Illinois Health Insurance Marketplace
Enrollment begins Oct. 1 in the new Illinois health insurance marketplace under the Affordable Care Act (ACA). If eligible, you can enroll between October 1 and December 31, with a coverage effective date of January 1, 2014.
Carle encourages all eligible individuals to enroll in a health plan that suits their needs. By obtaining coverage, you are taking a positive step toward better health care.
Health Alliance Medical Plans Has You Covered with 7 Plans to Choose From
Health Alliance Medical Plans is offering 7 different insurance plan options on the Illinois Marketplace. Go to healthalliance.org/learnmore to learn more about their plans and begin direct enrollment.
Helpful resources for residents of east central Illinois
Got Questions? Get Answers Here.
To help consumers complete the Health Insurance Marketplace online application and select a health plan, a network of approved community-based "assisters" is available for in-person consultations and support:
- Certified Application Counselors
- Staff and volunteers at these certified organizations will help you understand, apply and enroll for health coverage through the marketplace.
- In-Person Counselors
- These organizations received State of Illinois grant money to perform outreach and counseling. Many of the these in-person counselors will partner with hospitals and other providers to assist uninsured consumers participate in the new marketplace.
- These organizations received Federal grant money to perform outreach and counseling to assist uninsured consumers participate in the new marketplace.
Health Insurance Subsidy Calculator: This tool from Kaiser Family Foundation illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or "Marketplaces") created by the Affordable Care Act (ACA). Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.
Other General Resources
Health Reform In Illinois: Learn more about the Health Insurance Marketplace in Illinois from this official state of Illinois Health Care Reform web site.
HealthCare.Gov: A Federal government web site under the US Center for Medicare and Medicaid Services web site. Contains information for individuals and families, small businesses, and an easy-to- use interactive questionnaire to learn about your options.
Enroll America: Enroll America is a nonpartisan 501(c)(3) organization whose mission is to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act. Enroll America is a collaborative organization, working with partners that span the gamut of health coverage stakeholders-health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations, and philanthropies-to engage many different voices in support of an easy, accessible, and widely available enrollment process
IRS - Affordable Car Tax Information: Information for individuals, employers and others about ACA tax-related provisions, providing public information about premium tax credits, employer mandates and tax exemption for insurance companies.
Glossary of Key Terms
- Actuarial Value
- A health plan's actuarial value is the percentage of total average costs for benefits that a plan covers. Starting in 2014, all health plans will have an actuarial value assigned to them - bronze, silver, gold or platinum. As the metal category increases in value, so does the percent of medical expenses that a health plan will cover. This means the platinum-level plans will cover the highest percentage of health care expenses. These expenses are usually incurred at the time of health care services - when you visit the doctor or the emergency room, for example. The health plans that cover the greatest percentage of health care expenses also usually have higher premium payments.
- Affordable Care Act
- Enacted in March 2010, the federal Patient Protection and Affordable Care Act, commonly referred to as "Obamacare," provides the framework, policies, regulations and guidelines for implementation of comprehensive health care reform by the states. The Affordable Care Act will expand access to high- quality affordable insurance and health care.
- Ambulatory Patient Services
- Medical care provided without need of admission to a health care facility. This includes a range of medical procedures and treatments such as such as blood tests, X-rays, vaccinations, nebulizing and even monthly well-baby checkups by pediatricians.
- Annual Household Income
- The total amount of income for a family in a calendar year.
- Annual Limit
- A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.
- Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service, is called coinsurance. You pay coinsurance plus any deductible you owe. For example, if the health insurance plan's allowed amount for an office visit is $100 and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of allowed amount.
- A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
- The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of noncovered services. Cost-sharing in Medicaid and Children's Health Insurance Program also includes premiums.
- The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services.
- Essential Health Benefits
- Health care service categories that must be covered by certain plans, starting in 2014. These service categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitation services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including dental and vision care. Insurance policies must cover these benefits in order to be certified and offered in the marketplace, and all Medicaid state plans must cover these services by 2014.
- The contract (agreement) between the person buying health insurance and the company providing it, describing specific health care services that will be covered, any coverage limitations and any out-of- pocket costs (copays) that might be required.
- Federal Poverty Level
- A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits. In 2012, the federal poverty level for an individual was $11,170 per year and $23,050 for a family of four.
- Full-Time Equivalent Employees
- The federal government has not yet defined "full-time" or "full-time equivalent" for purposes of determining whether a business is small or large. More information will be forthcoming in the months ahead.
- Health Insurance
- A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.
- Open Enrollment
- A designated period of time each year - usually a few months - during which insured individuals or employees can make changes in health insurance coverage.
- Out-of-Pocket Limit
- The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn't cover. Some health insurance or plans don't count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums.
- Pre-existing Medical Condition
- Any illness or condition a patient has prior to obtaining insurance.
- The amount that must be paid for your health insurance or plan. You and/or your employer usually pay(s) it monthly, quarterly or yearly.
- Qualified Health Plan
- An insurance product that is certified by a marketplace, provides Essential Health Benefits, follows established limits on cost-sharing (like deductibles, copayments and out-of-pocket maximum amounts) and meets other requirements. A Qualified Health Plan will have a certification by each marketplace in which it is sold.
- Special Enrollment
- The opportunity for people who experience a life-changing event, such as the loss of a job, death of a spouse or birth of a child, to sign up immediately in an employer's health plan, even if it is outside of the plan's specified enrollment period.
- Starting in 2014, cost-sharing subsidies and tax credits will lower the cost of premiums and out-of- pocket expenses for health coverage that qualifying families purchase.
- Tax Credit
- One of the largest subsidy programs for health insurance, starting in 2014, to help consumers pay health insurance premiums. Tax credits will also be available to small businesses with no more than 25 full-time equivalent employees to help offset the cost of providing coverage.