Choosing a Managed Care Health Plan and Doctor

Last updated: September 30, 2021

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This section has some tips to make sure you choose the health plan and doctor that are best for you.

Choosing a managed care health plan and doctor

Most people approved for Medicaid will have to pick a managed care health plan in Health Choice Illinois. You will also need to choose a Primary Care Provider (PCP), who is your main doctor.

A health plan is the group of doctors, hospitals, and other providers who work together to coordinate all of your care. A health plan is also called a Managed Care Organization (MCO). All of your doctors, hospitals, and providers must be part of the same Health Plan, or MCO.

Choices you have to make and tips for choosing a plan

Illinois Client Enrollment Services will mail you an enrollment packet. This packet will include a letter saying by what date you need to choose a health plan. If you do not choose a plan by that date, a health plan and Primary Care Provider (PCP) will be chosen for you. Click here to view samples of all of the materials that will be in your enrollment packet.

Once you have picked a PCP and health plan, you will get information about your health plan and your health plan member ID card in the mail. You will use your health plan member ID card to get healthcare services.

Here are some questions to ask yourself that may help you decide which health plan and PCP are right for you.

Is there a doctor I already like?
What health plans does my doctor work with?
Does someone in my family have special needs?
How far do I want to travel to see my doctor?
Do I need a doctor who speaks a certain language?

To research the plans and decide which is right for you, go to EnrollHFS.Illinois.Gov for more information. You can also call the plan’s member services line to learn more about each plan.

For more help choosing a plan and finding a doctor, you can call Illinois Client Enrollment Services at (877) 912-8880 or go online to EnrollHFS.Illinois.Gov.

Changing your Health Plan or your Primary Care Provider

After you pick a health plan for the first time, if you decide you want a different plan, you have 90 days to change your health plan.

After that time, you cannot change your plan for about one year. You will be mailed a notice when it is time to change your plan.

You can call your health plan to change your Primary Care Provider (PCP) once per month. Call the plan’s member services number on your Member ID card to change your PCP.