A Guide to the Illinois Medicaid Program

Are you an Illanoisan looking for affordable healthcare options? Illinois Medicaid may be a great fit. This guide will provide an overview of the program, covering topics such as eligibility requirements, benefits, coverage options, and how to apply.

Extending coverage beyond the Medicaid program through third-party insurance can help ensure that you have access to the quality healthcare services you need while also providing financial protection against high medical costs. Insurdinary makes it easy to compare multiple insurance plans so you can find coverage at the best price. We can optimize your coverage to include a more comprehensive range of benefits and services by way of private health insurance.

With this information in hand, you can make better-informed decisions about your health insurance needs. In the meantime, let’s take an in-depth look at what Illinois Medicaid offers.

    What Is Illinois Medicaid?

    What is HFS coverage or Medicaid? It's a state-funded program in Illinois administered by the Illinois Department of Healthcare and Family Services.

    It aims to provide free health care services to eligible low-income individuals, families, and children. Depending on the eligibility category, coverage can include doctor visits, hospital care, preventive care, prescription medications, and more.

    The cost of Illinois Medicaid ranges from $0 to $70 per month depending on your income. The program is jointly funded by the state of Illinois and the federal government; the federal government matches at least 50% of the state's contribution.

    What Is an Illinois Medicaid Card?

    Illinois Medicaid

    A Medicaid card is an ID with a special number on it representing your program coverage. It identifies you as a participant in the program, and you can use it to access benefits at any authorized healthcare provider or pharmacy that accepts Medicaid.

    Applying for Illinois Medicaid

    If you want to learn how to apply for HFS or Medicaid, you can visit the Department of Healthcare and Family Services. Find your nearest Family Community Resource Center and inquire about the application process. Senior citizens can also go to their local Area Agency on Aging office for further assistance.

    For convenience, you can also apply:

    • Online - Visit the state website or Healthcare.gov (for non-disabled individuals under age 65) and follow the prompts to submit an application for benefits.
    • By mail or fax - Call the IDHS customer service hotline at 1-800-843-6154 (TTY 1-800-447-6404) and ask them to mail you an application. Fill in the documentation and mail or fax it to your nearest Family Community Resource Center.

    Eligibility Requirements

    Residents of Illinois must meet the following criteria to be eligible for Medicaid coverage:

    • For non-disabled individuals and families under age 65, family income must equal or be below 138% of the Federal Poverty Level (FPL).
    • Pregnant individuals must have a family income equal to or below 208% of FPL.
    • Children aged 0 to 18 must have a family income equal to or below 313% of FPL.
    • Blind, disabled, or aged individuals (over 65) must have a family income equal to or below 100% of FPL.

    When you exceed these eligibility numbers, but your medical spending puts you under the FPL, you may still be eligible for Medicaid reimbursements or "Pay-in Spenddown". After you submit your application, the HFS will notify you if you qualify.

    To ensure that you receive reimbursements, diligently record every monthly medical bill and expense. You'll need to submit proof of your spending to your nearest Department of Human Services office.

    Illinois Medicaid Coverage

    The HFS will automatically send you a Medicaid card after they approve you for coverage. The state has 45 days to process and authorize the applications. There are measures in place should someone require immediate treatment. If you haven't received your card after that time, contact your local Family Community Resource Center for further assistance.

    Renewing or Replacing Your Illinois Medicaid Card

    If you have lost your card or require a renewal, you can call DHS at 1-800-843-6154 or HFS at 1-800-226-0768 (TTY 1-877-204-1012) to request a new card for free. You can still receive coverage with a picture ID until your replacement card arrives in the mail.

    Illinois Medicaid Coverage

    What is HFS coverage or Medicaid? Generally, it includes the most necessary forms of medical assistance, from doctor's visits and hospital care to wellness screenings and medical transportation. Let's go over some of the most common benefits people inquire about:


    While considered an optional Medicaid benefit, many states, including Illinois, choose to offer dental coverage. The program covers extractions, dentures, prosthetics, jaw restructuring, restorative procedures, X-rays, and related drugs,

    Children receive additional premium benefits of cleanings, sealants, fluoride treatments, orthodontics, space maintenance, and other treatments. Always ask your healthcare provider if they accept Medicaid to make sure you have coverage.

    For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Illinois is advisable.

    Prescription Drugs

    Illinois Medicaid covers prescription drugs and some over-the-counter products. Some may require prior approval, so it's crucial to talk to your doctor and see if they will request a pre authorization for your medication. You can also check the Illinois Medicaid preferred drug list to find out if your meds have coverage.

    In general, the drugs listed won't require prior authorization. You can request coverage for non-preferred medication by calling 1-800-252-8942 or faxing a request to 217-524-7264. You can also ask your healthcare provider to file the proper paperwork.

    Medicaid typically covers up to four prescriptions monthly. If you exceed this limit, you need prior approval. However, it might not be necessary if you're under a flexible managed care plan.

    Extended Health Care

    The state of Illinois covers a wide range of extended healthcare benefits for individuals with special needs. From substance abuse relief and mental health services to renal dialysis and rehabilitative care, Medicaid provides coverage when other forms of insurance fail. To find out which services you qualify for, contact the nearest Department of Human Services office.

    Travel and Out-of-State Coverage

    Mandatory Medicaid benefits include transportation for medical care, but only within Illinois. The program will only cover emergency health care outside of Illinois. If you want to permanently transfer your coverage, you need to terminate your coverage in the State of Illinois and request enrollment in your new state.

    Most states provide retroactive coverage, allowing Medicaid to cover medical care up to 90 days before your application. You may have to pay out of pocket and then get reimbursed later. Always store your medical receipts in case you need them for proof of coverage. If you are traveling outside of Illinois for leisure, invest in proper travelers insurance.

    Students & Seniors

    This state plan doesn't specifically provide specific coverage for students, but anyone who meets the income requirements and age is eligible to apply. The same goes for seniors and individuals with a disability.

    About 43% of the program's long-term care spending goes toward intermediate care facilities and skilled nursing. The rest covers waiver programs allowing people to receive long-term care in senior living communities, assisted living facilities, or their own homes. Some ways your Medicaid membership can help with the costs include:

    • Nursing Homes. Aside from regular medical benefits, Medicaid also pays for personal care, room and board, skilled nursing, and specialized rehabilitation provided in nursing homes.
    • Assisted Living. You may be able to use Medicaid's Home and Community-Based Waiver Program to receive personalized health services at an assisted living facility. However, you will still have to pay for room and board.
    • Community Housing. Do you want to stay in your own home but need a little extra help? Medicaid waivers will pay for personal care, supportive services, and home modification costs provided in a residential setting, such as private abodes or subsidized senior apartments.

    If you want to qualify for these long-term care benefits, you must take a functional needs assessment that determines your ability to care for yourself safely. When you require nursing home levels of care and meet Illinois income and asset requirements, you will likely receive Medicaid coverage.

    Coverage for Subgroups

    In addition to seniors, students, and disabled individuals, Illinois Medicaid offers coverage for other specific subgroups. These include:

    Indigenous Americans

    Medicaid covers federally recognized Indigenous American tribes in Illinois. In fact, over a million Indigenous Americans in the United States already receive healthcare benefits from this program.

    State Medicaid agencies also regularly undertake "Tribal Consultations" to obtain input and advice from Indigenous American tribes on healthcare-related matters. If you are an Indigenous American and need coverage, check with your local tribes to learn more about the benefits available.


    Aside from TRICARE, military families can also take advantage of Illinois Medicaid. It can cover all the medical care that active duty service members need, including inpatient services, home health care, and mental health services. The program may also pay for long-term care if they meet income and asset requirements.

    Other subprograms include:

    • Veterans Care. If you or a loved one is an uninsured veteran under age 65, Veterans Care (VC) is an excellent option. You can apply for Veterans Care by visiting your local Department of Veterans Affairs Office or visiting their website.
    • Veterans' Homes. Illinois veterans and their spouses who need skilled and domiciliary care can reside in five unique veterans' homes in Illinois: Quincy, Anna, LaSalle, Chicago, and Manteno. You can find a full list of eligibility requirements here.

    What Illinois Medicaid Does Not Cover

    Now that you have a good idea of what HFS covers, here's what it doesn't cover:

    Any service considered medically unnecessary or "unreasonable"
    When charges were billed in another allowance or improperly bundled
    When another program already reimbursed the medical provider
    Medical equipment already replaced through a warranty
    Healthcare services offered by a different government agency
    Devices or health screenings that are already free
    Cosmetic procedures and any potential complications
    Beautician services and personal comfort items like television
    Medical care provided outside the US (unless a foreign hospital is closer than US alternatives or in specific travel-related issues)
    The permanently or temporarily injured

    Illinois Medicaid may cover the cost of a funeral depending on individual circumstances. Follow this link for additional information. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.

    Idaho Medicaid does provide some coverage for those who become injured or ill either in the short or long term. Depending on the nature of the injury or illness, it’s wise to explore disability insurance options to ensure no unnecessary out-of-pocket costs are incurred.

    Keep in mind that the coverage of this program regularly changes, so you should always inquire about your eligibility when considering a service.

    Common Procedures and Illinois Medicaid Eligibility

    When it comes to medical services, Illinois Medicaid offers quite a variety. Let's go over some of the most common procedures and their specifications.

    X-Rays and Exams You can visit your dentist for an exam at no cost. Medicaid also covers X-rays if your healthcare provider needs to check your teeth's roots, surrounding bones, and dental implants.
    Wisdom Teeth The program covers any dental service considered "oral surgery", including wisdom tooth removals and other tooth extractions.
    Eye Exams Illinois Medicaid includes coverage for an annual routine eye exam, but any additional tests usually don't qualify.
    Glasses Medicaid covers medically required eyeglasses. Children generally enjoy fewer restrictions for glasses and prescriptions, while adults need a medical letter from their healthcare provider to get coverage for a new pair.
    Laser Eye Surgery Medicaid may cover LASIK or similar procedures deemed necessary for visual acuity if recommended by an ophthalmologist. Inquire with your doctor for further details.
    Rhinoplasty Medicaid may cover reconstructive surgery to correct a deformity due to trauma or birth defect, but only when it causes breathing difficulties or functional impairment. If the goal is purely cosmetic, the program won't provide any coverage.
    Breast Reduction When an IPA physician considers it medically necessary, Medicaid may cover breast reduction surgery. The procedure's goal must be to reduce the size of large breasts and alleviate back pain or other associated problems.
    Hospital stays In general, Illinois will pay for the cost of a hospital stay when related to a medically necessary service. The state also covers ER visits and urgent care visits.
    Ambulance transportation Medicaid covers emergency ambulance services if the providers have a state license. The vehicle used should also have a state permit and appropriate safety measures.
    Giving birth Illinois Medicaid covers delivery services and postpartum care for 12 months and 60 days after the mother gives birth.
    Therapy and Counselling
    Illinois Medicaid typically covers mental health services. These include psychological counseling, psychiatric care, and professional assessments when deemed medically necessary by a doctor.
    Sexual Health
    Gynecologist visits Women affected by an illness or condition related to their reproductive health can visit a doctor without cost. Many related services like Pap smears and mammograms also have coverage.
    Erectile Dysfunction Viagra and other medications for the treatment of erectile dysfunction don't fall under the medically necessary umbrella and thus, don't have coverage. You can check with your healthcare provider for alternatives.
    Birth Control Illinois Medicaid covers all FDA-approved contraceptives, including long-acting reversible procedures (like IUDs and implants) and permanent birth control (like tubal ligation or vasectomy).
    Fertility Treatment The program won't cover fertility treatments, such as in-vitro fertilization or artificial insemination.
    Specialist Services
    Dermatology You can generally have skin conditions and diseases, including acne and eczema, evaluated by a dermatologist at no cost. However, cosmetic procedures like chemical peels, laser treatments, or Botox injections likely won't have coverage.
    Physiotherapy If your doctor recommends it, you can visit a physiotherapist without cost. For instance, you can get coverage for services related to chronic pain, stroke rehabilitation, and sports injuries.
    Massage Therapy Illinois Medicaid covers massage therapy when medically necessary and prescribed by a physician. However, recreational massages don't qualify.
    Podiatry and Foot Care Illinois Medicaid generally covers podiatric care, especially for diabetics and those with other risk factors. However, routine foot care like a callus or corn removal doesn't have coverage.
    Allergist and Allergy Testing Allergist consultations, medically necessary allergy immunotherapy, specific allergy testing, and other related services have coverage under Medicaid.
    Sleep Physician Services and CPAP Machines Medicaid may cover a trial of CPAP therapy if you have medically diagnosed obstructive sleep apnea. After the period ends, the program can continue to cover the machine and necessary supplies as long as your doctor deems it medically necessary.

    Extending Illinois Medicaid Coverage

    Private or third-party health insurance is an essential option for getting medical coverage in Illinois. You can use it to supplement Medicaid membership and receive coverage for services not covered by the program. Some potential benefits include:

    • Access to Out-of-Network Doctors and Specialists. Do you need to see a specialist who doesn't belong to the Medicaid network? You can use private insurance to cover the cost.
    • No Enrollment Caps When You Need Care. If you require more than one doctor's visit or treatment per month, Medicaid may put limits on how much it will cover and how often you can go back for treatment. Private health insurance can offer more extensive coverage.
    • Access to Alternative Treatments or Medications. Medicaid may not cover certain treatments and prescription drugs, including those related to mental health, fertility, and cosmetic procedures. Private insurance can pick up the slack here as well.
    • Faster Reimbursements. Since Medicaid is a government-run program, payments may take weeks or months to process. Private insurance can get you your money much faster.
    • Easier Access to Out-of-State Coverage. Need to go outside of Illinois for specialist care? Private insurance can make it easier to get the coverage you need.

    We at Insurdinary understand that deciding the best type of medical coverage can be a daunting task. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    With us, you can compare various quotes from leading providers and find a plan that fits your budget. With lower co-pays, extensive coverage options, faster claims processing, more flexibility, and lower out-of-pocket costs, you can save money and get the best care.

    Ready to get the best medical coverage for your needs? Whether you want to compare Illinois Medicaid plans or other private insurance solutions, we are here to help you. Get free quotes from top providers in your area today and save!


    How long does it take to get approved for Illinois Medicaid?

    The approval process duration for Illinois Medicaid can vary based on individual circumstances. On average, it takes about 60 days. Expedited processing is available for urgent cases.

    What are the methods to apply for Illinois Medicaid?

    You can apply for Illinois Medicaid through various means: online, in person, by mail, or at a local Illinois Department of Health and Welfare office. Ensure you provide essential documents like proof of income, household size, and residency when submitting your application.

    Does Illinois Medicaid cover the expenses of funerals?

    No, Illinois Medicaid is primarily focused on providing healthcare coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you may want to explore alternatives like funeral insurance.

    Who is eligible for Illinois Medicaid?

    Eligibility for Illinois Medicaid is determined by factors such as income, household composition, and other considerations. Generally, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is Illinois Medicaid?

    Illinois Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded through both federal and state resources, its goal is to ensure access to essential healthcare services for those in need.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    1. https://www2.illinois.gov/hfs/MedicalClients/Pages/medicalprograms.aspx
    2. https://www.benefits.gov/benefit/1628
    3. https://www.dhs.state.il.us/page.aspx?item=31436
    4. https://www.medicaidplanningassistance.org/medicaid-eligibility-illinois/
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