Harmony Health Plan of Illinois no longer appears on the Illinois Department of Healthcare and Family Services (HFS) list of active managed care plans for 2026.1Illinois Department of Healthcare and Family Services. IL2026 Managed Care Map If you had Harmony, your Medicaid coverage itself has not gone away, but your managed care plan has. You have almost certainly been moved to one of the other HealthChoice Illinois plans, and your first task is to confirm which one and decide whether to keep it.
Confirm Which Plan You Have Now
Call the Illinois Client Enrollment Broker at 1-877-912-8880 to find out which HealthChoice Illinois plan you are currently enrolled in.2HealthChoice Illinois. Contact Us The broker can also tell you what your options are if you want to change plans. Once you know the plan, you should receive a new member ID card from that plan; present it at every doctor visit and pharmacy trip. Call the member services number on the back of the card if you need a replacement or need to update your address or phone number.
The HealthChoice Illinois Plans You Can Choose From
Illinois delivers Medicaid managed care through HealthChoice Illinois. As of 2026, the statewide plans are Aetna Better Health, Blue Cross Community Health Plans, Meridian, Molina HealthCare, and YouthCare. CountyCare Health Plan is available only in Cook County.1Illinois Department of Healthcare and Family Services. IL2026 Managed Care Map Every plan covers the same core Medicaid benefits, but provider networks, referral rules, and extra services differ, so the plan you were assigned to may not be the best fit for the doctors you actually see.
Changing Plans After the Transition
You can change plans once a year during your annual open enrollment period. HFS mails an open enrollment letter about two months before your anniversary date, and any change takes effect on that anniversary.3HealthChoice Illinois. Managed Care Outside that window, switches are limited to qualifying circumstances. If you were auto-moved out of Harmony and are unhappy with the plan you landed on, ask the enrollment broker whether the transition itself opens a window for you to switch.
What Your New Plan Covers
Every HealthChoice Illinois plan covers the same Illinois Medicaid benefits package. That includes primary care and specialist visits, inpatient and outpatient hospital care, lab work and imaging, behavioral health services for mental health and substance use disorders, preventive care such as immunizations and wellness check-ups, and pregnancy-related care from prenatal through postpartum.4Illinois Department of Healthcare and Family Services. Healthcare and Family Services Medical Benefits Experimental treatments, cosmetic procedures, and care from providers removed from the Medicaid program are not covered. Out-of-network care is generally not covered either, with exceptions for emergencies, family planning, and a few other categories.
Adult Dental
Adult dental coverage is real but limited. You get one comprehensive oral exam per lifetime per dentist; routine periodic exams are not covered. Emergency dental care is covered for pain, infection, swelling, uncontrolled bleeding, or injury. Fillings and other restorative services are covered, crowns are available once every 60 months, and removable dentures are covered when chewing function is impaired or when an existing denture is at least five years old and no longer serviceable.5Illinois Department of Healthcare and Family Services. Benefits Covered – Adults – Age 21 and Over
Adult Vision
Eye exams by a physician or optometrist are covered, along with one pair of lenses and frames. A second pair is available if your glasses are lost or broken beyond repair. Trifocals and tinted lenses are not covered.6Illinois Department of Human Services. PM 20-13-00 Eye Care (TANF, AABD) Children get broader dental and vision benefits through the federal EPSDT program.
Prescriptions
Your plan covers prescription drugs based on its formulary. If a medication you need is not on the list, your prescribing provider can submit an exception request. Some drugs require prior authorization, have quantity limits, or are subject to step therapy, which means trying a lower-cost drug first. Most Medicaid enrollees pay nothing for covered prescriptions. Fill your prescriptions at a network pharmacy; a temporary supply may be available in an emergency when you are away from your service area.
Doctors, Referrals, and Rides
You choose a primary care provider from your plan’s network. Your PCP manages your overall care and coordinates access to other services. Use your plan’s online provider directory or call member services to search for in-network doctors.
Referral rules are not uniform. Each managed care organization sets its own policies on whether you need a PCP referral before seeing a specialist.7Illinois Department of Healthcare and Family Services. Illinois HFS Managed Care Organization Manual Check your new member handbook or call your plan to find out how referrals work. Family planning services never require a referral or prior authorization, and emergency services never require a referral.
If you cannot get to a medical appointment, your plan covers non-emergency medical transportation. Call the member services number on the back of your ID card to arrange a ride, and call well in advance because each plan has its own scheduling requirements.8Illinois Department of Healthcare and Family Services. Medical Transportation (Non-Emergency) The benefit covers rides to doctor visits, pharmacy pickups, therapy, and other covered services.
If Your Plan Denies a Service
When a plan denies, reduces, or terminates a service you asked for, that decision is called an adverse benefit determination. You can fight it through a two-step process.
Internal Appeal With the Plan
You or your provider files the appeal directly with your managed care plan. Standard appeals must be resolved and communicated within 30 calendar days. If waiting could seriously harm your health, you can request an expedited appeal, which the plan must resolve within 72 hours.9eCFR. 42 CFR 438.408 – Resolution and Notification
State Fair Hearing
If the plan rules against you, you have 120 calendar days from the appeal decision to request a state fair hearing through HFS. You can submit the request by mail, fax, email, or phone. To keep the disputed services in place while the hearing is pending, request the hearing within 10 calendar days of the plan’s decision letter and specifically ask for continuation of services. If you lose the hearing, you may have to pay for those continued services.10CMS. Illinois Notice of Fair Hearing Rights
Keeping Your Medicaid Active
Medicaid coverage is not permanent. HFS requires you to renew your eligibility every year through a process called redetermination. HFS mails you a letter with instructions when your renewal is due, and you can also renew through the Manage My Case online portal if you have an account.11Illinois Department of Healthcare and Family Services. Renewing My Medicaid Miss the renewal and your coverage ends automatically. Getting it back means reapplying from scratch and going without coverage in the meantime.
For renewals scheduled on or after January 1, 2027, most adults enrolled through Medicaid expansion will face eligibility checks every six months rather than annually, under the Working Families Tax Cut legislation.12Medicaid.gov. Implementation of Eligibility Redeterminations – Section 71107 of the Working Families Tax Cut Legislation Keep your address and phone number current with HFS so renewal notices actually reach you. If you moved during or after the Harmony transition and never updated your contact information, do that now.