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Humana Gold Plus Integrated eligibility

You are eligible to enroll in Humana Gold Plus Integrated as long as:

  • You live in our service area, and
  • You are eligible for Medicare Part A and enrolled in Medicare Parts B and D, and
  • You are receiving full Medicaid, and
  • You are at least 21 years of age or older at the time of enrollment

Individuals enrolled in home- and community-based services or waiver, and/or those residing in a nursing facility or long-term care facility, also may be eligible.

Joining is risk free. You can go back to your original Medicare-Medicaid plan, switch to another carrier, or even opt out completely. You have the power to choose.

Humana Gold Plus Integrated enrollment

To enroll in Humana Gold Plus Integrated:

  • Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a.m. – 6 p.m., and Saturday, 9 a.m. – 3 p.m., Central time
  • Visit the enrollment broker website, opens new window

Humana Gold Plus Integrated disenrollment

You can request to end your membership in Humana Gold Plus Integrated at any time.

If you want to go back to getting your Medicare and Medicaid services separately:

  • Your membership will end on the last day of the month that we get your request to change your plan. Your new coverage will begin the first day of the next month. For example, if we get your request on January 18, your new coverage will begin February 1.

If you want to switch to a different Medicare-Medicaid plan:

  • If you request to change plans before the 12th of the month, your membership will end on the last day of that same month. Your new coverage will begin the first day of the next month. For example, if we get your request on August 6, your coverage in the new plan will begin September 1.
  • If you request to change plans after the 12th of the month, your membership will end on the last day of the following month. Your new coverage will begin the first day of the month after that. For example, if we get your request on August 24, your coverage in the new plan will begin October 1.

For more information about when you can end enrollment in Humana Gold Plus Integrated, call:

  • Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a.m. – 6 p.m., and Saturday, 9 a.m. – 3 p.m., Central time
  • Senior Health Insurance Program (SHIP) at 800-548-9034 (TTY: 866-323-5321), Monday – Friday, 8:30 a.m. – 5 p.m., Central time
  • Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week

To end enrollment in Humana Gold Plus Integrated

  • Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a.m. – 6 p.m., and Saturday, 9 a.m. – 3 p.m., Central time,or
  • Call Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week

To join a different Medicare-Medicaid plan

If you want to keep getting your Medicare and Medicaid benefits together from a single plan, you can join a different Medicare-Medicaid plan.

  • Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a.m. – 6 p.m., and Saturday, 9 a.m. – 3 p.m., Central time.
  • Tell them that you want to leave Humana Gold Plus Integrated and join a different Medicare-Medicaid plan. If you are not sure what plan you want to join, they can tell you about other plans in your area.
  • If you request to change plans before the 12th of the month, your membership will end on the last day of that same month. Your new coverage will begin the first day of the next month. For example, if we get your request on August 6, your coverage in the new plan will begin September 1.
  • If you request to change plans after the 12th of the month, your membership will end on the last day of the following month. Your new coverage will begin the first day of the month after that. For example, if we get your request on August 24, your coverage in the new plan will begin October 1.

To disenroll from Humana Gold Plus Integrated and still get Medicare and Medicaid benefits without enrolling in a new Medicare-Medicaid plan

If you do not want to enroll in a different Medicare-Medicaid plan after you leave Humana Gold Plus Integrated, you will go back to getting your Medicare and Medicaid services separately.

You have 3 options for getting your Medicare services. By choosing 1 of these options, you will automatically end your membership in our plan.

How you will get Medicare services

You can change to: Here is what to do:

A Medicare health plan, such as a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE)

or

Original Medicare with a separate Medicare prescription drug plan

or

Original Medicare without a separate Medicare prescription drug plan

NOTE: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you tell Medicare you don't want to join.

You should only drop prescription drug coverage if you get drug coverage from an employer, union, or other source. If you have questions about whether you need drug coverage, call your Senior Health Insurance Program at 800-548-9034.

Call Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week, to enroll in the new Medicare-only health plan.

If you need help or more information:

  • Call the Senior Health Insurance Program (SHIP) at 800-548-9034.

You will automatically be disenrolled from Humana Gold Plus Integrated when your new plan's coverage begins.

How you will get Medicaid services

If you leave Humana Gold Plus Integrated, you will either get your Medicaid services through fee-for-service or remain in our plan to get your Medicaid services.

If you are in a nursing facility or are enrolled in a home- and community-based service (HCBS) waiver, you will remain in our plan to get your Medicaid services. You will:

  • Have 90 days to switch to another Medicaid-only health plan
  • Get a new member ID card, a new Member Handbook, and a new provider and pharmacy directory

If you are not in a nursing facility or enrolled in an HCBS waiver, you will be in Medicaid fee-for-service. This is how you received your Medicaid services before joining our plan. You can see any provider that accepts Medicaid and new patients.

Until your membership ends, you will keep getting your medical services and drugs through our plan

If you leave Humana Gold Plus Integrated, it may take time before your membership ends and your new Medicare and Medicaid coverage begins. During this time, you will keep getting your healthcare and drugs through our plan.

  • You should use our network pharmacies to get your prescriptions filled. Usually, your prescription drugs are covered only if they are filled at a network pharmacy including through our mail-order pharmacy services.
  • If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged. This will happen even if your new health coverage begins before you are discharged.

Your membership will end in certain situations

Under certain circumstances, Humana Gold Plus Integrated can ask Illinois Client Enrollment Services to disenroll you from our health plan. This is called “disenrollment for cause.” We can ask that you be disenrolled for cause for the following reasons:

  • The member moves away from Illinois
  • The member loses entitlement to either Medicare Part A or Part B
  • The member loses Medicaid eligibility or additional state-specific eligibility requirements
  • The termination or expiration of this contract terminates coverage for all members with the contractor. Termination will take effect at 11:59 p.m. on the last day of the month in which this contract terminates or expires, unless otherwise agreed to, in writing, by the parties
  • When a member remains out of the service area, or for whom residence in the plan service area cannot be confirmed, for more than 6 consecutive months
  • When a member no longer resides in the service area, except for a member living in the service area who is admitted to a nursing facility outside the service area and placement is not based on the family or social situation of the member. We can make you leave our plan for the following reasons only if we get permission from Medicare and Medicaid first:
    • When the department or the Centers for Medicare & Medicaid Services (CMS) determines that a member has other significant insurance coverage or is placed in spend-down status
    • If a member intentionally withholds or falsifies information about third-party reimbursement coverage
    • When CMS or the department is made aware that a member is incarcerated in any county jail, an Illinois Department of Corrections facility, another state’s correctional facility, or a federal penal institution
    • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan
    • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan
    • If you let someone else use your ID card to get medical care. If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General

We cannot ask you to leave our plan for any reason related to your health

If you feel that you are being asked to leave our plan for a health-related reason, call:

  • Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week, to enroll in the new Medicare-only health plan
  • Medicaid’s Health Benefits Hotline at 800-226-0768 (TTY: 877-204-1012)

We cannot disenroll you from our plan for any of the following reasons

  • Because of an adverse change in a member’s health status
  • Because of the member’s utilization of covered services
  • Because of diminished mental capacity or uncooperative or disruptive behavior resulting from such member’s special needs (except to the extent such member’s continued enrollment with the contractor seriously impairs the contractor’s ability to furnish covered services to the member or other members)
  • Because the member attempts to exercise, or is exercising, his or her appeal or grievance rights

We may, however, submit a written request, accompanied by supporting documentation, to the department and CMS to disenroll a member, for cause, if:

The member’s continued enrollment seriously impairs the contractor’s ability to furnish covered services to either this member or other members, provided the member’s behavior is determined to be unrelated to an adverse change in the member’s health status, or because of the member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs.

You have the right to make a complaint if we end your membership in our plan

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership.

For more information about ending your enrollment

For more information about ending your enrollment:

  • Call Customer Care at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time

Please note that our automated phone system may answer your call during weekends and holidays. You may leave your name and telephone number, and we’ll call you back by the end of the next business day.

Please note that Humana Gold Plus Integrated may terminate or not renew our contract or reduce our service areas. We will notify members of any changes to our contract or service area at least 30 days in advance of the change.

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