We are excited to share that MeridianCare, a WellCare company, is changing its name to WellCare, effective January 1, 2020!
You’ve got questions, we’ve got answers. If there’s a question you can’t find the answer to on our website, callMember
Services at1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
What is MeridianComplete?
MeridianComplete is a Medicare-Medicaid Plan (MMP) for beneficiaries eligible for both Medicaid and Medicare.
What is the phone number and hours of operation for MeridianComplete?
Call our MeridianComplete Member Services with any questions or concerns, or to file a grievance (complaint), at 1-855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. - 8 p.m.
You should call your Primary Care Provider (PCP) with any medical concerns that you have.
I've transitioned from a WellCare Medicare plan, what has changed?
The state of Illinois will soon be enrolling some members who are enrolled in WellCare Medicare plans in a Medicare-Medicaid Alignment Initiative (MMAI). It is a program that combines Medicare and Medicaid. Members have the option of keeping MMAI. It can replace a current WellCare (Medicare only) health plan.
The state has identified those members who qualify for both Medicare and Medicaid programs.
What is MMAI?
MMAI is a healthcare plan that covers Medicare, Medicaid, and prescription drug benefits. Our MMAI plan is called MeridianComplete. It is one of the MMAI plans offered in Illinois. MeridianComplete and WellCare are both part of Centene Corporation. That means the plan will change, but members will keep the same insurance group.
Full MMAI Passive Expansion notice for IL WellCare Members FAQ Document
Am I eligible to enroll in MeridianComplete?
MeridianComplete is a Medicare-Medicaid Plan (MMP).
You are eligible for MeridianComplete if you:
For other questions about MeridianComplete, please contact MeridianComplete Member Services at 1-855-580-1689 (TTY 711), Monday - Sunday, 8 a.m. to 8 p.m.
How do I enroll?
You can enroll in MeridianComplete by contacting Client Enrollment Services for the Illinois Department of Healthcare and Family Services at 1-877-912-8880 (TTY 1-866-565-8576), Monday - Friday from 8 a.m. to 7 p.m. The call is free. You can also visit the Illinois Client Enrollment Services website at http://enrollhfs.illinois.gov/.
For other questions about MeridianComplete, please contact MeridianComplete Member Services at1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
What are the costs (e.g., copays, deductibles, premiums, etc.) associated with enrollment in MeridianComplete?
MeridianComplete has no premiums, deductibles, or coinsurance for medical services.
In 2021 for generic drugs covered by Medicare (including brand drugs treated as generic) you will pay a $0 copay. In 2021, for brand drugs covered by Medicare, you will pay a $0 copay.
If you have any questions or concerns about premiums and/or cost-sharing associated with enrollment in MeridianComplete, or you receive a bill for medical or prescription services, please call Member Services at1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
How do I replace my Member ID card?
You can call our Member Services Department at:1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
Do you offer interpreter services for non-English speakers?
Yes, we offer interpreter services for over 140 different languages. For more information, call Member Services at1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
What is a PCP?
A Primary Care Provider (PCP) is a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides and manages your health care services. This can also be called a Primary Care Physician.
Your primary care provider is the person you see first for most health problems. They make sure that you get the care you need to keep you healthy. They also may talk with other doctors and healthcare providers about your care and refer you to them.
How do I find a PCP in my area?
Use our Provider Search tool to locate a provider near you. You can also call our Member Services Department at
1-877-902-6784 (TTY: 711), Monday - Sunday from 8 a.m. – 8 p.m.
How do I change my PCP?
Call Member Services at1-855-580-1689 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
Do I need a referral or authorization to have services performed?
Some healthcare services require a "prior-authorization" before they are performed. Before you visit the doctor, these services need to be approved by MeridianComplete. Your PCP or specialist can inform you if you need a prior-authorization and will take care of submitting the necessary information to coordinate these services.
What if I need emergency care?
Emergency care within the United States is a benefit covered byMeridianComplete
You do not need to contact MeridianComplete for approval before receiving emergency services. If your situation is urgent but not life threatening, you should call your Primary Care Provider's (PCP's) office or MeridianComplete at 1-855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. - 8 p.m. for help with finding an urgent care center.
What if I travel out of town and need health care services?
When you travel out of MeridianComplete's service area, you may go to an emergency room (ER) or go to an urgent care clinic. Make sure you tell the provider you are a MeridianComplete member and show them your MeridianComplete Member ID card. MeridianComplete will pay for your out-of-area emergency care, but routine care is not covered out of MeridianComplete's service area (even if it is provided in an ER).
Does MeridianComplete cover dental services?
MeridianComplete does cover some dental services. Please review your Member Handbook for more information. For a list of in-network dental providers, please visit the †DentaQuest website: www.dentaquest.com.
†Other Pharmacies/Physicians/Providers are available in our network.
I need to fill a prescription. What should I take to the pharmacy?
Take your MeridianComplete Member ID card to the pharmacy. You should also take personal identification, like a driver's license or state issued identification card, with your picture on it.
What is a List of Covered Drugs?
A List of Covered Drugs (Drug List) is a list of prescription drugs covered by Meridian Complete. The plan chooses the drugs on this list with the help of doctors and pharmacists. The Drug List tells you if there are any rules you need to follow to get your drugs. The Drug List is sometimes called a “formulary.” For more information on how to fill your prescriptions, please review your Member Handbook.
What is a Pharmacy Benefit Manager (PBM)?
A PBM is a business that works with insurance companies to fill member prescriptions. MeridianRx is the PBM for MeridianComplete. MeridianRX also takes care of drug prior authorization (PA) requests.
What is Prior Authorization (PA)?
There may be times when your doctor prescribes a drug for you that is not approved in your plan. Your doctor can fill out a PA request form, giving facts about your medical history and why you need the drug. Note: We must approve the drug before you can fill the prescription.
What happens if the Prior Authorization (PA) is not approved?
MeridianComplete and the MeridianRx Formulary Team may deny a drug request for medical reasons. If your doctor's PA request is not approved, you and your doctor will get a letter explaining why. The letter will also explain the appeal process if you and your doctor disagree with the denial.
What is a quantity limit (QL)?
For some drugs, there are limits to how much you can take safely. This limit is based on research from the drug maker and the FDA. The QL is the amount of drug that can be filled safely each month. If your doctor feels that you need more of a medication, he/she must fill out a PA request.
What is Step Therapy?
Sometimes more than one medication can be used to treat your condition. Step therapy means that one medication must be tried first before another medication can be tried. Your healthcare provider or pharmacist can explain which medication must be tried first.
I have a question about my drug. What is the MeridianRx phone number?
You can call MeridianRx toll-free at
1-855-898-1480 (TTY: 711), Monday - Sunday, 8 a.m. to 8 p.m.
MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.
You can get this document in Spanish, or speak with someone about this information in other languages for free. Call1-855-580-1689 (TTY users should call 711)
,Monday - Sunday, 8 a.m. to 8 p.m.
The call is free.
Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al1-855-580-1689
(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.
Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year
The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.
For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at1-855-580-1689 (TTY users should call 711)
Page Last Modified: 4/5/2022 2:50:09 PM