Paul Sanchez
Medicaid is a federal-state program that provides health care for low-income individuals of all ages. In Illinois, Medicaid is available to US citizens and qualified non-citizens, such as refugees and those lawfully present in the US for over five years. The eligibility criteria for Medicaid in Illinois are based on income and asset limits, with specific thresholds for children, pregnant women, adults, and seniors. While Medicaid is an essential safety net, it is not the only option for health insurance in Illinois. The state offers various health insurance plans, and individuals can explore additional coverage options through employers or the Affordable Care Act marketplace. This raises the question: can individuals with Medicaid coverage in Illinois also benefit from other forms of health insurance?
| Characteristics | Values |
|---|---|
| Eligibility | Children ages 0-18 with family income levels up to 142% to 147% of the federal poverty level (FPL) |
| Pregnant women with family income up to 208% to 213% of FPL | |
| Adults with family income up to 138% of FPL | |
| Young adults under age 26 who were formerly in foster care | |
| Seniors aged 65 and over | |
| U.S. citizens or qualified categories of non-citizens | |
| Application Process | Apply online, by phone, by mail or fax, or in person |
| Seniors can apply online, by phone, via paper application, or in person | |
| Assets | Countable: cash, stocks, bonds, investments, bank accounts, real estate, IRAs |
| Exempt: personal belongings, household furnishings, an automobile, primary home, irrevocable prepaid funeral burial contracts | |
| Additional Information | Illinois runs Get Covered Illinois, a website with a help desk to help residents find low-cost insurance options |
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What You'll Learn
Medicaid eligibility requirements in Illinois
In Illinois, Medicaid is available to people who are low-income adults aged 19 to 64 years, over 65 years, disabled, blind, or pregnant women. Each group has a different set of income and asset requirements.
Eligibility requirements
Medicaid eligibility depends on a combination of factors, including income, assets, and family size. To qualify for Medicaid, your income must be below the Medicaid income limit for your household size. Your household size is considered, including any dependents you plan to claim on your taxes, even if they do not live with you.
The value of countable assets is added together and counted towards Medicaid's asset limit. This includes cash, stocks, bonds, investments, bank accounts, and real estate in which one does not reside. IRAs are also counted in Illinois. Certain assets are considered exempt, including personal belongings, household furnishings, an automobile, and generally one's primary home.
For long-term care services, an applicant must have a functional need. For Institutional Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. For Illinois residents aged 65 and over who do not meet the financial eligibility requirements, there are other ways to qualify for Medicaid, such as the Medically Needy Pathway.
Enrollment options
There are several options to enroll in Medicaid in Illinois:
- Apply online using the Illinois website or Healthcare.gov (for non-disabled adults under 65).
- Apply in person and get help from the Department of Human Services (DHS).
- Apply by mail or fax, or call and ask DHS to mail you an application. Complete the application and mail or fax it back to the nearest Family Community Resource Center.
- Seniors can apply online at ABE (Application for Benefits Eligibility), via phone, by submitting a completed paper application, or in person at their local Illinois Department of Human Services (IDHS) office.
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Applying for Medicaid in Illinois
Medicaid is a state and federal program that helps with medical costs for people with low incomes. In Illinois, Medicaid is available to US citizens and qualified categories of non-citizens, such as refugees and those lawfully present in the US for over five years.
Eligibility for Medicaid in Illinois is based on income and assets. The income requirements vary depending on the applicant's age, health, and family situation. For instance, children under 18 qualify with family incomes up to 147% of the federal poverty level (FPL), while pregnant women can qualify with family incomes up to 213% of FPL. Adults under 65 without a disability qualify with family incomes up to 138% of FPL.
Additionally, assets are considered when determining eligibility. Countable assets include cash, stocks, bonds, investments, bank accounts, and real estate that is not the primary residence. On the other hand, exempt assets include personal belongings, household furnishings, automobiles, and usually one's primary home.
To apply for Medicaid in Illinois, you can use any of the following methods:
- Online: The Illinois website for applying online is https://abe.illinois.gov. Applying online allows you to keep track of the information you submitted and make changes if needed. You will be asked to create a secure account, and your information will be kept private and secure.
- By Phone: Seniors can apply by calling 1-800-843-6154 (IDHS Customer Help Line).
- By Mail or Fax: You can request a paper application by calling 1-800-843-6154 and then mailing or faxing the completed application to the nearest Family Community Resource Center.
- In Person: You can apply in person at your local Illinois Department of Human Services (IDHS) office or the nearest Family Community Resource Center.
The application process typically takes around 30 to 45 minutes to complete. Once you submit your application, you will be provided with a tracking number that you should keep for future reference. Remember to provide all the necessary information and documentation, as submitting false information can result in serious penalties, and failing to provide the required documents by the specified date may lead to a denial of your application.
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Other health insurance options in Illinois
Illinois residents have several health insurance options, including Medicaid, Medicare, short-term health insurance, and private health insurance.
Medicaid
Medicaid is a health care program for low-income individuals of all ages. Illinois residents may qualify for affordable Medicaid coverage if they meet certain eligibility requirements. These requirements are based on income and asset limits, and Illinois has established requirements that are near the national averages. For example, children ages 0-18 qualify with family income levels up to 147% of the federal poverty level (FPL), while pregnant women with family income up to 208% of FPL are also eligible. Additionally, Illinois offers extended postpartum coverage for mothers for 12 months after the baby is born.
Medicare
Medicare is another option for Illinois residents, and many Medicare beneficiaries also receive assistance through Medicaid. This includes help with Medicare premiums, cost-sharing, and services not covered by Medicare, such as long-term care expenses.
Short-Term Health Insurance
Short-term health insurance is available for individuals who are not eligible for subsidies, Medicare, or Medicaid. However, Illinois enacted legislation to ban the sale of short-term health insurance in the state starting in January 2025.
Private Health Insurance
Illinois residents can also purchase private health insurance through the Illinois Marketplace, which offers a range of plans from different insurance companies. Enrolling in the Illinois Marketplace may make individuals eligible for financial assistance through premium subsidies and cost-sharing reductions (CSR). When purchasing private health insurance, it is important to consider factors such as coverage, premiums, and waiting periods. Additionally, some insurance companies offer supplemental coverage, such as dental insurance, which can be a smart addition to one's health coverage.
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Losing Medicaid benefits in Illinois
Medicaid is a government-funded health insurance program that covers about 3.9 million people in Illinois, including low-income adults, children, pregnant women, and people with disabilities. It is jointly funded and managed through a partnership between the federal government and the Illinois Department of Healthcare and Family Services (HFS).
During the Covid-19 pandemic, Congress made changes to Medicaid to help people and states cope with the crisis. One change gave states extra federal funding to keep customers enrolled, even if they were no longer eligible. This "continuous coverage" ensured that customers would not lose coverage during the pandemic unless they moved out of state, requested cancellation, or passed away.
Now, Congress has set an end to continuous coverage. The first time anyone with Medicaid will get a renewal notice in the mail will be at the start of the month before their coverage is due for renewal. If someone doesn't qualify anymore, they may lose coverage a month after their renewal due date. This process is called "redetermination," and the relevant term used on the forms. People will get their renewal forms one month before they are due, and all renewals are due by the first day of the following month.
If a customer's redetermination has not been received by the mid-month cutoff date of the month in which their redetermination is due, they will receive a letter reminding them to return their completed Form B redetermination no later than the mid-month of their new, extended due date. This letter will also remind customers of the ways in which they can renew their medical coverage.
It is important to note that eligibility requirements for Medicaid in Illinois must be met. If one does not meet the income and/or asset limit(s), or are unsure if the eligibility criteria are met, Medicaid Planning is strongly suggested. The Medicaid application process can be complicated, and if not done correctly, can result in a delay of benefits or losing Medicaid coverage.
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Medicaid and insurance for seniors in Illinois
In Illinois, Medicaid is available to people with low incomes who are aged 19 to 64, over 65, disabled, blind, or pregnant. The program also covers young adults under 26 who were formerly in foster care. Each group has a different set of income and asset requirements.
Enrollment
Seniors can apply for Illinois Medicaid online at ABE (Application for Benefits Eligibility), via phone at 1-800-843-6154 (IDHS Customer Help Line), by submitting a completed paper application, or in person at their local Illinois Department of Human Services (IDHS) office.
Eligibility
To be eligible for Medicaid, one must be a U.S. citizen or fall within one of the qualified categories of non-citizens, such as refugees and persons lawfully present in the U.S. for over five years. If one does not meet the income and/or asset limit(s), or are unsure if the eligibility criteria are met, Medicaid Planning is strongly suggested.
Medicaid and Insurance
Many Medicare beneficiaries also receive assistance through Medicaid. This includes help with Medicare premiums, cost-sharing, prescription drug costs, and services not covered by Medicare, such as long-term care expenses.
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Frequently asked questions
To be eligible for Medicaid in Illinois, you must be a U.S. citizen or fall into one of the qualified categories of non-citizens, such as refugees and persons lawfully present in the U.S. for over five years. Additionally, there are income requirements that vary based on age and family size. For example, children aged 0-18 qualify with family incomes up to 142-147% of the federal poverty level (FPL).
You can apply for Medicaid in Illinois online, in-person, by mail, or by phone. To apply online, you can use the Illinois website or Healthcare.gov (for non-disabled adults under 65). To apply in person, you can visit your local Illinois Department of Human Services (IDHS) office or your nearest Family Community Resource Center. You can also apply by mailing or faxing an application to the Family Community Resource Center or by calling 1-800-843-6154.
If you are not eligible for Medicaid, you can explore other health insurance options through GetCoveredIllinois.gov, the official Affordable Care Act Health Insurance Marketplace for Illinois. This website offers free enrollment assistance and can help you find low-cost insurance options and determine if you qualify for financial help. You can also ask your employer about health insurance plans.
Having both insurance and Medicaid in Illinois can provide additional coverage and reduce out-of-pocket expenses. Medicaid can help with costs that other insurance may not cover, such as long-term care expenses, prescription drug costs, and services not typically covered by Medicare.
