You may have received a letter that your Medicare and Medicaid services are with Humana through Humana Gold Plus® Integrated Medicare-Medicaid. Here’s what to expect during the first 180 days of enrollment in our health plan.
Welcome to Humana Gold Plus Integrated Medicare-Medicaid
When you first join Humana Gold Plus Integrated
Enrollment into Humana Gold Plus Integrated happens when someone eligible for our plan:
- Selects Humana to provide his or her Medicare and Medicaid coverage
- Is assigned to Humana by the state of Illinois, if he or she did not pick a health plan
For people who had coverage with a different health plan prior to joining Humana, they’ll keep the benefits and services they were getting PLUS get extra benefits, like additional dental, hearing, and vision coverage.
Understanding applicable transition periods
We want to make sure you continue getting the care and services you may be getting prior to joining Humana, even if you’re getting care and services from a provider who is not in our provider network. We call this continuity of coverage your transition period. The length of your transition period varies depending on your specific circumstances.
Members enrolling into the Humana Gold Plus Integrated plan have a 180-day transition period during which they may maintain a current course of treatment with a provider who is not in the Humana Gold Plus Integrated provider network.
Members who transfer to the Humana Gold Plus Integrated plan from another plan have a 90-day transition period during which they may maintain a current course of treatment with a provider who is not in the Humana Gold Plus Integrated provider network.
Members in a nursing facility when enrollment in Humana Gold Plus Integrated begins may remain in the facility as long as they continue to meet the criteria for nursing facility care, unless a member and/or his or her family prefers moving to a different nursing facility or returning to the community. Nursing facility continued stay criteria is established by the state of Illinois.
After the applicable transition period ends, members must see doctors and other providers in the Humana Gold Plus Integrated plan network. An in-network provider is a provider contracted to work our health plan. Your Member Handbook includes more information about in-network and out-of-network providers.
Medication help for new members
New Humana Gold Plus Integrated members may need help with medications. We want to make enrollment or transition into our plan as easy as possible.
- During the first 90 days of enrollment, members can receive up to a 30-day supply of the Part D drugs you currently take. If the prescription is for less than a 30-day supply, Humana Gold Plus Integrated will allow multiple fills of the prescription for up to a 30-day supply.
- During the first 180 days of enrollment, members will have access to the Medicaid-covered drugs they currently take:
- If the drug is not on our list of covered drugs
- If health plan rules do not cover the amount ordered by a doctor
- If the drug requires prior approval by Humana Gold Plus Integrated
- During the first 90 days of enrollment, for members who live in a long-term care facility
- Long-term care facilities may provide prescription medicine in small amounts at a time to prevent waste.
Please call us at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time, if you have questions, or to use our free interpreter services to answer questions about your health and drug plans.
Within the first 60 days of enrollment, members will receive a health risk screening (HRS) assessment. Some new members may receive an HRS screening within 15 days of enrollment. The HRS helps us understand a member’s healthcare needs. We provide each of our members with a personalized, accessible, and patient-centered approach to care using information we get from a completed HRS.
Most new members have 3 options for completing an HRS:
- We will call you to complete the HRS.
- We will send you an HRS to complete at home, if we can’t reach you by phone.
- We can visit you in your home and complete the HRS with you in person, if you want.
Some new members must receive an HRS in person. We will work with these members to set up a home visit.
When we send you an HRS, we also will send you a postage-paid return envelope for you to use to return the form to us. If you want help completing the form, we can call you or meet face to face.
For help, call us at 800-559-3917 (TTY: 711), Monday – Friday, 8 a.m. – 5 p.m., Central time, and choose option 4. However, please note that our automated phone system may answer your call after hours, during weekends, and on holidays. If prompted, please leave your name and telephone number, and we’ll call you back by the end of the next business day.
Humana Gold Plus Integrated