Illinois Health Insurance Marketplace
Introduced in October 2013 for the 2014 plan year and later, the health insurance exchange (or marketplace) is designed for Illinoisans who need coverage and couldn’t obtain it very easily up to this point. This applies to the low-to-moderate income population as well as those with pre-existing conditions under age 65 shopping on the individual health insurance market. Small business owners also have access to the marketplace, which makes insuring a small team of full-time employees more reasonable. If you don’t have health benefits available through your employer or a public program like FamilyCare or Medicaid, the marketplace might be for you. The marketplace is also especially helpful for those with lower incomes, as you can receive financial assistance for premiums and cost sharing if your income falls between 138 and 400 percent of poverty.
The exchanges began nationwide as a provision of the Affordable Care Act, signed into law in March 2010. The ACA gave states about three years, which was ultimately shortened by lawsuits and other attempts to dismantle the law, to decide how they wanted to set up the exchange before open enrollment started in October 2013. States could choose to create their own exchange, an option Illinois may take in later years, partner with the federal government to implement the marketplace, or hand all responsibilities over to the Department of Health and Human Services in Washington. Illinois opted for a partnership exchange, with hopes of setting up a state-based marketplace eventually.
The state built its own portal, GetCoveredIllinois.gov, to provide residents information on their options under health reform. As policies sold on the marketplace must meet coverage guidelines to be considered Qualified Health Plans (QHPs), benefits are robust and coverage isn’t skimpy. QHPs are required to have an actuarial value of at least 60 percent, and exchange plans must cover ten categories of Essential Health Benefits (EHBs) — services the law thinks all insurers should cover in a comprehensive plan.
Subsidies: Making Coverage Affordable
As an increasingly expensive product, the ACA sought to lower the cost of health insurance for a large group of people by offering subsidies based on income. These tax credits are available to reduce premiums and medical expenses to members of marketplace plans only. In order to allow for subsidies, taxes had to be raised in many areas, but the gain for millions of Americans will be beneficial.
Your income determines the size of your subsidy and how it contributes to your coverage and care.
If you earn between 138 and 400 percent of the federal poverty line, you may qualify for a discount on your monthly premium.
If you earn between 138 and 250 percent of poverty, you may receive premium and cost sharing assistance.
The amount of your subsidy varies with income, household size, and location. For an estimate of what your subsidy will cover if you qualify, use the Subsidy Calculator.
Health Plans on the Exchange
In order to meet the guidelines for minimum essential coverage and qualified health plans, each QHP sold on the exchange must cover at least 60 percent of your total medical costs. Further, every plan on the marketplace is categorized by a metal so that customers can more easily identify plan types. Bronze plans provide the lowest premiums, and for some members eligible for a large subsidy, they can be premium-free. However, they leave policyholders with higher medical bills as they don’t cover as much. Silver plans offer an affordable monthly premium with sufficient coverage for included benefits, and gold and platinum plans are more costly but provide better coverage.
Another option is offered to younger Illinois residents who are healthy and don’t require too many medical services throughout the year. Catastrophic plans are a low-cost alternative to the metallic comprehensive plan system. They cover 4 office visits at no cost, free preventive services like flu shots and annual exams, and emergency care subject to the plan’s deductible. Essentially, catastophic plans provide a few necessities and leaves customers financially exposed for any other medical care they may require.
Each insurer selling plans through Get Covered Illinois must include ten groups of services — essential health benefits — in their covered benefit lists. They are also likely to cover doctor’s office visits, which aren’t listed as an EHB. Individual plans sold off the exchange are also required to cover EHBs under the ACA, yet the marketplace is the only source of coverage that ensures you receive every single category of coverage. Atypical of plans predating the ACA, these plans cover maternity, mental health and prescriptions, some of which were either excluded or available as a supplemental benefit in the past.
Illinois policyholders have access to each of these services for a copay or coinsurance when shopping on the exchange:
- Emergency care
- Preventive and wellness services, and chronic disease management
- Hospital care
- Maternity and newborn services
- Laboratory tests
- Pediatric care, including dental and vision
- Ambulatory patient services
- Rehabilitative and habilitative services and devices (following an injury or for disabilities)
- Mental health and substance abuse services, including behavioral health care
Illinois’ marketplace is served by 8 different carriers, both large and small. They include some of the great health plans we’ve sold off the exchange in Illinois for years, as well as a few local brands. Selection of health insurance companies varies based on where you live, as a small handful has been chosen to serve each area. You can choose from PPO or HMO in certain regions, and each plan offers great quality coverage that can be discounted with subsidies. The following insurers actively serve the Illinois marketplace.
- Aetna Life Insurance Company
- Coventry Health and Life Insurance Company
- Coventry Health Care of Illinois
- Health Alliance Medical Plans
- Health Care Service Corporation, a Mutual Legal Reserve Company (Blue Cross)
- Humana Health Plan
- Humana Insurance Company
- Land of Lincoln Mutual Health Insurance Company
Apply for Coverage
GetCoveredIllinois.gov is the primary portal for health plan information and applications for the Illinois marketplace. This method allows for online application, calling for a paper application, and apply by phone. Various health centers and other facilities throughout the state should also serve as application centers, staffed with navigators to help you use the website to apply for coverage. You can also apply directly with a licensed East Coast Health Insurance agent, as we are certified in exchange plans. Call 888.803.5917 to determine if you qualify for tax credits and reduced-cost coverage.
Compare Illinois Marketplace Plans
Below is a cost comparison tool demonstrating plans, rates and tax credit amounts on the exchange in your region. These estimates are based on averages released by Illinois marketplace insurers. To sign up for a subsidized Illinois health plan, call a licensed agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.