website to find out whether your regular pharmacy is in-network under your new plan and, if not, what pharmacies in your area are in-network.

Make sure you look at your specific plan, and check back regularly to make sure that changes aren’t made in coverage for your medications.

Insurance Company Phone Number Covered Pharmacies and Prescription Drugs
Aetna (877) 302-3862 Click here for pharmacies covered by Aetna.Click here for lists of prescription drugs covered by Aetna individual and family plans.
Blue Cross Blue Shield of Illinois (800) 538-8833 Click here for pharmacies covered by Blue Cross Blue Shield of Illinois. Log into your MyPrime account for a plan specific list.Click here for lists of prescription drugs covered by Blue PPO individual and family plans. Click here for lists of prescription drugs covered by Blue Choice PPO and Blue Precision HMO individual and family plans.
Coventry (877) 849-9690 Click here for pharmacies covered by Coventry. Note, this is the website for Express Scripts, which Coventry uses for pharmacy services.Click here for lists of prescription drugs covered by Coventry individual and family plans.
Health Alliance (800) 851-3379, option 4, Monday through Friday, 8 a.m. to 5 p.m. Click here for pharmacies covered by Health Alliance.Click here for lists of prescription drugs covered by Health Alliance individual and family plans.
Humana (888) 543-2058 Click here for pharmacies covered by Humana. Log into your MyHumana account for a plan specific list.Call Humana to determine which drug list your plan uses.
Land of Lincoln (877) 371-6155 Click here for pharmacies covered by Land of Lincoln.Click here for lists of prescription drugs covered by Land of Lincoln individual and family plans.Note, these are websites for Catamaran, which Land of Lincoln uses for prescription drug benefits.

Note: Drug lists above are for individual and family plans. Small business owners and employees should contact insurance companies for drugs covered under small group plans.

Some insurers may provide a one-time refill for your medication after you first enroll. Ask your insurer if they offer a one-time refill until you can discuss next steps with your doctor. If you cannot get a one-time refill, you have the right to follow your insurer’s medicine exceptions process.

Does my plan cover emergency care?
In an emergency, you should get care from the closest hospital.Insurers cannot require you to get permission before getting emergency room services from a provider or hospital outside your plan’s network or make you pay more than you would pay for a provider or hospital inside your plan’s network.If you have not received your insurance card, you may still be able to use coverage to pay for services. Call your insurer or have the emergency room do so, to confirm your coverage is effective.

Aetna – (877) 302-3862
Blue Cross Blue Shield of Illinois –  (800) 538-8833
Coventry – (877) 849-9690
Health Alliance – (866)247-3296 Ext. 1425
Humana – (888) 543-2058
Land of Lincoln – (877) 371-6155
What do I do if I have chosen a plan, but have not paid my premium?
In order to finish enrollment, you need to pay your premium by the end of the month before your coverage start date. You may be contacted about making your first premium payment by your insurance company. For quicker service, you can call your insurance company directly. Make sure to have your social security number, payment information and member ID, if it’s available, when you call.

Aetna: (877)302-3862
Blue Cross Blue Shield: (800)538-8833
Coventry: (877)849-9690
Health Alliance: (866)247-3296 Ext. 1425
Humana: (888)543-2058
Land of Lincoln: (877)371-6155

You can also call the Get Covered Illinois Help Desk at (866) 311-1119 for help. The Help Desk can help answer your questions and transfer your calls.

What should I do if I signed up for a health plan through the Marketplace, but have not received my insurance card?
Even though you have not received your insurance card, you may still be able to use your coverage for services. If you need to see a doctor or get a prescription filled before you get your insurance card, call your insurer to confirm your coverage is effective.

Aetna: (877)302-3862
Blue Cross Blue Shield: (800)538-8833
Coventry: (877)849-9690
Health Alliance: (866)247-3296 Ext. 1425
Humana: (888)543-2058
Land of Lincoln: (877)371-6155

You can also call the Get Covered Illinois Help Desk at (866) 311-1119 for help. The Help Desk can help answer your questions and transfer your calls to get you to the right place.

How do I use my Medicaid coverage to visit the doctor?
Once you have been approved for Medicaid, you will receive a piece of paper that has your Recipient Identification Number (RIN) on it. That is your medical card, keep it safe. Give your RIN to the Medicaid provider or pharmacy. When you are first enrolled in Medicaid, you can seek care from any Medicaid provider who is seeing new patients. At some point after enrollment, you will receive your client enrollment packet in the mail and will need to choose a primary care provider and health plan. You can find a list of providers in your area online. You can search for Medicaid providers by visiting the following sites:

  • If you live in Cook County, click here to find Medicaid providers.
  • If you live outside of Cook County, click here to find Medicaid providers. You can also call the Illinois Health Connect call center at (877)912-1999 (TTY: 1-866-565-8577).
What do I do if I need to see a doctor, but haven’t received any confirmation in the mail?
If you need health services while your Medicaid application is pending, make sure:

  1. That you visit a Medicaid provider. You can find a Medicaid provider online depending on where you live:
    • If you live in Cook County, click here to find Medicaid providers.
    • If you live outside of Cook County, click here to find Medicaid providers. You can also call the Illinois Health Connect call center at (877)912-1999 (TYY: 1-866-565-8577).
  2. That Medicaid covers the service that you need by calling the Health Benefits Hotline at (800)226-0768.
  3. That you ask the provider send you a bill and not require payment at time of service.
What do I do if I applied for Medicaid but saw a doctor before I was approved?
In many cases, Medicaid is able to cover unpaid medical bills back to the date of your application, or even three months before that if they are for Medicaid-covered services provided by a Medicaid provider. This does not apply to some children in higher income groups. Also, some adults without dependent children are only eligible for coverage back to January 1, 2014. Medicaid cannot reimburse you for bills you paid to a provider or pharmacy. If you are found eligible and there is an unpaid bill for Medicaid covered services from a Medicaid provider, you should contact the provider, give the provider your Recipient Identification Number (RIN) on your new medical card, and have the provider submit the bill to Medicaid.
I was told I was eligible for Medicaid, now what?
You will receive an approval letter in the mail. Within 10 days of receiving the approval letter, you will receive a piece of paper that includes your Recipient Identification Number (RIN) – that is your medical card, keep it safe. The RIN is what you give providers and pharmacies when you need care. Soon after getting your medical card, you will receive a client enrollment package in the mail. This will explain your benefits, and how to pick a primary care provider and health plan. If you live in Cook County, your client enrollment packet may be delayed. You can continue to access any Medicaid provider until you receive your client enrollment packet. Once you have been approved for Medicaid, even if you have not gotten your enrollment packet in the mail yet, you can find a list of providers in your area online. You can search for Medicaid providers by visiting the following sites:

  • If you live in Cook County, click here to find Medicaid providers.
  • If you live outside of Cook County, click here to find Medicaid providers. You can also call the Illinois Health Connect call center at (877)912-1999 (TTY: 1-866-565-8577).
When does my Medicaid coverage start?
If you are approved for Medicaid, you will have coverage for any unpaid bills for Medicaid-covered services by a Medicaid provider during the month when your coverage starts — even if you don’t get your Medicaid card until a following month.In many cases, Medicaid is able to cover unpaid medical bills back to the date of your application, or even three months before that if they are for Medicaid-covered services provided by a Medicaid provider. This does not apply to some children in higher income groups. Also, some adults without dependent children are only eligible for coverage back to January 1, 2014. Medicaid cannot reimburse you for bills you paid to a provider or pharmacy.Medicaid does not reimburse for medical bills that you pay while your application is pending. You can search for Medicaid providers by visiting the following sites:

  • If you live in Cook County, click here to find Medicaid providers.
  • If you live outside of Cook County, click here to find Medicaid providers. You can also call the Illinois Health Connect call center at (877)912-1999 (TTY: 1-866-565-8577).
If I am approved for Medicaid, will it cover my doctor/pharmacy bills from when I applied?
In many cases, Medicaid is able to cover unpaid medical bills back to the date of your application, or even three months before that if they are for Medicaid-covered services provided by a Medicaid provider.This may not apply to some children in higher income groups. Also, some adults without dependent children are only eligible for coverage back to January 1, 2014. Medicaid cannot reimburse you for bills you paid to a provider or pharmacy.If you are found eligible and there is an unpaid bill for Medicaid covered services from a Medicaid provider, you should contact the provider, give the provider your Recipient Identification Number (RIN) on your new medical card, and have the provider submit the bill to Medicaid.
How do I report an information change for my approved Medicaid case?
If you have Medicaid coverage, you must report any change that affects your benefits including:

  • A change in income
  • A change in the number of people living in your household
  • A change of address
  • Death
  • Discharge from a long-term care facility or skilled living facility
  • A change in assets if you are in the Aid to the Aged, Blind, or Disabled (AABD) program

You can report changes two ways:

  1. Send information in the mail to the local Family and Community Resource Center (FCRC) that is maintaining your case.
  2. Call the ABE Customer Call Center at (800)843-6154.

For more on reporting changes, click here.