Coverage from head to toe
Your Medicaid plan gives you access to services like adult day health care, durable medical equipment, home care and occupational therapy. There are special benefits and programs designed to help you live healthier a more independent life. This coverage includes preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for added help.
You need to review the information in this section closely. It helps you understand what is covered by your plan, what is not and how you can find the right care when you need it.
A member handbook is a document that goes over your plan details. It also explains costs that you may have to pay and defines some common terms.
Your benefit summary will help you understand how your health plan works. It provides details about the kind of care you can get, what services are covered, and much more.
Out-of-network and emergency care
Stay in-network and save
Except in certain cases, you cannot visit a care provider outside of our network. For example, emergencies are not included in this rule. “In network” providers are listed in our directory. These care providers have agreed to charge less for many services. If you do not use in-network providers, you may be responsible for these charges.
If you have questions about this, call Member Services at 1‑866‑600-2139 (toll-free), 24 hours a day, 7 days a week. TTY Relay Illinois 7-1-1. You also can use the Find a Provider
How do I know if it’s an emergency?
For more information about emergency care, please review your Member Handbook (coming soon).
Your mental health is important
Behavioral health benefits cover services to help you improve your mental health. For example, if you suffer from mental illness, alcohol or drug addiction, you may need therapy or medicine. Your Aetna Better Health Premier Plan covers many kinds of services for mental health. Below is a partial list of what is covered. For a more complete list, view your Summary of Benefits - English / Spanish.
- Medicine for mental health
- Mental health assessments
- Group therapy
- 24-hour access to help for a crisis
- Partial hospitalization
- Alcohol and drug detoxification
- Community support
- Lab services for urine screens
- Methadone administration
As a member of Aetna Better Health Premier Plan, you will have your own case manager as part of our case management program. Your case manager can help you find the right care and services. Your case manager will contact you soon after you are enrolled with Aetna Better Health Premier Plan.
A case manager will work with you, your doctors and other providers to make sure you receive the right care and services with your needs in mind. The goal is to build a treatment plan just for you to help you live a healthier life. Your case manager will meet with you by phone or where you live as often as needed.
A case manager can help guide you if you have had any of these or other issues:
- You are having to go to the ER a lot
- You are having trouble getting things your doctor has ordered
- Your doctor just told you that you have a disease like CHF (congestive heart failure) or diabetes but you would like to get more information about a disease or treatment
- You need services to help you at home and need help getting long term services and support
- Your doctor wants you to see a specialist, but you don't know what to do
If you want to discuss your health care needs and questions with your case manager, call Member Services to ask to speak to your case manager. Your case manager is there for you!
Extra support to care for you
Our disease management programs are designed just for members with chronic (ongoing) conditions. This may include things like asthma, diabetes, lung disease or a heart issue.
What is a disease management program?
These programs provide education and outreach to you based on your medical needs. The goal is to help you be healthier and get quality care. If you choose to be part of our program, we work doctor to create a plan for your care. This plan will include goals that will help you and your doctor track your results. We will also provide education to you about how to stay well.
We have disease management programs for:
- Chronic Obstructive Pulmonary Disorder (COPD)
- Congestive Heart Failure (CHF)patients with:
When you sign up for one of our disease management programs, we give you all the help we can. We will also connect you with other resources to help you manage your condition.
If you want to know more about our disease management programs, call Member Services at 1-866-600-2139 (toll-free), 24 hours a day, 7 days a week. TTY Relay Illinois 7-1-1.
Important notice for members
After December 31, 2017, Aetna Better Health will no longer be a health plan choice in the Illinois Medicaid Managed Care Program.
Beginning January 1, 2018, Aetna Better Health is teaming with either CountyCare Health Plan or Meridian Health Plan of Illinois for your Medicaid healthcare services. Members will receive one of the following notices based on the health plan they will be transitioned to:
Aetna member transition notice to CountyCare Health Plan
Aetna member transition notice to Meridian Health Plan of Illinois