Some services require prior authorization. Your provider will submit any needed prior authorizations.
Need care away from home? For urgent or routine care away from home, you must get approval for CountyCare to go to an out of state or out-of-network provider. Call Member Services at 312-864-8200, 711 (TTY/TDD) to get this approval.
You should visit your dentist regularly to prevent cavities and other problems. You must go to an in-network provider to receive dental services. You can find a CountyCare dental provider by going on our website www.countycare.com or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Please refer to CountyCare’s dental benefits here. If you have questions about specific services, please call Member Services.
You must go to an in-network provider to receive dental services. Please refer to CountyCare’s dental benefits here.
If you have questions about dental benefits, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
As an added benefit, CountyCare also covers:
You must go to an in-network provider to receive vision services. You can find a CountyCare vision provider by going on our website www.countycare.com or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Please refer to CountyCare’s vision benefits here. If you have questions about specific services, please call Member Services.
Your children’s pediatrician or nurse will test their vision during a routine check-up. If you or your child’s doctor have any concerns about your child’s vision you can take them to an eye doctor.
You must go to an in-network provider to receive vision services.
If you have questions about vision benefits, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
You can get free counseling services through CountyCare’s partnership with Aunt Martha’s Health & Wellness. CountyCare provides no-cost telehealth counseling services to help you cope during the pandemic. Telehealth lets you talk to a therapist from your own home using video chat or phone call.
CountyCare has other in-network providers that provide telehealth counseling and psychiatry services. Please click here to find a full list of providers.
If you feel that you would like to talk to someone, call 877-MY-AUNT-M (877-692-8686) and select “option 2” to schedule an appointment. Representatives are available from 7:00 a.m.-7:00 p.m. Monday-Friday, and Saturday from 8:00 a.m.-4:00 p.m.
CountyCare provides pharmacy coverage for members through our vendor, CVS Caremark. Your prescription drugs are provided at no cost to you when you have your prescriptions filled at an in-network pharmacy.
Please review the list of medications that are covered under the State of Illinois’ Preferred Drug List (PDL). The PDL is sometimes called the formulary.
You may also download a print-friendly Preferred Drug List or request a paper copy by calling Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
If you need a medication that does not appear on the Preferred Drug List, your provider can ask for a prior authorization formulary request.
If you are new to CountyCare, you can continue any medication you currently use for your first 90 days with us, even if it is not part of the CountyCare Preferred Drug List. You will be told how you and your provider can ask for a prior authorization Preferred Drug List request.
CountyCare also covers over-the-counter medications. You will need a prescription from your provider to have the over-the-counter drug covered.
Criteria for medication coverage:
You must have a prescription written by your provider to get your medication. You can take your prescription to one of our in-network pharmacies, including national retail chains such as CVS, Kmart, Kroger, Walgreens, Target, Jewel-Osco and Walmart. Make sure you have your CountyCare member ID card to show at the pharmacy.
Many pharmacies are now offering free medication delivery (including Walgreens, CVS, Jewel-Osco and others). The CountyCare Pharmacy Help Desk is available 24 hours a day, 7 days a week at 1-833-845-4702 to help you access your medications. For direct medication reimbursements requests, please use this form.
CountyCare members who would like to use CVS Caremark’s mail order pharmacy should follow the steps outlined here. To enroll in mail order please use the form here.
If you see a Cook County Health provider, you may also use the Cook County Health pharmacies. You can also get prescriptions mailed to your home. Call the Cook County Mail Order Pharmacy 24 hours a day at 800-458-0501.
If your PCP is part of a community health center, you may be able to use his/her pharmacy to get your prescription.
Some prescription drugs require a prior authorization. Your doctor can submit a prior authorization form to request approval for a drug that is non-preferred or preferred by prior authorization only on CountyCare’s Preferred Drug List.
CountyCare works with CVS Caremark to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the Preferred Drug List, as well as certain drugs not listed on the list.
Follow these steps for completing your pharmacy prior authorization requests:
To submit a specialty pharmacy prior authorization, please complete and submit online the Medication Request Form or fax the printed Medication Request Form to CVS Caremark at 1-866-255-7569.
To submit a Preferred Drug List exception request, please complete and submit online the Medication Request Form or fax the printed Medication Request Form to CVS Caremark at 1-866-255-7569.
Log in to the CVS Caremark portal to check the status of your prior authorizations, get information on the medications you are taking or to print out a list of your medications.
On the CVS Caremark portal, you can also do the following:
CountyCare provides transportation to and from your scheduled medical, behavioral, dentist, and eye appointments, pharmacies, medical equipment providers, certain events sponsored by CountyCare, or Women, Infants, and Children (WIC) food assistance locations.
Schedule a ride through CountyCare’s transportation partner, Modivcare, at least 72 hours (3 days) before your appointment.
If this is your first time using the web portal or mobile app to schedule a ride, you will need to select “Login” and then “I’m a new user” to create an account. Enter your name, email, and phone number.
Request public transportation passes (Ventra) 2 weeks before your appointment by calling Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). Your passes will be mailed after your appointment is verified with the doctor.
Mileage reimbursement: Do you have a family member or a friend that is driving you to your doctor’s visit? CountyCare can reimburse them for bringing you to your medical appointment.
Here is how it works:
To schedule a trip eligible for mileage reimbursement, call Reservations & Ride Assistance (Where’s my Ride): 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). For more information, please visit the below:
Non-Emergency Ambulance: As of January 1, 2022 if a non-emergent ambulance trip is required, please contact Healthcare and Family Service’s transportation partner, Transdev Fee for Service (FFS), at 877-725-0569 (Monday through Friday, 8 a.m. to 5 pm. CST). They will then provide a list of transportation providers for you to call and schedule your trip. If you are having issues scheduling, you can contact Transdev Fee for Service again or your care coordinator.
If you are having a medical emergency, call 911. CountyCare covers ambulance service for emergency care.
If you have a life-threatening emergency, please call 911 or go to the nearest hospital emergency department.
CountyCare wants to help you stay healthy in mind as well as body. We offer behavioral health services to treat mental health and substance use disorders. Behavioral health services are available for both children and adult members.
To learn more about behavioral health and substance use services, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
If you need these services speak with your PCP, your care coordinator, or call Member Services at 312-864-8200/ 855-444-1661 (toll-free) / 711 (TDD/TTY).
You must go to an in-network provider to receive behavioral health services.
CARES or Crisis and Referral Entry Services is a telephone response service that handles mental health crisis calls for children and adults in Illinois. CountyCare members can use the 24-hour Crisis and Referral Entry Services (CARES) line to talk to a behavioral health professional. You can call if you or your child is a risk to themselves or others, having a mental health crisis or if you would like a referral to services.
Call the CARES line at 1-800-345-9049 (TTY: 1-773-523-4504).
CountyCare covers services for maternal and child health services for expectant families, pregnant mothers, and their children through our Brighter Beginnings program. This includes:
CountyCare offers family planning services through our network of family planning providers. You can get services from any qualified family planning provider, and they do not have to be a network provider. You also do not need a referral from your PCP or permission from CountyCare to get these services.
CountyCare covers:
Having a healthy pregnancy is one of the best ways to promote a healthy birth and baby. Prenatal care is the health care you get while you are pregnant. Getting early and regular prenatal care improves the chances of a healthy pregnancy. If you know or think you might be pregnant, call your doctor or a prenatal care provider to schedule a visit.
Prenatal diagnostic procedures, including genetic testing, are covered if you have a high-risk pregnancy.
Postpartum care is the care received after delivery. The weeks following birth are a critical period for babies and families setting the stage for long-term well-being. To optimize the health of parents and infants, postpartum care should be timely, occurring within six weeks of delivery. Postpartum care includes a comprehensive assessment of physical, social, and psychological well-being and supporting any identified needs of the family and infant. People who experience a miscarriage, stillbirth, or neonatal death should schedule timely follow-up care as well.
CountyCare covered services include:
CountyCare also covers mental health services for mothers experiencing postpartum depression.
It is important that you see your women’s health provider for an annual Well Woman checkup. During this visit, your provider may perform a PAP smear, a breast exam, STI testing, and can provide family planning services.
Long-term care sometimes goes by different names such as nursing home, nursing facility, long-term care facility or skilled nursing facility.
These facilities have services that help both the medical and nonmedical needs of residents who need assistance and support to care for themselves due to a chronic illness or disability.
If you are living in a long-term care facility, CountyCare has supports in place to ensure you are getting the care you need. If you are able, we have resources to assist in transitioning you back to living independently in the community.
Contact your care coordinator if you would like to talk about long-term care or living in the community.
CountyCare operates Waiver Programs through the Illinois Department of Healthcare and Family Services for individuals who qualify.
A waiver program provides services that allow individuals to remain in their own homes or live in a community setting, instead of living in an institution or a nursing facility. These HCBS or LTSS waiver services are available in addition to medical and behavioral health benefits. The five (5) HCBS Waiver Programs currently operated by CountyCare include:
The State of Illinois determines who can receive waiver services. Contact Member Services if you think you may qualify for a waiver program. We can help you apply.
MLTSS is a program for members who have full Medicaid and Medicare benefits, who live in a nursing facility or receive HCBS (Waiver Services).
