Changes are coming very soon if you have Medicare and full Medicaid (no spenddown). You will receive a letter in mail from Healthcare & Family Services (HFS). Be sure to respond to it! It is not junk mail!
The State of Illinois is forcing patients with Medicare & Medicaid into a managed care plan through the Medicare-Medicaid Alignment Initiative(MMAI). A managed care plan means that your healthcare will be controlled by an insurance company.
The letter will guide you through your options of selecting a plan, opting out (keeping your current coverage), or to do nothing. If you do nothing, you will automatically be assigned to a plan.
Here are a few Questions & Answer that may help you through this process:
- What is MMAI?
The Medicare Medicaid Alignment Initiative (MMAI) is an insurance program ran by the State of Illinois that replaces Medicare Parts A, B & D and your Medicaid secondary coverage.
- Is MMAI enrollment mandatory?
MMAI is mandatory, but individuals CAN OPT OUT of the program at any time and receive their original Medicare/Medicaid benefits as they do today.
- Who does this effect?
This will effect most Illinois residents over age 21 who have Medicare A & B as their primary coverage and Medicaid without a spenddown for their secondary insurance. If your insurance card says QMB Coverage – THIS WILL EFFECT YOU!
- What changes can I expect?
- There will be really big changes. The plan would require you to see in-network providers. Those providers may not be your hometown. It is important to call your current physician’s office and ask if they belong to the network of the plan you are considering.
- Another change is WHAT MAY BE COVERED. MMAI plans should have more benefits, but your care would have to be directed by your primary care doctor. Your current prescriptions may not be covered. Your care (tests, prescriptions, advanced imaging, surgeries) would have to be pre-approved through a lengthy prior authorization process.
- You should expect more difficulty to receive services. . To understand the plan specifics, you would have to contact the MMAI plan for questions.
- How does this impact my care at Orthopaedic Center of Southern Illinois?
OCSI does not plan to participate with these plans, which means you may need to seek orthopaedic care elsewhere.
- When will this happen?
The new plans would become effective September 1, 2021. You may have received your letter already.
- Who can help me opt out?
The number for the Senior Health Insurance Program is 618-242-3505. We have spoken with Eva, who is very knowledgeable and willing to guide Seniors through the changes.