Questions About Coverage?
We know that coverage can be confusing – and we’re here to help make sure that your able to see the Carle Health providers that you know and trust.
We know that coverage can be confusing – and we’re here to help make sure that your able to see the Carle Health providers that you know and trust.
Q: I have heard that Carle Health may no longer accept my insurance. What does this mean for me?
Carle Health continues to accept Health Alliance throughout the current plan year and continues to be in network with many other insurance providers. Patients can maintain access to care with Carle Health providers by selecting a plan that includes Carle Health during the upcoming open enrollment period.
Carle Health encourages patients to compare plan options at ChooseCarleHealth.org, confirm plan details with their provider and insurer and actively choose a plan that supports their ongoing care needs.
Q: Will I need to find a new doctor?
For most patients, no immediate changes will be necessary. Carle Health will continue accepting many insurance plans. However, continued access depends on the health plan selected during open enrollment. Visit ChooseCarleHealth.org for guidance – and to find the latest plans accepted. Patients with ongoing or scheduled care are encouraged to confirm coverage status and ensure a smooth transition by coordinating with both their healthcare provider and insurance carrier.
Q: Which insurance plans include Carle Health?
Carle Health is in network with a number of regional and statewide health insurance plans. However, coverage can vary based on the plan and tier assignment. Patients are encouraged to compare their options through ChooseCarleHealth.org, confirm with their employer or insurer that Carle Health is included in-network and at a preferred tier level and choose a plan that chooses Carle Health.
Q: What steps should I take during open enrollment?
Patients are encouraged to:
This information will help you choose a plan that chooses Carle Health. Patients can find more information at ChooseCarleHealth.org.
Q: I have heard conflicting information. How can I find out what is accurate?
Carle Health remains a trusted provider of care throughout Illinois. While some health plans are changing, extending access to care is important to us and Carle Health continues to be in network with many insurance carriers. Patients are encouraged to rely on verified resources—including their insurance provider or employer—for current and accurate coverage information. Visit ChooseCarleHealth.org to find out more.
Q: Is Carle Health still in network for my current plan?
For most patients, Carle Health remains in network through the end of their current plan year. However, continued access in 2025 and beyond depends on the plan selected during open enrollment. Patients should confirm provider participation and coverage tier with their insurer to avoid any surprises.
Q: What happens if I do not actively choose a plan during open enrollment?
In some cases, employers may automatically enroll individuals into a default insurance plan. That plan may or may not include Carle Health or may place Carle Health in a less favorable tier. Patients are encouraged to compare their options through ChooseCarleHealth.org, confirm with their employer or insurer that Carle Health is included in-network and at a preferred tier level and choose a plan that chooses Carle Health.
Q: I already have a treatment, surgery or ongoing care scheduled. What should I do?
Patients with scheduled care should speak with both their provider’s office and insurance carrier to confirm how any changes may affect approvals, billing or access. If switching plans, prior authorizations and medical records may need to be transferred. Taking early action helps ensure care is not delayed.
Q: Can I change my plan after open enrollment ends?
Once open enrollment closes, changes can generally only be made in the event of a qualifying life event, such as marriage, job change or the birth of a child. Patients are encouraged to make a confident and informed selection during open enrollment using resources available at ChooseCarleHealth.org.
Q: What is tiering and why is it important?
Insurance plans categorize providers into different tiers based on negotiated rates and other factors. Even if Carle Health is in network, patients may face higher out-of-pocket costs if the plan places Carle Health in a higher-cost tier. Confirming both network status and tier assignment is essential to avoid surprise expenses. Patients are encouraged to compare their options through ChooseCarleHealth.org, confirm with their employer or insurer that Carle Health is included in-network and at a preferred tier level and choose a plan that chooses Carle Health.
Q: Can I still receive care at Carle Health if my plan is out of network?
In some cases, patients may continue to access Carle Health care using out-of-network benefits. However, this may result in higher out-of-pocket costs and additional administrative steps. To avoid disruption and maintain affordable access, patients are encouraged to select a plan that includes Carle Health in-network.
Q: Why should I choose a plan that chooses Carle Health?
While the Carle Health system may begin to look different, our commitment to increasing access to innovative, high-quality care from compassionate care team members is unwavering. We are invested in improving the health outcomes of this community and its our privilege to guide patients through their healthcare journeys. Our vision for the future is steadfast as we work to address the healthcare needs of today and tomorrow with inclusive care for every patient we serve.