The Federal Affordable Care Act (ACA), also called Obamacare, was signed into law in March 2010. When it became law, it created a system through which uninsured and underinsured Americans could purchase medical coverage. It also made healthcare coverage required by law and set guidelines for fines and fees for people who do not purchase insurance.
Today, all 50 states use either a state or federally run insurance marketplace to help citizens buy insurance. In addition, small-business owners can use the marketplace to purchase insurance for their employees. Enrollment in these health insurance plans is limited to a specific period each year, but you have options if you need to buy insurance outside that open enrollment period.
As of July 2015, Get Covered Illinois has eight health insurance companies offering plans. These include:
- Blue Cross Blue Shield of Illinois
- Health Alliance
- IlliniCare Health
- Land of Lincoln Health
- United Healthcare
By law, all health insurance plans offered through a federal- or state-run exchange must cover at least the following 10 essential services:
- Check-ups: All preventative and wellness doctors’ visits, such as check-ups and screenings, are covered by these plans. These types of appointments and screenings are designed to help you maintain your health and reduce your risk for possible problems and conditions in the future.
- Chronic disease management: Appointments for the purpose of monitoring and managing existing conditions (diabetes, for example) are covered by health insurance plans available in the marketplace.
- Outpatient services: Medical tests and services that do not require an overnight stay are covered.
- Emergency care: Medical services that are needed to treat a sudden or unexpected medical/surgical condition or injury are covered.
- Hospitalization: If a condition requires that you stay the night in the hospital, your insurance will cover those expenses. Also covered will be any services, surgeries, or tests that are conducted in the hospital.
- Maternity and newborn care: Any medical services or tests you need while you are pregnant will be covered. Additionally, your insurance plan will cover your baby’s delivery and your care after the baby arrives.
- Mental healthcare: Services for substance abuse and mental illness are covered.
- Rehabilitative services: Speech, occupation, and physical therapy services are covered. This includes services needed after an accident or medical disability.
- Laboratory services: Any service your doctors use to diagnose or measure an illness or problem, including blood tests, urine tests, and imaging tests (if appropriately ordered) are covered.
- Pediatric care: Health services for a child, including dental and vision care, are covered.
Additionally, adults can purchase vision and dental insurance through the marketplace. Individual plans are available, but must be purchased separately from your health insurance.
Five basic types of health insurance plans are available through the marketplace. Each type offers varying levels of coverage. Each level will have different rates for deductibles, copayments, coinsurance, premiums, and out-of-pocket maximums.
These levels include:
- Platinum: Your plan covers 90 percent; you pay 10 percent.
- Gold: Your plan covers 80 percent; you pay 20 percent.
- Silver: Your plan covers 70 percent; you pay 30 percent.
- Bronze: Your plan covers 60 percent; you pay 40 percent.
- Catastrophic: These plans pay less than 60 percent of your costs in a year. They’re only available to people under the age of 30 or those who qualify for a special exemption.
When you sign up for the exchange, you will be able to compare your options. Get Covered Illinois offers a Plan Comparison Tool that will help you weigh your options. It will take into account your risk, cost, and the quality of coverage.
During your application process, Get Covered Illinois may determine that you’re actually eligible for the state’s Medicaid program, a health insurance plan for low-income individuals and families. If you do qualify, you will be given instructions on how to sign up yourself and your family for the program.
The plan you decide to purchase will depend on your financial situation, in addition to the level of coverage you need from your plan. If you have a chronic illness that requires frequent treatments and tests, you may benefit from purchasing a higher metal plan, such as a silver, gold, or platinum plan. This way, your out-of-pocket expenses are more reasonable and capped at a lower range. You will pay more in premiums each month, but what you will owe at the doctors’ office, lab, or hospital will be significantly less.
A silver plan is considered mid-level in the metal level plan. In Get Covered Illinois, silver plans range from $231 to $279 per month for a 30-year-old nonsmoker from Illinois. These prices are before any subsidies or tax credits are applied.
Fortunately, some individuals who sign up for health insurance through Get Covered Illinois will actually qualify for cost-saving subsidies or tax credits. These financial incentives are designed to help individuals offset the cost of purchasing the insurance.
These credits and subsidies are designed to help people cover the new cost of health insurance while also helping protect them against additional financial difficulty.
When you’re ready to apply for insurance, you can turn to several options. These include:
- Get Covered Illinois’s web site: getcovered.illinois.gov
- Get Covered Illinois’s phone hotline: (866) 311-1119
- licensed agents or brokers (people designed to help individuals navigate the marketplace)
You will need to fill out an application. In the application process, you’ll be asked for a variety of information, including tax data from previous years. This helps the marketplace determine if you’re eligible for any credits or subsidies.
The 2016 annual open enrollment for Get Covered Illinois starts November 1, 2015. If you miss the open enrollment period, you may be eligible to apply for insurance during a special enrollment period.
If you’re curious about your options, make an appointment or call Get Covered Illinois to talk about your options, what you need to apply, and what you should do before you begin the application process. In the end, being insured is important for your health and your financial future.