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Elizabeth M. Whitehorn, Director

Medical Providers and Health Plans

Health Plans and Primary Care Providers

Most people enrolled in an HFS Medical Program will be required to pick a health plan and a Primary Care Provider (PCP) within that health plan for their health care services

A Primary Care Provider (PCP) is the family doctor, internist, nurse, or doctor at a health clinic who takes care of you and your family.

  • Your PCP will give you regular check-ups, help you get better when you are sick, help you manage diseases like diabetes, and refer you to other healthcare providers when you need them.

  •  A health plan is a group of doctors, hospitals, and other providers who work together to give you the healthcare you need.  It includes your Primary Care Provider (PCP) and all of the specialists you may need.  Health plans help you coordinate your care so you don’t have to do it on your own. The health plans available to you depend on what county you live in.

Every health plan will cover the same services, including doctor's visits, hospital visits, prescription drugs, and mental health care. Some plans may provide additional services, such as additional dental services, services or products for babies, and free help to stop smoking.  There is no monthly cost for joining a health plan and some plans may help you save money by reducing or waiving co-payments for some services. 

If you are required to pick a health plan and Primary Care Provider (PCP), you will receive an enrollment packet in the mail from Illinois Client Enrollment Services.  This enrollment packet will give you information on your health plan choices and information on how to enroll.  Be sure to watch for this enrollment packet in your mail.

 It will arrive in a white envelope that has a picture of the state seal.  This enrollment packet will list your health plan options.  You will have 60 days from the date stated on your enrollment letter to pick a health plan and Primary Care Provider (PCP).  If you do not pick, the State will pick for you. It is important that you pick your health plan and PCP since you know your healthcare needs best.

What if you are NOT required to pick a plan?

.Some people are not required to pick a health plan and Primary Care Provider (PCP).  If you are not required to pick a health plan and PCP, you will continue to use your HFS Medical Card to access services and Illinois Health Connect will continue to be your primary contact to help you find enrolled providers.  

  • If you have a question about whether or not you are required to pick a health plan, contact the Illinois Client Enrollment Services at 1-877-912-8880. (TTY: 1-866-565-8576).
  • If you need to see a doctor before you receive an enrollment packet, Illinois Health Connect will help you find a doctor in your area who accepts Medicaid.  Call Illinois Health Connect at 1-877-912-1999 

Picking a Health Plan and a Primary Care Provider (PCP)

Some things to think about when picking a health plan:

  • Does the health plan have the doctors, hospitals, and specialists you use now?  Contact all of your providers to find out which health plans they have joined. You can also call Client Enrollment Services (1-877-912-8880) or go to the Client Enrollment Services website www.EnrollHFS.Illinois.gov to see which health plans include your doctors.

  • Do you want a new doctor or clinic?

  • Does anyone in your family have special health needs?

  • What extra services does the health plan give you?

Some things to think about when picking a Primary Care Provider (PCP):

  • What are your special medical needs?
    Is there a doctor, nurse practitioner, or other type of provider that you already like?

  • How far are you willing to travel to see a provider?

  • Do you need a provider who speaks a certain language?

  • Do you need a provider who is available on evenings and weekends?

  • If you are picking a PCP for other members of your family, each eligible family member can have his or her own PCP.

Enrolling in a Health Plan or With a Primary Care Provider

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  • Does the health plan have the doctors, hospitals, and specialists you use now?  Contact all of your providers to find out which health plans they have joined. You can also call Client Enrollment Services (1-877-912-8880) or go to the Client Enrollment Services website www.EnrollHFS.Illinois.gov to see which health plans include your doctors.

  • Do you want a new doctor or clinic?

  • Does anyone in your family have special health needs?

  • What extra services does the health plan give you?