Health Insurance in Illinois

Whether you’re enjoying a busy life in the Windy City or keeping it simple in one of the more rural areas of the state, living life in Illinois is better if you know you have comprehensive and affordable health care coverage. But that can be tricky to find if you don’t know where to look. Luckily, we do. We’ll be more than happy to show you some of the best and most cost-effective health insurance options available to Illinois residents like you. Just keep reading if you want to know more about how to save money on health care coverage from the Exchange, short-term Insurance options, health share plans, and more.

Major Medical Insurance in Illinois

The Affordable Care Act has been in effect since March of 2010. But the law has gone through several changes since that date. Additionally, tens of millions of Americans have gone from being completely uninsured to finding affordable and comprehensive coverage to help them meet their health care needs. Now that the individual mandate has recently been done away with, there is no federal or state-level law in Illinois that requires you to seek this coverage each year. But it costs nothing other than a few minutes of your time to file an application and see whether or not you qualify for a subsidized plan – so you literally have nothing to lose by trying.

Most people can only enroll during Open Enrollment which starts on November 1st of each year. It usually continues through December 15th, although sometimes the deadline changes based on demand. There are no state exchanges in the state of Illinois, so you will have to enroll via HealthCare.gov and shop around online through the Health Insurance Marketplace. The application process is very simple and straightforward and is largely based on your income.

There are a few different reasons why major medical policies available from The Exchange are so much more popular than many of the other options we are about to discuss. The first and one of the most important reasons is that every single policy sold on the exchange is guaranteed issue. This means that no matter how sick you are or how many pre-existing conditions you come in with, you cannot be refused coverage on the Exchange. On top of that, you can’t be charged extra based on your pre-existing conditions or other factors that are out of your control. In fact, the only variables which are allowed to raise your premium unfavorably are:

• Your age 
• Your location
• Your use of tobacco products
• Whether you are applying for an individual policy or a family policy

On top of that, every single policy on the exchange comes with all 10 Essential Health Benefits guaranteed by your provider. These benefits have been agreed upon by health experts as mandatory in order to promote optimal health and wellness in a given population. Those benefits are: 

• Ambulatory/outpatient services
• Emergency services
• Hospitalization
• maternity/newborn care
• Mental health and substance abuse
• Prescription drugs
• hab/rehab services and devices
• Lab tests
• Preventive and wellness services and chronic disease management
• Pediatrics (including oral and vision)

Lastly, you can get all of this at a discounted rate if you are making somewhere between 138% and 400% of the federal poverty level. If you’re unsure where your income puts you on that scale, simply take a look at the chart below. It’s based on a combination of your household size and your annual income. As long as you’re making at least 138% of the federal poverty level, you will qualify for a subsidy. If you make between 138% and 100% of the federal poverty level, the state of Illinois has accepted federal funding that can help you qualify for Medicaid if you meet certain income and disability requirements. For more information, be sure to apply through the Illinois ABE web portal and check your eligibility. 

Unfortunately, despite all of these efforts, there are still lots of people in Illinois who neither qualify for a subsidy nor meet the requirements to enroll in Medicaid. If you happen to be one of those people, don’t lose hope just yet. You can either get your medical needs covered or your medical costs partially covered through short-term health insurance, a health share plan, fixed indemnity coverage, a medical discount card, or some combination of the above. 

Short Term Health Insurance in Illinois

If you feel like you can’t afford major medical coverage through the Exchange, you might be considering short-term health insurance. But you should know that within the state of Illinois, providers take the phrase “short term” fairly literally. Most of these plans by law cannot last longer than 6 months, and you won’t be allowed to purchase a new plan from the same provider for at least two months after that coverage ends.

but that doesn’t mean that short-term health insurance plans in Illinois are without merit. They can indeed help if you need medical coverage in the interim after losing a job, losing your current coverage, or for some other unexpected reason. These plans are more beneficial than some of the other options we’re about to discuss because you have a massive amount of consumer protection, legally speaking. It is easier to take a short-term health insurance provider to court over a disputed claim and get the money you are owed than it is with most other types of non-ACA coverage. You may also have the option to add certain coverage benefits to your short-term health insurance policy in order to come close to having all of your Essential Health Benefits covered. And these plans typically cost about one-third less than paying for an unsubsidized health insurance plan from the Health Insurance Marketplace.

Unfortunately, you might not be able to get all of the benefits you need for essential health and wellness with short-term health insurance. Then there are the time restrictions we discussed a moment ago. And you won’t have any guaranteed issue protections which prevent your insurance provider from charging you more or rejecting you for having a pre-existing condition. But in a pinch, these plans can help protect you from exorbitant out-of-pocket medical costs if you happen to suffer a medical emergency while you are uninsured. So they are at least worth looking into while you try to find better coverage.

Christian Health Plans/Health Share Plans in Illinois

Another option you may wish to consider is a health sharing plan, sometimes referred to as a Christian health plan. Back in the days of the individual mandate, Christian health plans became a very popular cost-effective alternative to the ACA Marketplace because these plans would fulfill that mandate but usually didn’t cost as much as a major medical plan. However, now that the individual mandate is no longer a legal requirement in the state of Illinois or on a federal level, their popularity has lessened a bit.

That doesn’t mean they aren’t worth looking at, however. You just have to be careful as a consumer and know what you’re getting yourself into before you sign up with one of these plans. Here are some of the most important facts about health share plans which most consumers may not know:

• These plans are NOT guaranteed issue
• They will likely have unlimited out-of-pocket costs
• Almost all plans come with lifetime and annual benefit caps
• These plans do not include guaranteed Essential Health Benefits

But that’s not all. The fact that these organizations are largely religious means that they aren’t subject to federal or state regulations the way most insurance companies are. And while there are many good faith actors in this space, it does mean that these companies aren’t legally obligated to make good on their promises or pay out on medical claims that you submit. So you won’t necessarily be able to take them to court if you feel you have been treated unfairly. Instead of paying your typical monthly premium, the amount you pay to maintain your plan is called a “monthly share amount”. Health share plans don’t necessarily charge deductibles, co-pays, or coinsurance like short-term insurance or major medical does; rather, you pay an as-needed “personal responsibility amount” (AKA an “unshared amount”). We also feel it’s important to mention the existence of participation guidelines which many of these plans will ask you to follow. You will likely have to declare a specific religious faith, stop using any and all tobacco products, and you may be asked to stop consuming alcohol or engaging in other risky behaviors.

Fixed Indemnity Plans in Illinois

There are different types of fixed indemnity coverage you can purchase based on what your needs are. Those can include doctor indemnity plans, hospital indemnity plans, or you may get lucky and find an insurance policy that combines both. These will typically pay out on a daily, monthly, weekly, per event, or per visit basis. But they are not a replacement for major medical coverage. In fact, they’re typically sold as a supplement to major medical coverage or some equivalent. The amount of money they pay out per claim is also fixed, hence the name fixed indemnity.

But this fixed amount of money is usually fairly small, and only partially covers your expenses at best. That’s a big part of the reason why these plans don’t count as a replacement for major medical. Furthermore, you can’t exactly customize your coverage or get all the way towards providing yourself with the 10 Essential Health Benefits that you would get through the ACA. That being said, fixed indemnity plans can at least take the edge off of your out-of-pocket medical expenses should you find yourself without major medical coverage. But if you have major medical coverage or something like it, fixed indemnity plans can take a serious bite out of your total out-of-pocket costs.

Discount Cards in Illinois

Another way you can take a bite out of your out-of-pocket costs in Illinois is to sign up for a medical discount card program. If you’re familiar with AARP or AAA, then you have a basic idea of how these discount programs work. You find a reputable provider, you pay a monthly or an annual fee, and you get issued a discount card in the mail. Then when you shop or get care from participating providers, you receive a substantial discount right there at the register. You don’t have to file claims or deal with any paperwork. But remember that this is just a discount program; it is in no way, shape, or form a replacement for major medical coverage.

You should exercise caution when shopping around for one of these plans. Not all discount card providers are necessarily truthful about the discounts they provide, or the providers they claim to participate with. If you want to make sure you’re getting the best deal, you have to do your due diligence and investigate their claims. If you find out that you won’t quite get the discounts they promise, or if they’re advertising participating providers who aren’t actually a part of their program, then you know you need to avoid them and save your money. But if it turns out that the claims they advertise are valid, then a medical discount card can be financially beneficial – whether you’re using it to supplement your major medical coverage or to keep your out-of-pocket costs under control.