Illinois State Medicaid Health Care Benefits Printable Application PDF Form for 2012 & 2013

April 17, 2012
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Illinois has over 12.7 million residents and some of these citizens may qualify for Medicaid health care benefits.  Unfortunately, the only way you will know if you qualify or are eligible is to complete an application online or sent through the mail.  The dhs.state.il.us website offers all the forms needed to apply for Medicaid in 2012 or 2013.  Make sure to access the following link to get all your Medicaid information: Printable Medicaid Application Forms Online.


Here is the application needed to apply this year:

Illinois PDF Medicaid Application

For more information on how to apply make sure to access this link.

Choices for Health Care Medicaid in the State of Illinois

Residents will have two choices of health care delivery once they have qualified for Medicaid.  Each member of a family can have an individual doctor or managed care program or there can be one doctor and/or program for the entire family.  No matter which decision is made the same amount of financial support will be offered by Medicaid.  If you decide to choose the “fee for service” Medicaid program you will have to find your own primary doctor that is associated with a Medicaid health care plan.  This can be quite the chore so you might want to start research now.  The managed care plan will manage all the health care needs of you and your family.

There are currently two types of managed care plans in the state of Illinois – Health Maintenance Organizations (HMOs) and Prepaid Health Plans (PHPs).  HMOs are usually sponsored by healthcare and insurance companies that happen to have both Medicaid and private patients.  A PHP is run by hospitals and medical schools and only has Medicaid patients.’

Managed Care Delivery System Options for Medicaid

There are three managed care delivery systems in the state of Illinois – Integrated Care Program (ICP), Primary Care Case Management (PCCM), and Voluntary Managed Care (VMC).

ICP is an Illinois program for older adults and adults with disabilities who are eligible for Medicaid but not Medicare.  It is a mandatory program in the counties of Cook (all zip codes that do not begin with “606”), DuPage, Kane, Kankakee, Lake and Will.  Those eligible must choose between Aetna Better Health and IlliniCare Health Plan, Inc.  Here is the contact information for each option:

IlliniCare Health Plan, Inc. (Centene)
99 Oakmont Plaza Drive, Suite 400
Westmont, IL  60559
1-866-329-4701
TDD/TTY:  Illinois Relay 7-1-1
IlliniCare Health Plan, Inc. Web site

Aetna Better Health
One South Wacker Drive, 12th Floor
Mail Stop F646
Chicago, IL 60606
1-866-212-2851
TDD/TTY: Illinois Relay 7-1-1
Aetna Better Health Web site

All children, Moms and Babies, and FamilyCare clients living in specific counties have the option to choose a PCP in a Managed Care Organization (MCO).  The counties that offer MCO options include Adams, Brown, Cook, Henry, Jackson, Kane, Lee, Madison, McHenry, Mercer, Perry, Pike, Randolph, Rock Island, St. Clair, Scott, Washington and Williamson. Remember that not all MCOs are available in all of these counties. Here are the MCOs that participate in the state of Illinois:

Harmony Health Plan – Cook and Kane Counties in northern Illinois, and Jackson, Madison, Perry, Randolph, St. Clair, Washington and Williamson counties in southern Illinois.

Harmony Health Plan
200 West Adams Street
Chicago, Illinois 60606
Telephone: 312-630-2025
Fax: 312-368-1784
Member Services: 1-800-608-8158

Family Health Network – has network of 29 hospitals, more than 590 primary care doctors, over 1,960 specialists, and more than 270 behavioral health professionals. Family Health Network serves Cook County.

Family Health Network
910 West Van Buren, 6th Floor
Chicago, Illinois 60607
Telephone: 312-491-1956
Fax: 312-491-1175
Member Services: 1-888-346-4968

Meridian Health Plan – Cook County in northern Illinois and Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott counties in western Illinois.

Meridian Health Plan
222 North LaSalle, Suite 930
Chicago, IL 60601
Fax: 312-705-2900
Member Services: 1-866-606-3700

Illinois’ Primary Care Case Management (PCCM) Program, named Illinois Health Connect, is the statewide health plan available to most individuals covered by an HFS Medical Program.

Check out the website at www.illinoishealthconnect.com or call Illinois Health Connect at:

Illinois Health Connect Helpline
1-877-912-1999
TTY: 1-866-565-8577
The call is free.

This can be all very confusing so I would suggest talking with someone who has gone through the process.  If you do not know anyone who has gone through this process then you can contact a Human Services Office in your area.  Check out this link to find out what is available.

Human Services Offices in Illinois

Here are some recent articles that should help many better understand where the state of Illinois is when it comes to Medicaid.  There are plenty of opportunities to receive financial help in the future.  July 2012 is going to be a huge date but it could be pushed up after an application from the state.

2012 Medicare Advantage Plans Available to Residents of Illinois

Here are some very valuable medicare advantage healthcare plans for those looking for a low monthly premium.  Note that these are Medicare plans and not Medicaid plans.

Adams County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00

Alexander County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Bond County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Boone County, IL

  • Coventry Total Care (HMO) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Brown County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Bureau County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Calhoun County, IL

  • Gold Advantage Option 1 (HMO) – Monthly Premium: $0.00

Carroll County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Cass County, IL

  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Champaign County, IL

  • WellCare Value (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00

Christian County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Clark County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Clay County, IL

  •  Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

 

Clinton County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Coles County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00

Cook County, IL

  • Aetna Medicare Value Plan (HMO) – Monthly Premium: $0.00
  • Aetna Medicare Standard Plan (PPO) – Monthly Premium: $79.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Crawford County, IL

  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

DeKalb County, IL

  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

De Witt County, IL

  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Douglas County, IL

  • WellCare Value (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

DuPage County, IL

  • HealthyAdvantage Preferred (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Edgar County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Edwards County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Effingham County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Fayette County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Franklin County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Fulton County, IL

  • Care Improvement Plus Medicare Advantage (PPO) – Monthly Premium: $53.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Gallatin County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Greene County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Grundy County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Hamilton County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Hancock County, IL

  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

Hardin County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Henderson County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

Henry County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Iroquois County, IL

  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

Jackson County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Jasper County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Jefferson County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Jersey County, IL

  • Gold Advantage Option 1 (HMO) – Monthly Premium: $0.00

Jo Daviess County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

Johnson County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Kane County, IL

  • HealthyAdvantage Preferred (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Kankakee County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Kendall County, IL

  • Humana Gold Plus H1406-022 (HMO) – Monthly Premium: $27.00
  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Knox County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Lake County, IL

  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

La Salle County, IL

  • Humana Gold Plus H1406-025 (HMO) – Monthly Premium: $47.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Lawrence County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Lee County, IL

  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Livingston County, IL

  • Humana Gold Plus H1468-007 (HMO) – Monthly Premium: $51.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

Logan County, IL

  • Humana Gold Plus H1406-026 (HMO) – Monthly Premium: $17.00
  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

McDonough County, IL

  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

McHenry County, IL

  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

McLean County, IL

  • Humana Gold Plus H1468-007 (HMO) – Monthly Premium: $51.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Macon County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Madison County, IL

  • Essence Advantage (HMO) – Monthly Premium: $0.00
  • AARP MedicareComplete Choice (PPO) – Monthly Premium: $42.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Marion County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Marshall County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00

Mason County, IL

  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

Massac County, IL

  • HumanaChoice H1418-016 (PPO) – Monthly Premium: $56.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Menard County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Mercer County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Monroe County, IL

  • Essence Advantage (HMO) – Monthly Premium: $0.00
  • AARP MedicareComplete Choice (PPO) – Monthly Premium: $42.00

Montgomery County, IL

  • Humana Gold Choice H8145-009 (PFFS) – Monthly Premium: $116.00

Morgan County, IL

  • Care Improvement Plus Medicare Advantage (PPO) – Monthly Premium: $53.00

Moultrie County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Ogle County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Peoria County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Today’s Options Premier Plus 450B (PFFS) – Monthly Premium: $27.00

Perry County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Piatt County, IL

  • PersonalCare (PPO) – Monthly Premium: $13.00

Pike County, IL

  • Care Improvement Plus Medicare Advantage (PPO) – Monthly Premium: $53.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Pulaski County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Putnam County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

Randolph County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Richland County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Rock Island County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

St. Clair County, IL

  • Essence Advantage (HMO) – Monthly Premium: $0.00
  • AARP MedicareComplete Choice (PPO) – Monthly Premium: $42.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Saline County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Sangamon County, IL

  • Humana Gold Plus H1406-026 (HMO) – Monthly Premium: $17.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Schuyler County, IL

  • Care Improvement Plus Medicare Advantage (PPO) – Monthly Premium: $53.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Scott County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00

Shelby County, IL

  • HumanaChoice H1418-007 (PPO) – Monthly Premium: $87.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Stark County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00

Stephenson County, IL

  • Humana Gold Plus H1406-026 (HMO) – Monthly Premium: $17.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Tazewell County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Today’s Options Premier Plus 450B (PFFS) – Monthly Premium: $27.00

Union County, IL

  • HumanaChoice H1418-016 (PPO) – Monthly Premium: $56.00
  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Vermilion County, IL

  • WellCare Value (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00

Wabash County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Warren County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • Care Improvement Plus Medicare Advantage (PPO) – Monthly Premium: $53.00

Washington County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Wayne County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

White County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Whiteside County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H5525-004 (PPO) – Monthly Premium: $87.00

Will County, IL

  • HealthyAdvantage Preferred (HMO-POS) – Monthly Premium: $0.00
  • HumanaChoice H1418-002 (PPO) – Monthly Premium: $97.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Williamson County, IL

  • Any, Any, Any Gold (PFFS) – Monthly Premium: $0.00

Winnebago County, IL

  • Coventry Total Care (HMO) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00
  • Humana Gold Choice H8145-008 (PFFS) – Monthly Premium: $121.00

Woodford County, IL

  • AARP MedicareComplete Plus Plan 1 (HMO-POS) – Monthly Premium: $0.00
  • PersonalCare (PPO) – Monthly Premium: $13.00

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