Illinois health insurance

Health insurance in Illinois

● Illinois has a partnership health insurance exchange with the federal government.

● Open enrollment for 2021 health insurance plans runs from November 1, 2020 to December 15, 2020. Illinois residents with qualified events can still sign up or make changes to their coverage for 2020.

● Short-term health plans can be sold in Illinois on terms of up to six months.

● Six insurers will offer 2021 coverage in the state's individual marketplace, up from five in 2020.

● About 294,000 people have signed up for private plans for 2020 through the Illinois exchange.

● Illinois adopted the ACA's Medicaid expansion in 2014.

● The state's CO-OP, Land of Lincoln Health, ceased operations in 2016, but its ownership received funding for risk corridors expired by the federal government in 2020.

This page is dedicated to helping consumers quickly find health insurance resources in Illinois. Here you will find information about the many types of health insurance coverage available. You can find the basics of the Illinois health insurance marketplace and the upcoming open enrollment period; a brief overview of Medicaid expansion in Illinois; information on short-term health insurance rules and availability in the State; statistics on Medicare in Illinois; as well as a collection of Illinois health insurance resources for residents.

Illinois Health Insurance marketplace

Illinois operates a partnership exchange with the federal government. That means the state operates Get Covered Illinois -- which provides a website, in-person support, and help desk -- while Illinois residents use HealthCare.gov to enroll in health coverage and make changes to their plan.

Illinois opens enrollment period and dates

Open enrollment for 2021 health plans runs from November 1, 2020 to December 15, 2020. During that window, Illinois residents can change their coverage for next year or renew the plan they currently have. Outside of that window, residents with qualifying events can still sign up or make changes to their coverage for 2020.

Five insurers offer coverage for 2020 through the Illinois exchange, but this will grow to six starting in 2021, with the addition of Bright Health in the Chicago area.

Illinois enrollment in qualified health plans

For 2020 coverage, 294,263 people enrolled in qualified health plans (QSPs) through the Illinois health insurance marketplace during the open enrollment period. All of these people are enrolled in plans that provide coverage for the ACA's essential health benefits, as well as Illinois residents enrolled in ACA-compliant plans outside of the exchange (directly through insurance companies).

As with most states using HealthCare.gov, enrollment peaked in Illinois in 2016, when 388,179 people enrolled.

Since then, enrollment has declined each year, due to a number of factors, including reducing federal funding for marketing and raising awareness of exchanges, higher premiums for people who don't get subsidies, eliminating the sanction of the ACA's individual mandate, and expanding short-term health plans as an alternative to ACA-compliant plans.

Small business owners in Illinois can enroll in small-group ACA-compliant health plans directly through private health insurance companies that offer small-group coverage in Illinois. But there are no more SHOP-certified small business health plans available in Illinois as of 2020.

Medicaid expansion in Illinois

Medicaid expansion in Illinois was authorized in 2013 and went into effect in 2014. As a result, about 350,000 new enrollees were approved in the first few months alone. A year later, in 2015, total enrollment under the Medicaid expansion in Illinois had reached 623,000. By August 2016, the total had exceeded 646,000, although it had fallen to just over 600,000 by mid-2018.

As of May 2020, nearly 3 million Illinois residents were covered by Medicaid/CHIP. That was 13% more than the total enrollment at the end of 2013. Medicaid enrollment across the country has tended upwards in 2020 due to widespread job and income losses caused by the COVID-19 pandemic.

Short-term health insurance in Illinois

Illinois enacted legislation in 2018 that limits short-term health plans to six-month deadlines and prohibits renewals. The legislation was blocked by the governor, but lawmakers overwrite the veto.

How Obamacare is helping Illinois residents

Illinois has had relative success under the Affordable Care Act. Its uninsured rates have been nearly halved as more residents access coverage through subsidized private plans on the Illinois health insurance marketplace, and more than 600,000 people are covered by expanded Medicaid.

12.7% of the population was uninsured in 2013, according to U.S. Census data, and this had fallen to 6.5% in 2016, mainly due to the ACA. At that point, the average uninsured national rate was 8.6%. In 2018, the state's uninsured rate had returned to 7%, reflecting a nationwide increase in the uninsured rate under the Trump administration.

Other ACA reform provisions

The Affordable Care Act established a federal loan program called the Consumer Operated and Oriented Plan (CO-OP) Program. The program is designed to increase consumer choice and expand competition by allowing new nonprofit health insurers to enter the market.

In Illinois, the Land of Lincoln Health received more than $160 million in grant funds. But like most CO-Op's Land of Lincoln struggled financially and ceased operations on September 30, 2016. The huge lack of funding for corridors at risk was partly responsible for the failure of co-op. In 2020, the Supreme Court ruled that the federal government should pay health insurance companies the money owed under the risk corridors program. Although Land of Lincoln Health had closed several years earlier, its property received $129 million in risk corridor funds in the summer of 2020, to be distributed to creditors.

As of December 2020, only four CO-POs created by the ACA remained operational, out of 23 that began offering coverage in the fall of 2013. And one of them, New Mexico Health Connections, will close its doors at the end of 2020, leaving only three remaining CO-OPs nationwide in 2021.

Does Illinois have a high-risk pool?

Before the reforms that the ACA brought to the individual health insurance marketplace, coverage was underwritten in nearly every state, including Illinois. People with pre-existing conditions often found themselves ineligible to purchase private plans or able to obtain only cover that excluded pre-existing conditions.

The Illinois Comprehensive Health Insurance Plan (ICHIP) was created in 1989 to provide a coverage option for people who are unable to get private plans because of their medical history.  Due to budget shortfalls, the plan stopped joining new members in September 2000, and candidates were placed on a waiting list.  The program was able to reopen to new registrations in spring 2001. The pool also briefly suspended re-enrollment in the summer of 2009.

In 2001, the risk pool had about 5,700 members, but that number had grown to more than 18,000 by the end of 2010.

According to the ACA, all new health insurance policies have become guaranteed to be issued since 2014, with all essential health benefits covered regardless of a person's medical history. This reform measure has largely eliminated the need for high-risk pools, as medical history is no longer an obstacle to obtaining private health insurance coverage in the individual marketplace.

ICHIP was still enrolling eligible candidates in the HIPAA pool, but stopped renewing traditional coverage of risk pool members after April 30, 2014. They notified members and posted extensive data on their website explaining how to switch to an exchange plan.

Medicare coverage and enrollment in Illinois

As of July 2020, there were 2,265,369 Illinois residents enrolled in Medicare. 87% of the state's Medicare beneficiaries are 65 years of age or older, while the other 13% are under 65 and are eligible for Medicare due to disability.

Medicare beneficiaries can choose between Original Medicare and Medicare Advantage (you need to live within the service area of a Medicare Advantage plan to select that plan; Medicare Advantage plans generally cover additional optional benefits that go beyond what Original Medicare provides, but are also available with more limited supplier networks and other disadvantages; there are pros and cons either way). Compared to the national average, a lower percentage of Illinois

Health insurance resources in Illinois

● The Illinois Department of Insurance regulates individual, small-group, and large-group health plans in Illinois (but not self-insured health plans). The Department also regulates brokers and agents who sell private health insurance plans to individuals and groups. You can contact them for assistance on everything from sales and marketing practices, pre-authorization requirements, claims processing.

● If you need help with Medicare in Illinois, you can contact Illinois' senior health insurance program with questions.

● If you have any questions about Medicaid eligibility or enrollment in Illinois, you can contact the Illinois Department of Health care and Family Services. HFS also has information about All Kids, the Children's Health Insurance Program that covers 1.6 million children in Illinois and Family Care, the state's Medicaid coverage for parents with younger children. These plans offer excellent health coverage benefits to people for whom private health insurance would simply be too expensive.