Medicare Enrollment In Illinois
If youre eligible for Medicare, you can sign up at certain times throughout the year. These times include:
- Initial enrollment period. This 7-month period is available for people who become eligible for Medicare when they turn age 65. It starts 3 months before the month you turn 65 years old and ends 3 months after your birthday month.
- Annual open enrollment period. The annual open enrollment period runs from October 15 to December 7. If you sign up for a Medicare Advantage plan during this period, your new coverage will start on January 1.
- Medicare Advantage open enrollment period. From January 1 to March 31 every year, you can switch to a different Medicare Advantage plan. If you make changes, your new coverage starts on the first day of the month after the insurer gets your request.
- Special enrollment period. If you experience certain life events, youre allowed to sign up for Medicare outside of the annual enrollment periods. You could have a special enrollment period if you lose your employer health coverage, for example.
In some circumstances, you may be signed up for Medicare automatically. If youre eligible for Medicare due to a disability, youll be enrolled after you receive SSDI checks for 24 months. If you get Railroad Retirement benefits or Social Security retirement benefits, youll be enrolled when you turn 65 years old.
Illinois Health Insurance Marketplace Enrollment
Illinois operates a Health Insurance Marketplace in partnership with the federal government called Get Covered Illinois.3You can apply for individual or family health insurance through the Marketplace, over the phone, by mail, or in-person at consumer assistance centers located statewide. This also applies if youre a self-employed entrepreneur with no employees.
Open enrollment for health insurance in Illinois generally runs from . After this date, you can only enroll in Obamacare if you have a qualifying life event.
Illinois Marketplace enrollment has declined every year since 2016. More than 388,000 residents were enrolled back then compared to about 291,000 in 2021.4
What You Need To Bring To An Appointment Or Workshop:
The DuPage County Health Department can help you apply for health coverage and financial assistance during Open Enrollment.
For more help finding the coverage that’s right for you, visit:
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Insurance For Families In Illinois
Compare carefully to determine if the available plans cover the services your family needs most. Depending on your needs, you may want to check the coverage available for durable medical equipment, massage therapy, fertility services, chiropractic care, and rehabilitation services. Its also essential to determine if the plan covers any services before youve paid your full deductible. Some plans cover preventive care even if you havent paid your deductible yet. This feature can be beneficial if you typically only need routine preventive care.
Finally, think carefully before choosing an HMO plan over a PPO plan. HMO plans tend to be more restrictive than other types of health insurance. Youre pre-assigned a primary care provider, and you cant see a specialist unless your PCP gives you a referral. If someone in your family needs ongoing specialty care, it may be worth the extra cost to sign up for a PPO plan that allows you to see a specialist even if you dont have a referral from your PCP.
Do You Need Help Applying For Health Insurance
The DuPage County Health Department has trained and certified in-person assisters throughout the county to help you enroll in health coverage.
Schedule an appointment: In-person and virtual appointments are available.
- Weekend appointments are available on Saturday from 9 am 12:30 pm.
- Appointments are available for those new to the marketplace and those who are renewing.
- All appointments are 90 minutes. Please plan accordingly.
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Medicaid Funding For Enhanced Mental Health Care
In September 2016, Illinois officials requested permission from the federal government to use existing Medicaid funds to test different approaches to treating Medicaid enrollees who need mental health and/or substance abuse treatment. The state had planned to implement the changes in July 2017, but CMS didnt approve the waiver proposal until May 2018.
The idea is to focus more on preventive care, supportive housing services, and community-based care, rather than institutional care. The state notes that while 25% of Illinois Medicaid enrollees have mental health and/or substance abuse diagnoses, their treatment accounts for 56% of the Medicaid programs total cost.
Under the terms of the approved waiver, Illinois is running ten pilot projects that provide coverage for services that werent previously covered by Medicaid, including short-term inpatient substance abuse treatment, services to help people manage withdrawals during substance abuse recovery, home health visits for new babies and for children born to opioid-addicted mothers, and job coaching and transportation services designed to help people obtain and keep employment.
Whos Eligible For Medicare In Illinois
The eligibility rules for Medicare vary depending on your age. If youre younger than age 65, you may become eligible in either of these situations:
- youve been diagnosed with end stage renal disease or amyotrophic lateral sclerosis
- youve been on Social Security Disability Insurance for 2 years.
If youre turning 65 years old, youre eligible for Medicare in Illinois in either of these situations:
- you live in the United States and are a U.S. citizen or permanent resident
- you already receive Social Security retirement benefits or qualify for them
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Illinois Has Accepted Federal Medicaid Expansion
- 3,342,166 Number of Illinoisans covered by Medicaid/CHIP as of June 2021
- 715,223 Increase in the number of Illinoisans covered by Medicaid/CHIP fall 2013 to May 2021
- 46% Reduction in the uninsured rate from 2010 to 2019
- 27% Increase in total Medicaid/CHIP enrollment in Illinois since Medicaid expansion took effect
Health Insurance Plans In Illinois
Loading Shopping for coverage on your own? Open Enrollment for 2022 plans has ended. If you’ve had a qualifying life event you could still be eligible to get a plan during Special Enrollment, which runs until Oct. 31, 2022.
To shop for a plan during the Special Enrollment Period, visit HealthCare.gov.
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Key 2020 Open Enrollment Dates
- The 2020 Open Enrollment Period runs from Friday, November 1, 2019, to Sunday, December 15, 2019.
- If you donât act by December 15, you canât get 2020 coverage unless you qualify for a Special Enrollment Period
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if youâve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
- Plans sold during Open Enrollment start January 1, 2020.
Looking for coverage for the rest of 2019?Answer these questions to see if you can apply through a
Do I Have To Use The Healthcare Marketplace In Illinois
If you want to get an Advanced Premium Tax Credit to help pay your premiums, you have to apply for coverage via the Health Insurance Marketplace. Otherwise, you can purchase a health plan directly from an insurance company that offers coverage in Illinois. Individuals, families, and small business owners who do not qualify for a tax credit may benefit from purchasing a plan directly from an off-exchange insurance company.
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Medicaid Eligibility By State
Each state in the US has different eligibility requirements. Senior Planning offers an interactive map showing Eligibility for Medicaid long-term care. Just pick the state you want to see the requirements for.
Medicaid is available for low-income people and families. For people who dont qualify for Medicaid, open enrollment starts in November 2022. Visit Get Covered Illinois to learn more about healthcare coverage options. If you have not registered yet, you may qualify for Marketplace through the Special Enrollment Period. You have 60 days after a qualifying event to enroll.
How Much Do These Plans Cost
The amount you pay monthly for your coverage will vary depending on where you live, the size of your household, your income, and other factors.
Nine out of ten people get financial help when enrolling in a plan through the Affordable Care Act4, and 43% pay less than $10/month after federal assistance.*
Learn more about health care subsidieshealth care subsidies
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How Much Does Health Insurance Cost In Illinois
The Health Insurance Marketplace uses metal names to classify on-exchange health plans. Checking a plans tier makes it easier to estimate your total out-of-pocket costs for health coverage.
Plan details are prominent when you shop for a plan via the Health Insurance Marketplace. You can estimate your total out-of-pocket costs just by glancing at the plan summary. You can also download plan documents with more detailed information inside.
|Average premiums in Illinois|
Who Is Eligible For Medicaid In Illinois
Federal law specifies mandatory and optional coverage groups for Medicaid. States must cover the mandatory groups to receive federal Medicaid funding, and they qualify for additional funding if they cover optional groups.
The federal government specifies minimum thresholds for eligibility for the various groups, and states can set their requirements at or above the minimum threshold. Illinois has established requirements that are near national averages.
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Do I Need Health Insurance If I Have An Hsa/fsa
Health savings accounts and flexible spending accounts arent substitutes for health insurance. Even if you have money in an HSA or FSA, you should still have health insurance if you develop an illness or injury requiring a lengthy hospitalization or visit to an emergency room. In 2016, the average cost of a hospital stay was $11,700, higher than the annual limit for HSA and FSA contributions. Having health insurance protects you from having to bear the burden of these high costs on your own.
Insurance For Individuals In Illinois
If youre shopping for yourself, try to find a plan that offers the best coverage at the most affordable price. Remember that the monthly premium is only part of the total cost of your coverage. You also need to consider the annual deductible, percentage of expenses covered by each plan, and copay required for each service. If youre in good health and generally only visit the doctor once or twice per year, consider balancing an affordable monthly premium with a reasonable deductible.
If you have a chronic health condition requiring prescription medications or frequent medical appointments, it may benefit you to consider a plan with a higher monthly premium but lower annual deductible. When you compare deductibles and coinsurance requirements, the more expensive plan may be the better bargain as it reduces your out-of-pocket expenses for usage.
You also need to check each plans out-of-pocket maximum. The out-of-pocket maximum is the maximum amount youll pay per year before your insurance company starts covering 100% of your medical costs.
The type of plan you choose is also an important consideration.
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Frequently Asked Questions About Illinois’s Aca Marketplace
Illinois operates a partnership exchange with the federal government the state department of insurance runs Get Covered Illinois, including a website, in-person assistance, and a help desk, and the federal government provides the IT platform Healthcare.gov that Illinois residents use to enroll in coverage or make changes to their plan.
Former Gov. Pat Quinns administration announced in July 2012 that the Illinois marketplace would operate as a state-federal partnership. Quinn had hoped to leverage the partnership model as an interim step toward a state-run marketplace for the 2015 coverage year. However, a state exchange bill passed in the Senate in 2013 didnt get a vote in the House. There was some hope that exchange legislation would be considered during the fall 2014 session. However, the House did not take up the issue, and Illinois continues to have a partnership exchange .
Rep. Robyn Gabel had hoped the issue would gain traction in 2015, given that the U.S. Supreme Court was considering whether premium subsidies could be lawfully provided in states that dont run their own health insurance exchange. By transitioning to a state-run exchange, Illinois would have secured ongoing subsidies for its residents regardless of how the Court ruled. But the Court ultimately deemed subsidies to be legal in every state, regardless of whether the federal government is running the exchange or not.
Hepatitis C Drug Coverage Expanded In Stages Now Available To Anyone With The Disease
In the past few years, drugs that can cure Hepatitis C have burst onto the medical scene, heralded as miracles. But they can also be a strain on budgets, as the pill initially could cost more than $1,000 per day, and the treatment course lasts 12 weeks. Medicaid programs across the country have been grappled with how to handle the situation, and Illinois announced in September 2016 that they would loosen their guidelines in terms of when Hepatitis C drugs would be covered.
Rather than restricting coverage only to the sickest patients, Illinois Medicaid began to cover Hepatitis C drugs for people with stage 3 and 4 liver scarring, rather than just 4. Advocates cheered the new rules, but cautioned that there was still no coverage for treatment in people with chronic Hepatitis C that hadnt progressed as far as stage 3 liver scarring, and urged the state to continue to consider the issue.
By 2018, the price of Hepatitis C medications had declined, and a generic version was set to hit the market in early 2019, priced at $24,000 for the full treatment course . And in October 2018, the state eliminated the restrictions on access to Hepatitis C drugs, allowing several thousand Illinois residents to obtain Hepatitis C medication through Medicaid, regardless of the stage of their disease and without having to prove sobriety.
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What Types Of Alternative Health Insurance Plans Are Available In Illinois
If you dont want to purchase traditional health coverage, you may join a health sharing plan. Under this type of plan, you pay a monthly fee that goes into a pool of funds to pay members medical expenses. Health sharing plans arent health insurance and are not required to cover pre-existing conditions. Theres no guarantee a health share plan will pay your medical expenses.
Tips For Enrolling In Medicare In Illinois
There are many things to consider as you evaluate the many Medicare plans in Illinois. To find the plan that best suits your needs, consider these factors:
- Covered services. Medicare Advantage plans may cover services that original Medicare doesnt, such as dental, vision, or hearing care. Some even offer perks, such as gym memberships. Look for plans that cover the services you want or need.
- Cost. The cost of Medicare Advantage plans varies. For some plans, you may be charged a monthly plan premium in addition to the Medicare Part B premium. Copayments, coinsurance, and deductibles will also affect your out-of-pocket costs.
- Provider network. If you join a Medicare Advantage plan, you may need to get care from doctors and hospitals in your plans network. You may want to ask your current healthcare providers if they participate in plans you are considering.
- Service area. Original Medicare provides nationwide coverage, while Medicare Advantage plans serve more limited areas. If you plan to travel, you may prefer a Medicare plan that offers travel or visitor benefits.
- Ratings. Every year, the Centers for Medicare & Medicaid Services rates plans from one to five stars. These star ratings are based on customer service, quality of care, and other factors. To check a plans rating, go to CMS.gov and download the Star Ratings Fact Sheet.
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Medicare Enrollment And Coverage Options In Illinois
Illinois has the seventh-highest number of Medicare beneficiaries of any state. More than 2.2 million residents enrolled as of 2020. Approximately 73% are Original Medicare enrollees. The rest signed up for Medicare Advantage plans sold by private insurance companies.6
Some residents also get Medicare Advantage through group retiree programs. For instance, members of Illinois Teachers Retirement Insurance Program have access to Medicare benefits through Total Retiree Advantage Illinois . TRAIL is a Medicare Advantage plan that offers medical and prescription drug coverage to eligible members and their dependents.
If youre an Original Medicare member, you can enroll in Medicare Supplement to help pay out-of-pocket expenses, such as copays and deductibles. In Illinois, Medicare beneficiaries under 65 receive the same open enrollment rights as seniors. Illinois law also mandates that insurers cant charge people under 65 more for a policy than they would a senior.
Because Original Medicare doesnt cover most prescription drugs, many beneficiaries also add a separate Medicare Part D drug plan. In 2018, more than 1.1 million Illinois beneficiaries enrolled in these plans.
What Should I Do Next
When youre ready to shop for a Medicare plan, heres what you can do next:
- To sign up for Medicare parts A and B, contact the Social Security Administration. You can call 800-772-1213, visit your local Social Security office, or use Social Securitys online Medicare application.
- If youre interested in Medicare Advantage plans in Illinois, you can compare plans at Medicare.gov. If you see a plan you like, you can enroll online.
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