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If you need to find affordable health insurance in Illinois, you have several options. Even if your employer doesn’t offer coverage, you can buy a plan from the Health Insurance Marketplace, purchase a private plan, or enroll in a government-funded plan.
This guide explains your Illinois health insurance options in detail.
Visit HealthCare.gov and set up an account if you don’t already have one to use the Health Insurance Marketplace. Make sure you have the full name, birth date, and Social Security number of every person in your family who needs coverage before you start the application process.
The application includes several questions related to your income and family, including the following:
You’ll need to provide your name, contact information, and details about your income to determine if you qualify for an Advance Premium Tax Credit. The Advance Premium Tax Credit is paid to you in advance to make your health premiums more affordable. Be sure to estimate your annual income as accurately as possible. If you underestimate, you may receive more credit than you would otherwise be eligible to receive. You’ll have to pay back the excess in back premiums when you file your taxes.
Once you set up your account, you can search for plans available in your area. You’ll be able to see how much each plan costs per month and download more information about the plans’ deductibles, copays, coinsurance requirements, and coverage restrictions. The site also tells you whether each option is a health maintenance organization (HMO) plan, preferred provider organization (PPO) plan, point-of-service (POS) plan, or exclusive provider organization (EPO) plan.
The following insurance companies offer individual health insurance plans to Illinois residents in the marketplace:
The process of signing up for health insurance is the same whether you’re enrolling yourself or your entire family. However, there are some essential factors to consider when choosing a plan:
If you’re shopping for yourself, try to find a plan that offers the best coverage at the most affordable price. Remember that the monthly premium is only part of the total cost of your coverage. You also need to consider the annual deductible, percentage of expenses covered by each plan, and copay required for each service. If you’re in good health and generally only visit the doctor once or twice per year, consider balancing an affordable monthly premium with a reasonable deductible.
If you have a chronic health condition requiring prescription medications or frequent medical appointments, it may benefit you to consider a plan with a higher monthly premium but lower annual deductible. When you compare deductibles and coinsurance requirements, the more expensive plan may be the better bargain as it reduces your out-of-pocket expenses for usage.
You also need to check each plan’s out-of-pocket maximum. The out-of-pocket maximum is the maximum amount you’ll pay per year before your insurance company starts covering 100% of your medical costs.
The type of plan you choose is also an important consideration.
Compare carefully to determine if the available plans cover the services your family needs most. Depending on your needs, you may want to check the coverage available for durable medical equipment, massage therapy, fertility services, chiropractic care, and rehabilitation services. It’s also essential to determine if the plan covers any services before you’ve paid your full deductible. Some plans cover preventive care even if you haven’t paid your deductible yet. This feature can be beneficial if you typically only need routine preventive care.
Finally, think carefully before choosing an HMO plan over a PPO plan. HMO plans tend to be more restrictive than other types of health insurance. You’re pre-assigned a primary care provider, and you can’t see a specialist unless your PCP gives you a referral. If someone in your family needs ongoing specialty care, it may be worth the extra cost to sign up for a PPO plan that allows you to see a specialist even if you don’t have a referral from your PCP.
The Health Insurance Marketplace uses metal names to classify on-exchange health plans. Checking a plan’s tier makes it easier to estimate your total out-of-pocket costs for health coverage.
Plan details are prominent when you shop for a plan via the Health Insurance Marketplace. You can estimate your total out-of-pocket costs just by glancing at the plan summary. You can also download plan documents with more detailed information inside.
|Average premiums in Illinois||2018||2019||2020||2021|
|Most affordable bronze plan||$345||$367||$361||$337|
|Most affordable silver plan||$460||$447||$435||$415|
|Most affordable gold plan||$529||$501||$499||$478|
Not everyone can afford to pay a hefty monthly premium for a health plan. Illinois has several options for low-income individuals and families. For residents who earn too much to qualify for Medicaid, the state also has All Kids and FamilyCare, with higher income limits for qualification.
Medicaid provides coverage to low-income Americans who meet any of the following eligibility requirements:
As of 2021, the monthly income limit is $1,073 per month for individuals and $1,452 per month for married couples. The asset limit is $2,000 for single individuals and $3,000 for married couples that apply for coverage. In some cases, only one spouse applies for Medicaid. If this applies to you, the asset limit for institutional Medicaid and Medicaid waiver programs is $2,000 for the applicant and $109,560 for the non-applicant.
For some types of Medicaid, you need to meet additional eligibility criteria. For example, applicants for institutional Medicaid and Home and Community-Based Services waiver programs must require a nursing facility level of care to qualify for coverage. To receive Illinois Medicaid benefits, you must be a resident of Illinois and a U.S. citizen or lawful immigrant.
All Kids Assist, which has no premiums and no copays, has a monthly income limit ranging from $1,530 to $3,696 per month, depending on your household size. All Kids Share has no monthly premiums and a maximum of $100 in copays for all services received in a calendar year. The monthly income limit ranges from $1,531 to $3,947 per month based on household size.
For All Kids Premium Level 1, you can expect to pay $15 per month for the first child, $25 per month for the second child, and $5 per month for each additional child. Each family has a maximum copay of $100 for all services received each year. The income limit for this level of coverage ranges from $1,635 to $5,255 per month. Level 2 coverage costs $40 per child, up to a maximum of $80 for two or more children. The annual out-of-pocket limit is $500 per child for hospital services. The income limit ranges from $2,176 to $7,995 per month, depending on household size.
FamilyCare provides coverage for the parents and caregivers of children who are under 18. The monthly income limit ranges from $1,436 to $4,994 for household sizes of one to eight individuals. If more than eight people are in the household, the income limit increases by $508 for each additional person. FamilyCare has some basic cost-sharing requirements, such as a $2 copay for generic prescriptions and a copay of up to $3.90 per day for hospital care.
Illinois also has Medicare available for residents who meet the eligibility requirements. Typically, Medicare coverage starts at age 65 or if you have a disability that qualifies you for Social Security Disability Insurance payments. In most cases, you don’t qualify for Medicare until you’ve received at least 24 SSDI payments. Some conditions — such as Lou Gehrig’s disease and end-stage renal disease — make you eligible earlier.
Medicare has several enrollment periods each year. If you miss your opportunity to enroll during one of these periods, Illinois also has special enrollment periods if you lose health coverage, get married, adopt a child, have a baby, or have some other qualifying life event.
When you enroll, you have the option of choosing Original Medicare or Medicare Advantage.
|Eligibility and Enrollment|
|Eligibility||To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease.|
|Enrollment||Three months before you turn 65, you’ll become eligible for an initial enrollment period. During the IEP, you’ll have an opportunity to sign up for Medicare. If you started receiving Medicare before the age of 65, you could make changes to your coverage at this time.
Medicare has an open enrollment period from October 15 to December 7 each year. You can sign up for Medicare or switch your Medicare Advantage or Medicare Part D plan to meet your needs better during open enrollment.
Serving Health Insurance Needs of Elders (SHINE) is Florida’s State Health Insurance Assistance Program. If you have questions about your Medicare options or need help enrolling in Original Medicare or Medicare Advantage, call SHINE at 1-800-963-5337 to speak with a counselor.
In Illinois, insurance companies are allowed to sell “short-term, limited-duration” health plans. These plans provide no more than 180 days of coverage and are considered nonrenewable. Additionally, you can’t purchase another short-term plan if you’ve had short-term coverage within the previous 12 months. If you buy short-term health insurance, the insurance company can’t rescind your coverage unless you fail to pay your premiums or fraudulently obtained the plan.
Short-term insurance isn’t a replacement for regular health insurance. The plans aren’t regulated the same way, so a short-term plan may not cover the services you need, and you may have to pay a much higher portion of your medical costs. But short-term health insurance may be a good solution if you need to cover a temporary lapse in insurance. For example, when you start a new job or are waiting for open enrollment to begin.
No. Illinois has no laws requiring residents to have health insurance. The Affordable Care Act requires all Americans to have coverage, but there is no longer a federal penalty if you don’t carry health insurance.
If you want to get an Advanced Premium Tax Credit to help pay your premiums, you have to apply for coverage via the Health Insurance Marketplace. Otherwise, you can purchase a health plan directly from an insurance company that offers coverage in Illinois. Individuals, families, and small business owners who do not qualify for a tax credit may benefit from purchasing a plan directly from an off-exchange insurance company.
If you don’t want to purchase traditional health coverage, you may join a health sharing plan. Under this type of plan, you pay a monthly fee that goes into a pool of funds to pay members’ medical expenses. Health sharing plans aren’t health insurance and are not required to cover pre-existing conditions. There’s no guarantee a health share plan will pay your medical expenses.
Health savings accounts and flexible spending accounts aren’t substitutes for health insurance. Even if you have money in an HSA or FSA, you should still have health insurance if you develop an illness or injury requiring a lengthy hospitalization or visit to an emergency room. In 2016, the average cost of a hospital stay was $11,700, higher than the annual limit for HSA and FSA contributions. Having health insurance protects you from having to bear the burden of these high costs on your own.
Health insurance and short-term disability coverage have different purposes. Health insurance covers your medical expenses, while short-term disability replaces your lost income if you can’t work due to an injury. It’s good to combine STD coverage with your health insurance to ensure you have some income coming in while you’re recuperating.
If an accident or injury leaves you unable to work for six months or more, long-term disability will replace some of your lost income to pay your household expenses. Health insurance only covers your medical expenses, so it doesn’t provide the same financial protection as long-term disability. Therefore, it’s wise to purchase LTD coverage in addition to your health coverage.
All Kids covers various medical services for children up to 18 years old, such as doctor visits, immunizations, hospital care, and prescription medications. The plan also covers dental care, vision care, and corrective lenses.
Illinois FamilyCare covers parents with the same services as All Kids, including routine checkups, inpatient care, prescription drugs, and emergency medical care.