Alyssa Lane
If you're looking to get medical insurance in Illinois, there are several options available to you. You can get health insurance through your employer or a family member's employer, or you can purchase it individually through the Affordable Care Act (ACA) Health Insurance Marketplace on Healthcare.gov or Getcoveredillinois.gov. If you meet certain income requirements, you may be eligible for a zero-dollar premium plan or premium tax credits to help with the cost of coverage. Additionally, you can explore public programs like Medicare and Medicaid, which provide coverage for individuals over 65 or with specific needs. Illinois also offers supplemental plans and short-term gap coverage to ensure you get the care you need at a price that works for you.
| Characteristics | Values |
|---|---|
| How to get health insurance in Illinois | Get coverage through public programs like Medicaid and Medicare; get coverage through your employer; or buy health insurance on your own through the Affordable Care Act (ACA) Health Insurance Marketplace on Healthcare.gov or Getcoveredillinois.gov |
| Health Insurance Marketplace | ACA Health Insurance Marketplace on Healthcare.gov or Getcoveredillinois.gov |
| Health Insurance Glossary | Get Covered Illinois |
| Financial help | Available for those who qualify |
| Premium subsidies | Vary by address and subject to eligibility; those with incomes between 100% and 150% of the federal poverty level (FPL) may qualify for a zero-dollar premium silver or bronze plan (after tax credits) |
| Health Insurance Counseling | In Illinois, the Senior Health Insurance Program (SHIP) – Illinois Department on Aging provides free health insurance counseling services for Medicare beneficiaries and their caregivers |
| Short-term, limited-duration health plans | Beginning January 1, 2025, insurance companies are prohibited from selling these in Illinois |
| Hospital insurance | Underwritten by Golden Rule Insurance Company, pays cash benefits in a fixed amount for qualifying hospital stays and related medical costs |
| Lump sum insurance | Pays a lump sum when the enrollee experiences death, dismemberment, disability, or hospital and medical care caused by an accident |
| Dental or vision insurance | You may purchase insurance covering only dental or vision or other specified care |
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What You'll Learn
Financial help and subsidies
If you are struggling to pay for health insurance in Illinois, there are several options for financial help and subsidies available to you. Firstly, you can look at individual coverage on Get Covered Illinois/HealthCare.gov. This is the only way to get help from the government to pay for your private insurance. The amount of premium you pay depends on your income and your plan. The government may subsidize your monthly premium and help you get a plan with lower copayments if you have a low to moderate income. However, you must meet other eligibility rules to get subsidies. When your income is assessed, most of your earned and unearned income is counted. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts.
Medicaid is another option for financial assistance. It is a government health program for people with low incomes. There are no monthly premiums, and copayments for services are much lower than those required by individual plans. To qualify for Medicaid, your family's income must be at or below 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four). Federal matching funds are available under Medicaid for seniors, blind people, and persons with disabilities with incomes up to 100% of the FPL and no more than $2,000 of non-exempt resources.
If you are unable to obtain Medicaid, Medicare, or employer-sponsored coverage, you may be eligible for individual coverage. This is where an individual or family pays a monthly premium, and a private health insurance company agrees to pay some of the costs of approved medical services. If your employer offers you health coverage that costs less than 9.02% of your household's income and meets a certain level of benefits, you won't be eligible for government assistance with an individual plan.
There are also specific programs targeting certain groups, such as the State Sexual Assault Survivors Emergency Treatment Program, which pays for emergency outpatient medical expenses and 90 days of follow-up care for survivors of sexual assault. The State Hemophilia Program provides assistance to eligible patients with bleeding or clotting disorders to obtain anti-hemophilic factor, comprehensive visits, and other outpatient medical expenses related to the disease. Additionally, Illinois non-profit hospitals must report the community benefits they provide annually, including charity care, and the Hospital Uninsured Patient Discount Act mandates discounts of up to 100% for uninsured patients at certain income levels.
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Public programs like Medicaid and Medicare
In Illinois, you can obtain health insurance through public programs like Medicaid and Medicare. These programs are typically available to individuals who meet certain eligibility requirements, such as income or age.
Medicaid is a state-run program that provides health coverage for low-income individuals and families. It is funded by both the state and federal governments and is administered by the state. Eligibility requirements and benefits may vary from state to state, but generally, Medicaid covers essential health services, including doctor visits, hospital stays, prescription drugs, and more. To enrol in Medicaid, individuals must meet income and asset guidelines, which can be found on the state's official website.
On the other hand, Medicare is a federal program that primarily covers individuals aged 65 and older, as well as younger people with disabilities. It helps pay for most medical expenses, including hospital stays, doctor visits, and prescription drugs. However, it's important to note that Medicare does not cover all expenses, and some beneficiaries may opt to purchase a Medigap policy to help cover additional costs, such as deductibles. In Illinois, Medicare beneficiaries and their caregivers can access free health insurance counselling services through the Senior Health Insurance Program (SHIP) offered by the Illinois Department on Aging.
To enrol in Medicare, individuals must typically be aged 65 or older and be a US citizen or a legal resident who has lived in the country for at least five years. Enrolment periods are usually held annually, and late enrolment may result in penalties. For those who do not qualify for traditional Medicare, there are other options, such as Medicare Advantage, which is provided by private insurance companies approved by Medicare.
In Illinois, the state has partnered with the Centers for Medicare & Medicaid Services (CMS) to implement the Medicare-Medicaid Alignment Initiative. This initiative aims to provide a more coordinated and person-centred care experience for enrollees in both programs, with health plans contracted to deliver and be accountable for all covered services.
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Employer-provided insurance
In Illinois, most people get health care coverage through their job or a family member's job. Employees and their families usually have the opportunity to sign up for coverage when starting a new job and once each year during an enrollment period. State insurance regulators help oversee insurance plans that employers purchase, especially when the employer has fewer than 50 employees.
The Consumer Coverage Disclosure Act (CCDA) applies to all employers that offer group health coverage to employees in Illinois, including state and local government and school districts. Employers must provide a list of essential health benefits (EHBs) and a comparison of which of those benefits are covered by the insurance plan provided by the employer. This must be provided to all employees at hire, annually, and upon request. Employers don't have to offer the listed EHBs, but they must identify which are included in their plan. Employers can use a sample comparison chart provided by regulators to help complete this process.
Employees should ask their employer's Human Resources department to learn how to sign up for health insurance. An employer may offer more than one plan, and there are usually trade-offs between them. For example, one plan may require a higher monthly premium, while another may require higher copayments when you visit a doctor. It is important to sign up for coverage when it is first offered, as otherwise, you may have to wait until the annual open enrollment period, which is usually near the end of the year.
If you lose your employer-sponsored coverage, you may be able to keep the same health plan through COBRA, a federal law that applies to companies with 20 or more employees. However, you will have to pay the entire premium for COBRA coverage, which can be expensive.
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Individual market insurance
If you're looking to purchase health insurance on your own in Illinois, you're considered to have 'individual market' coverage. This means that you or your family are buying health insurance and are not part of a group that gets health coverage together, such as through an employer.
There are several ways to obtain individual market insurance in Illinois. One option is to purchase coverage through the Affordable Care Act (ACA) Health Insurance Marketplace, also known as the Health Insurance Marketplace. This can be done through websites such as Healthcare.gov or Getcoveredillinois.gov. Buying coverage through the ACA Marketplace may allow those who qualify to receive premium tax credits to help with the cost of their insurance plan. Additionally, Illinois operates Get Covered Illinois, which offers in-person and online assistance to help you navigate the world of health insurance and choose the right plan for your needs.
Another option for obtaining individual market insurance is through public programs such as Medicaid and Medicare. Medicaid is a public program that provides health coverage for those who meet certain income and eligibility requirements. On the other hand, Medicare is a federal program that typically covers individuals aged 65 or older, as well as those under 65 who are receiving Social Security disability benefits. It is important to note that Medicare does not cover all expenses, and some beneficiaries may opt to purchase additional coverage, such as a Medigap policy, to help with certain out-of-pocket costs.
Furthermore, short-term health plans are available in Illinois to provide temporary coverage for individuals who may be without comprehensive insurance. These plans typically have a duration of at least 31 days and can cover continuous in-hospital care and certain outpatient services. However, beginning January 1, 2025, insurance companies in Illinois are prohibited from selling short-term, limited-duration health plans (STLDs).
When considering individual market insurance in Illinois, it is important to familiarize yourself with the different plan categories, types, and costs. Additionally, understanding common health insurance terms can help you make an informed decision about the coverage that best suits your needs. Resources such as the Health Insurance Glossary provided by Get Covered Illinois can be a helpful starting point to learn more about the industry jargon used in health insurance plans.
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Insurance for specific needs
Illinois offers a range of insurance options to cater to specific needs. Firstly, there is the Health Insurance Marketplace, a website where Illinois residents can shop for and purchase discounted health insurance. This is an ideal place to start for those seeking insurance, as it offers a screening tool to help determine eligibility for different programs. The Marketplace can be accessed through HealthCare.gov, where you can find health insurance plans and learn about different plan categories, types, and costs.
For those with specific medical needs, Illinois has several options. For example, Cigna Healthcare offers 24/7 support and access to licensed clinicians for health questions. They also provide accidental injury, critical illness, and hospital care plans. Additionally, military veterans and their unmarried dependents under 30 who are Illinois residents may be eligible for specific insurance plans.
Medicaid is another option for those seeking health insurance in Illinois. This program provides coverage for millions of people, including low-income individuals and families, pregnant women, the elderly, and people with disabilities. To determine eligibility for Medicaid, one can use the State of Illinois' Application for Benefits Eligibility (ABE) screening tool.
Special Enrollment Periods are also available for those who have experienced a major life event, such as a change in marital status, the birth of a child, or a move to a new ZIP code. These periods allow individuals to get the coverage they need, even outside of the regular Open Enrollment periods.
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Frequently asked questions
There are several ways to get medical insurance in Illinois. You can get coverage through your employer or a family member's employer, or you can purchase health insurance on your own through the individual market, such as the Affordable Care Act (ACA) Health Insurance Marketplace on Healthcare.gov or Getcoveredillinois.gov. You can also look into public programs like Medicaid and Medicare.
The ACA Health Insurance Marketplace is a platform where individuals and families can shop for health insurance plans offered by private companies. It is a part of the Affordable Care Act, which aims to provide affordable and reliable coverage options for those who may not have access to employer-provided insurance.
Typically, you will pay a premium every month, and in return, your health insurance plan will cover a portion of your medical expenses when you need services from a doctor or another provider. The amount of the premium and the coverage provided can vary depending on the specific plan you choose.
Financial help is available for those who may struggle to afford health coverage in Illinois. You can check if you qualify for assistance by answering a few questions. Additionally, premium subsidies are available for those with incomes between 100% and 150% of the federal poverty level (FPL), who may qualify for a zero-dollar premium silver or bronze plan after tax credits.
