Your Medicare and Medicaid Could Be Changing This Fall


Individuals enrolled in Medicaid and Medicare will start to receive mail on November 1st regarding changes to their dual enrollment plans. If you are enrolled in both healthcare programs, your insurance could be changing to Medicare-Medicaid Alignment Initiative (MMAI). MMAI is a voluntary health program for people with both Medicaid and Medicare.

In MMAI, individuals will be able to receive all health benefits through one plan and have only one card when they go to the doctor, hospital, or pharmacy; simplifying the way individuals access their benefits. Through MMAI, beneficiaries can get all of their benefits through one health plan, instead of accessing different types of benefits separately through Medicare Part A, Medicare Part B, Medicare Part D, and Medicaid. Beneficiaries must use the plan’s network of doctors, specialists, hospitals, and pharmacies. MMAI is not a HealthChoice Illinois Program. As a consumer, it is important to know and understand what all of these changes mean, what your options are, and what works best for you.


Enrollment

If you are on both Medicaid and Medicare, you may receive information in the mail explaining that you have been automatically enrolled in a MMAI program. You will have 60 days before the effective date to choose a different plan or to opt-out of MMAI completely. If you take no action, you will remain automatically enrolled in the plan listed on your notice.

  • Qualifying individuals will be automatically enrolled in a MMAI program.

  • Beneficiaries will receive an enrollment packet with their selected plan in the mail.

  • Individuals will have at least 60 days before the effective date to choose their plan or opt-out of MMAI completely.

  • If no active choice is made by the individual, Client Enrollment Services will proceed with passive enrollment into the MMAI plan listed in the notice.

  • An individual can enroll, disenroll, or switch MMAI plans at any time of the year, even if the beneficiary is automatically enrolled

  • Reminder: all enrollment/disenrollment is conducted through Client Enrollment Services – so dial MMAI Ombudsman at 877-912-8880

  • Disenrollment date will be effective the 1st of the month, following the month of the disenrollment request

  • If a beneficiary chooses to opt out of MMAI, they will return to Original Medicare, FFS Medicaid, and a standalone PDP.

  • For Randolph County residents that have never been enrolled in an MMAI plan before: MMAI provides a 180 day “Transition Period” for brand new MMAI plan enrollees where the beneficiary can continue seeing out of network providers if they are receiving current ongoing treatment

  • What does this mean: if a patient was auto-enrolled in a plan that Memorial Hospital/Chester Clinic/Steeleville Family Practice is not in network with, they have a 180 day grace period to continue seeing Memorial Hospital/Chester Clinic/Steeleville Family Practice providers before they will need to find an in-network provider or switch to a plan Memorial Hospital/Chester Clinic/Steeleville Family Practice accepts

  • For individuals that have been in MMAI plans prior to 2021, the transition period is 90 days for switching plans

  • What does this mean: if a patient was auto-enrolled in a plan that Memorial Hospital/Chester Clinic/Steeleville Family Practice is not in network with and have been in MMAI before, they have a 90 day grace period to continue seeing Memorial Hospital/Chester Clinic/Steeleville Family Practice providers before they will need to find an in-network provider or switch to a plan Memorial Hospital/Chester Clinic/Steeleville Family Practice accepts

Coverage

MMAI health plans cover all of the services that Medicare and Medicaid cover. Coverage is PLAN SPECIFIC and individuals should check with the plan options to make their decision. Coverage includes:

  • Doctor visits​

  • Hospital stays​

  • Home health​

  • Medical equipment​

  • Lab tests​

  • Ambulance​

  • Skilled nursing care​

  • Prescription drugs​

  • Hearing and vision services​

  • Mental/behavioral health and substance use services​

  • Transportation​

  • Dental

  • Long term services and supports (LTSS) - services provided in a nursing home, supportive living facility (SLF) or in your home through the Community Care Program or Department of Rehabilitative Services

MMAI plans may also cover additional services, depending on the plan:

  • Extra dental, vision, or transportation services​

  • $0 for most prescription drugs​

  • Some over-the-counter medications and supplies​

  • Gym memberships or fitness classes​

  • Gift cards or other incentives for receiving certain preventive healthcare services​

Care coordination services are also offered with all MMAI plans. Care coordinators can help navigate the healthcare system and schedule appointments, manage chronic health conditions, find resources, and assist with appeals requesting coverage for services/prescription drugs that are not typically covered by the plan.


Questions

What should I consider when choosing an MMAI plan?

  1. Are your providers in the plan’s network?

  2. Does the plan cover your prescription drugs?

  3. Does the plan require prior authorization or other restrictions on any of your prescription drugs?

  4. Does the plan offer extra benefits that might be helpful?

What plans will Memorial Hospital, Chester Clinic, and Steeleville Family Practice be accepting?

  • Traditional Medicare/Traditional Medicaid,

  • Blue Cross Community MMAI (Medicare-Medicaid Plan)

  • Molina Healthcare Dual Options Medicare-Medicaid Plan

If you were auto-enrolled in a different MMAI plan and wish to continue receiving services at Memorial Hospital, Chester Clinic or Steeleville Family Practice, you will need to opt-out of your current plan and choose a plan as listed above or revert back to Traditional Medicare/Traditional Medicaid.


Where can I get help with enrollment?

If you need assistance with switching plans, we can help at 618-826-4581, explain you need to speak with someone about MMAI network benefits and you will be transferred appropriately or call the Senior HelpLine and ask for the MMAI Ombudsman at 877-912-8880.


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