You are eligible to enroll in Humana Dual Fully Integrated (HMO D-SNP) as long as you:

• Live in our service area, and
• Are a U.S. citizen or are lawfully present in the U.S., and
• Are at least 21 years of age or older at the time of enrollment, and
• Have Medicare Part A and Medicare Part B, and
• Are enrolled in Medicaid Aid to the Aged, Blind, and Disabled category of assistance, and
• Meet all other Demonstration criteria and are in one of the following Medicaid 1915(c) waivers:
  • Persons who are elderly
  • Persons with disabilities
  • Persons with HIV/AIDS
  • Persons with brain injuries
  • Persons residing in supportive living facilities

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

If you lose eligibility but can be expected to regain it within 6 months then you’re still eligible for our plan. Call Member Services for more information.

To qualify for Humana Dual Fully Integrated, you must be eligible for both Medicaid and Medicare in Illinois

To apply for Medicaid:

1. Get Your Information Ready
   You will need your Social Security number, birthdate, and income 
2. Choose How to Apply
   • Online: Go to www.abe.illinois.gov and fill out the application.
   • By Phone: Call 1-800-843-6154 and ask for help with the application.
   • By Mail: Print an application from the website or ask for one to be mailed to you. Fill it out and mail it back to your local office.
   • In Person: Go to your local HFS office and fill out the form there.
3. Fill Out the Application
   Answer all the questions about you and your family.
4. Turn In the Application
   Send your application online, by mail, or give it to someone at the DHS office.

If you need help, you can call the Illinois DHS Help Line at 1-800-843-6154.

Each year, Illinois checks to make sure you are still eligible for Medicaid coverage. To ensure a review of your Medicaid coverage, please update your information with the state. You will get a letter in the mail from the State of Michigan when it is time to renew your Medicaid. Read the letter carefully.

• Get your personal information ready. You may need papers like your pay stubs, bills, or proof of where you live.
• You can recertify by mail by completing the forms you receive with the letter and returning them to Michigan DHS before the deadline.
• You can also recertify online Visit newmibridges.michigan.gov and select “Login” to manage your case.
• Verify your mailing address under “Contact Us.”
• Locate your due date (the “redetermination” date) in your “Benefit Details.” You can opt-in for text and email alerts about your renewal date. Select the “Account Management” tab under “Manage your communications preferences.”
• Everyone’s renewal date is different, so it is critical that you get ready to renew.
• You will receive renewal information in the mail about 1 month before your renewal date. Please complete and return it right away. You can complete your renewal online by returning the form in the mail, or by calling 800-843-6154.

For help with your renewal, call 800-843-6154.

To enroll in Humana Dual Integrated (HMO D-SNP)

• Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, 8 a.m. – 6 p.m.
• Visit the enrollment broker website

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.

You can request to end your membership in Humana Dual 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 18th 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 Illinois Client Enrollment Services gets your request on August 6, your coverage in the new plan will begin September 1.
• If you request to change plans after the 18th 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 Illinois Client Enrollment Services gets 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 Dual 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

 

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

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

• A Medicare health plan, such as a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE)
• Original Medicare with a separate Medicare prescription drug plan
• Original Medicare without a separate Medicare prescription drug plan

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.

If you leave Humana Dual Fully Integrated, you will either get your Medicaid services through fee-for-service or be required to enroll in the HealthChoice Illinois Managed Long-Term Services and Supports (MLTSS) program 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 be required to enroll in the HealthChoice Illinois MLTSS program to get your Medicaid services.

To choose a HealthChoice Illinois MLTSS health plan:

• Call Illinois Client Enrollment Services at 877-912-8880 (TTY: 866-565-8576), Monday – Friday, from 8 a.m. – 6 p.m., and
• Tell them that you want to leave our plan and join a HealthChoice Illinois MLTSS health plan
• 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.

Upon enrollment in a new plan, you will get a new member ID card, Member Handbook, and Provider and Pharmacy Directory from that plan.

If you leave Humana FIDE SNP, 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.

Under certain circumstances, Humana Dual Fully 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:

• You move away from Illinois
• You lose entitlement to either Medicare Part A or Part B
• You lose 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
• You remain out of the service area, or we cannot confirm your residence in the plan service area, for more than 6 consecutive months
• When you no longer live 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: [end bold]

• 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.

Please note that Humana FIDE SNP 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.

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. Visit our Grievance and appeals webpage for more information about how to file a complaint.