The Centers for Medicare & Medicaid Services has notified the Illinois Department of Healthcare and Family Services (HFS) and Meridian that all Illinois Medicare Advantage (MA) D-SNP lookalike (LAL) products are to sunset effective January 1, 2023.
*Beneficiaries of Wellcare of Illinois health plans H1416-048 and H5779-006 will be transitioned to a Medicare-Medicaid Alignment Initiative (MMAI) plan or another MA plan as noted below.
- Full dual eligible LAL members will be transitioned to the Meridian Medicare-Medicaid Plan (MMP), formerly known as MeridianComplete.
- Partial dual eligible and non-dual eligible members will be transitioned to another Wellcare of Illinois MA plan.
Impacted member will begin to receive mailed notices from the HFS in October 2022.
Do members enrolled have to stay with the MMAI/Meridian MMP plan?
There are options available to meet members’ healthcare needs. Keeping a current Wellcare Medicare plan is one of the options. Impacted members can change health plans by calling Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576), Monday to Friday 8 a.m. to 6 p.m.
Will there be a gap in members’ coverage?
No. There will be no gap in members’ coverage.
Can members keep their current provider with Meridian MMP?
Yes. Members can keep seeing their current provider for up to 180 days once enrolled in MMAI. This includes if a provider is out of network. This is to prevent a disruption in treatment. After 180 days, they will need prior authorization to see that provider.
What if members need to see a provider that is out of network?
They must get prior authorization from Meridian MMP before they can:
- Get a specific service
- Get a specific drug
- See an out-of-network provider
Members can use providers outside of the Meridian MMP network, without prior authorization if:
- They have an emergency
- Urgently need care
- Need out-of-area dialysis services
What if members need to see a specialist?
They will need a referral from their primary care provider to see a specialist. They will not need a referral to see:
- Audiologists (for routine hearing exams)
- Optometrists (for routine vision exams)
What about member prescriptions?
Meridian MMP’s pharmacies will provide all prescription drugs. Members must use a Meridian MMP pharmacy to get their prescriptions. To check if a pharmacy is in Meridian MMP’s network, call Members Services at 1-855-580-1689 (TTY: 711) or go online to mmp.ILmeridian.com.
Can members keep taking current medications with Meridian MMP?
Yes. They will have access to a 30-day supply at a retail pharmacy or a 31-day supply at a long-term care pharmacy of any Part D drugs they are currently taking during their first 90 days in the plan. There is a $0 copay for all Part D prescription medications covered by the plan.
Members have access to the Medicaid-covered drugs they take during their first 90 days in the plan if:
- They are taking a drug that is not on our List of Covered Drugs
- Health plan rules don’t let them get the amount ordered by their doctor
- The drug requires prior approval by Meridian MMP
Do members have to pay for Meridian MMP?
No. If they are using a Meridian MMP provider, they will not have to pay a:
- Plan premium
To ask if a current provider is in the Meridian MMP network, please call 1-855-580-1689 (TTY: 711) or go online to findaprovider.ILmeridian.com/location.
What does the Meridian MMP plan cover?
Members will continue to get the same great care. The plan still covers:
- Doctor visits
- Hospital services
- 27/7 Nurse Line
- Medical supplies
- Hearing services
- Eye care services
- Dental services
- Hospice care
- Home health care
- Lab tests and X-rays
- Behavioral health services
Who can members contact to talk about options?
- Meridian MMP Member Services
1-855-580-1689 (TTY: 711)
Monday to Friday, 8 a.m. to 8 p.m. CST
- Illinois Client Enrollment Services
Monday to Friday, 8 a.m. to 7 p.m.
What happens next?
Qualifying members will receive a Meridian MMP Welcome Kit and member ID card. They only need one ID card for access to all MMAI services. This includes Medicare, Medicaid, and pharmacy.
If you have questions, please call 1-855-580-1689 (TTY: 711). The Meridian MMP Provider Services team will be happy to answer your questions.
*Some exceptions may apply.