Illinois Health Insurance: Find Affordable Plans

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 Affordable Care Act’s Health Insurance Marketplace, purchase a private plan through a local insurance agency, or enroll in a government-funded plan.

This guide explains your Illinois health insurance options in detail.

• Marketplace plans: Many people in Illinois have health insurance through an employer. You can purchase a health plan if your employer doesn’t offer coverage, the coverage offered is too expensive, or the plan doesn’t cover other members of your family. You can also buy individual health insurance if you’re self-employed and don’t qualify for a group health plan.
• Open Enrollment: Open enrollment is when you can sign up for health coverage for yourself or your family members. For coverage in 2023 in Illinois, the open enrollment period runs from October 15 through December 7, 2022.
• Special Enrollment: A Special Enrollment Period allows you to sign up for health coverage outside of Open Enrollment. You may qualify for special enrollment if you have a qualifying life event (QLE) that causes you to lose coverage—for example, moving into a different zip code, losing your job, getting married, or having a child. You have 60 days from the date of the event to select a new plan.
• Health Insurance Marketplace: Illinois and 35 other states use the federal Health Insurance Marketplace created by the Affordable Care Act. If you want to purchase a plan from the exchange, you must do so by visiting HealthCare.gov. This website allows you to view available plans and calculate your estimated out-of-pocket costs.
• Premium tax credit: If you don’t qualify for a tax credit or don’t want to take the tax credit, you don’t have to use the Health Insurance Marketplace to buy a health plan. You can purchase coverage directly from an insurance company.
• Coverage types: Nearly 55% of Illinois residents have employer-sponsored health coverage, while 7.3% have no insurance at all. Another 5.2% have non-group coverage, 0.7% have military coverage, Medicare covers 14.1%, and 18.2% have Medicaid.

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:

• Are you single or married?
• How many tax dependents will you claim on your current return?
• How much income will your household make this year?
• Do you want to see if you can get help paying for coverage?

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 health insurance plans to Illinois residents in the marketplace:

• Blue Cross and Blue Shield of Illinois
• Health Alliance
• United Healthcare

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:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for individuals in Illinois

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.

• Health Maintenance Organization (HMO) plans typically cost less than other health coverage types and have some restrictions that can affect your ability to access care. For example, you may have to ask for a referral to see a specialist, and your network is local.
• Preferred Provider Organizations (PPOs) don’t require referrals and usually offer nationwide coverage but tend to cost more than HMO plans. Most PPOs also have out-of-network benefits.
• Point-of-Service (POS) plans combine the features of an HMO with the features of a PPO. You have to ask for a referral to see a specialist, but you can get care from out-of-network providers if you’re willing to pay a larger percentage of the cost.

Insurance for families in Illinois

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.

• Bronze plans tend to cost the least but also have the highest deductibles. A Bronze plan typically pays only 60% of the covered cost of each service, which means you’d need to pay the other 40%. For example, if your covered service is $1,000, a Bronze plan would cover $600, and you’d owe $400. The most affordable Bronze plan in Illinois costs $340 per month.
• Silver plans are mid-level plans that cost a little more than Bronze plans and give you a little more coverage. A Silver plan typically covers 70% of the cost of each covered service, leaving you with 30% coinsurance. Although Silver plan premiums are higher than Bronze, your deductible or out-of-pocket maximum may be lower with a Silver plan than a Bronze plan. The most affordable Silver plan in Illinois costs $449 per month.
• Gold and Platinum plans provide a high level of coverage at a higher monthly price and tend to have lower deductibles and lower out-of-pocket maximums. If someone in your family has a chronic medical condition, it may cost less overall to pay for a Gold or Platinum plan than it does to pay for a cheaper Bronze plan with higher deductibles, coinsurance requirements, and out-of-pocket maximums. The most affordable Gold plan in Illinois costs $482 per month.

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 in Illinois

Medicaid provides coverage to low-income Americans who meet any of the following eligibility requirements:

• At least 65 years old
• Pregnant
• Blind
• Under 18

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

All Kids Assist, which has no premiums and no copays, has a monthly income limit ranging from $1,578 to $3,802 per month, depending on your household size. All Kids Share has no monthly premiums and no copay for services.

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 $1,686 to $5,406 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 $2,244 to $8,226 per month, depending on household size.

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.

FamilyCare

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 FamilyCare covers parents with the same services as All Kids, including routine checkups, inpatient care, prescription drugs, and emergency medical 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.

• Original Medicare is the most basic form of Medicare available. It includes Part A (hospital care) and Part B (outpatient care, durable medical equipment, and similar services), but it doesn’t have prescription coverage. If you choose Original Medicare, you can buy Medicare Part D and Medicare Supplement Insurance (Medigap). Part D covers prescription drugs, while Medigap covers some out-of-pocket expenses associated with Medicare, such as deductibles and premiums. The Medicare Part A deductible for inpatient hospital stays is $1,600. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage provides the same basic coverage as Original Medicare. Because an insurance company sells each plan, you may be able to get coverage for additional services. For example, some plans cover dental care or hearing aids. If you have a Medicare Advantage Plan covering prescriptions, you can’t buy a Part D plan. As of 2023, there are 173 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

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

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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.

• AHRQ | National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2017 | Last accessed December 22, 2022
• American Council on Aging | Illinois Medicaid Eligibility for Long Term Care: Income & Asset Limits | Last accessed December 22, 2022
• Get Covered Illinois | Home | Last accessed December 22, 2022
• HealthCare.gov | Advance Premium Tax Credit | Last accessed December 22, 2022
• HealthCare.gov | Out-of-pocket maximum/limit | Last accessed December 22, 2022
• HealthCare.gov | The ‘metal’ categories: Bronze, Silver, Gold & Platinum | Last accessed December 22, 2022
• HHS.gov | Who is eligible for Medicare? | Last accessed December 22, 2022
• IHFS | About All Kids | Last accessed December 22, 2022
• IHFS | FamilyCare | Last accessed December 22, 2022
• IHFS | How Much Does It Cost? | Last accessed December 22, 2022
• IHFS | Illinois Healthcare Reform Under the Affordable Care Act | Last accessed December 22, 2022
• Illinois General Assembly | Short-Term, Limited Duration Health Insurance Coverage Act | Last accessed December 22, 2022
• KFF | Average Marketplace Premiums by Metal Tier, 2018-2021 | Last accessed December 22, 2022
• KFF | Health Insurance Coverage of the Total Population | Last accessed December 22, 2022
• Lamber Goodnow Injury Lawyers | What Is PIP? | Last accessed December 22, 2022
• Medicare.gov | How Original Medicare works | Last accessed December 22, 2022
• Medicare.gov | Medicare Advantage Plans | Last accessed December 22, 2022
• NC Department of Insurance | Alternate Plans | Last accessed December 22, 2022
• UCnet | Basic and Voluntary Disability | Last accessed December 22, 2022