With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make healthcare insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Illinois, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Illinois
Illinois placed 30th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include ready availability of primary care physicians, ready availability of dentists, and low occupational fatalities. Key challenges Illinois faces include a high prevalence of binge drinking, high levels of air pollution, and a high rate of preventable hospitalizations. The state has seen a decrease in preventable hospitalizations, infant mortality and premature death, as well as an increase in physical activity and immunization coverage among adolescents.
The U.S. Department of Health and Human Services reported that 217,492 individuals in Illinois selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Illinois enrolled in a marketplace plan increased to 349,487 during the open enrollment period.3
Illinois individual and family health insurance
When Obamacare’s Health Insurance Marketplace launched for 2014 open enrollment, Illinois elected to participate in a partnership exchange. The state is responsible for plan management, as well as consumer information and assistance, and the federal government operates the Web portal for application and enrollment. In Dec. 2014, a bill to create a state-based exchange did not pass the Illinois state House committee.4
Those who buy health insurance through Illinois’ exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Illinoisans may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Get Covered Illinois to learn more about coverage options; then, visit the federal Health Insurance Marketplace to apply for a health insurance plan.
|Illinois’ health insurance exchange:||getcoveredillinois.gov / healthcare.gov|
|Illinois department of insurance:||insurance.illinois.gov|
Illinois small group health insurance plans
Small business owners who live in Illinois and have 50 or fewer employees may offer them access to coverage through the federal Health Insurance Marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Illinois’ partnership exchange.
Illinois state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Illinois small group COBRA continuation variations are as follows5:
|Eligible group sizes||All employers offering fully insured group and accident health plans, regardless of the group’s size; all employers offering fully insured HMO coverage, regardless of the group’s size|
|Maximum continuation period – standard||12 months|
|Maximum premium Increase||100 percent|
|State legislation reference||Illinois Continuation (mini-COBRA) Law|
|Additional notes||Offered to employees and eligible dependents who were continuously covered under the group policy three months prior to termination of employment or reduction in hours below the minimum required by the group plan; continuation must be requested within writing within the 30-day period following the latter of the date of termination or reduction in hours or the date written notice of your write to continue coverage is presented or mailed to you—employers must notify you in writing of your right to continue coverage within 10 days of the qualifying event.|
Illinois high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.6
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).7
Illinois is among the states that expanded Medicaid in 2014.8 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Illinois’ Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Illinois Department of Human Services|
|How to apply online||abe.illinois.gov/abe/access/ / healthcare.gov|
|Additional application options||hsd.state.nm.us/LookingForAssistance/apply-for-benefits.aspx|
|Phone number||800-843-6154 / 800-447-6404 TTY|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Illinois’ health insurance program for low-income children:
|Program name||All Kids|
|Where to apply||abe.illinois.gov/abe/access/|
|Phone number||866-255-5437 / 877-204-1012 TTY|
|Eligibility||Based on family size and income|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Staff. “Illinois Lawmakers Fail to Pass State Health Insurance Exchange, Passing Up $270M in Federal Funds.” Chicago Business Journal. Dec. 4, 2014. http://www.bizjournals.com/chicago/news/2014/12/04/illinois-lawmakers-fail-to-pass-state-health.html.
5 Illinois Department of Insurance. Illinois Insurance Facts. “Health Insurance Continuation Rights (mini-COBRA) The Illinois Law.” Updated July 2014. http://insurance.illinois.gov/HealthInsurance/continueIL.pdf.
6 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
7 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
8 Centers for Medicare & Medicaid Services. “Illinois.” http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/illinois.html.