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Do you have health insurance? If not, you could be gambling with both your physical and financial health. We’ve created a complete guide to health insurance in Illinois to help you get the coverage you need.
Get Health Insurance in Illinois
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The Best Health Insurance in Illinois:
- Best Overall in Illinois: BCBS
- Most Affordable in Illinois: HealthAlliance
- Best for HMO Plans: Ambetter
- Best for Preventive Care: Cigna
- The Best Health Insurance in Illinois:
- What is Health Insurance?
- Average Cost of Health Insurance in Illinois
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance not Cover?
- Best Health Insurance Providers in Illinois
- Find the Right Health Insurance for You
- Frequently Asked Questions
What is Health Insurance?
Health insurance is a type of protection that helps you pay for medical care. Your health insurance can help cover a percentage of the cost of any hospital treatments, specialists’ visits, prescription drugs and lab tests you need. You’ll no longer face a tax penalty for not having health insurance coverage but it’s usually not a good idea to go too long without protection. An accident or illness can strike at any moment — and if you don’t have insurance, you’ll need to cover 100% of the bill.
Most people get their health insurance through their employer or a government program like Medicare or Medicaid. If you don’t qualify for government-sponsored health insurance or insurance through your employer, you can purchase an independent health insurance plan through the Affordable Care Act (ACA) Marketplace. You can access the Marketplace by creating an account at Healthcare.gov.
When you start shopping for insurance, you might notice a number of prices listed for each plan. Let’s take a closer look at a few cost-related terms you need to know before you buy a plan:
- Premium: Your premium is a monthly bill that you pay to your insurance provider in exchange for your health insurance coverage. You need to pay your premium every month, even if you don’t see a doctor during any given month.
- Deductible: Your deductible is a set dollar amount that you need to spend on your own insurance expenses before your insurance starts covering your bill. For example, if you have a deductible of $1,000 and you get a $2,000 hospital bill, your insurance won’t start paying out before you pay off $1,000 of your bill.
- Coinsurance: Once you meet your deductible, you only need to pay your coinsurance percentage of any medical bill you receive. Your insurance provider covers the remainder of your bill. For example, let’s say that you have a plan with a coinsurance rate of 20% and you receive a medical bill for $1,000. You’d pay 20% of this bill ($200) and your insurance would cover the remaining 80%.
- Out-of-pocket maximum: Your out-of-pocket maximum is the maximum dollar amount you’ll spend on health care in a given year. Once you hit your out-of-pocket maximum, your insurance covers 100% of any other medical care costs you accumulate.
Average Cost of Health Insurance in Illinois
The average Illinois resident pays about $536 each month for their health insurance plan. However, you might qualify for a subsidy to help you pay for the monthly cost of your premium. Begin by creating an account on the federal government’s official website for the ACA Marketplace. After answering a few questions about your income, you’ll see federal subsidies you qualify for.
Types of Health Coverage
When you shop for health insurance, you might notice multiple types of plans available from a single insurance company. Let’s take a look at a few of the most common types of insurance plans you might see on the Marketplace.
- Health maintenance organization (HMO): When you enroll in an HMO plan, you’ll receive information on local doctors and medical care specialists who accept your insurance. You must choose a primary care provider from this list and you must stick to hospitals and specialists within your network. The only exception is in the event of an immediate emergency. If you go outside of your plan network at any other time, you can’t use your benefits. You will also need a referral from your primary care provider before you can see a specialist. HMOs are the most affordable health insurance option but they give you the least freedom to choose your insurance.
- Preferred provider organization (PPO): PPO plans allow you to see any doctor or specialist you’d like, regardless of whether they’re in your network. They also allow you to see a specialist without getting a referral from your doctor. PPO plans are more expensive than HMOs but might be worth the cost if you have a doctor you want to continue seeing.
- Point-of-service (POS) plans. POS plans function as a combination of an HMO and a PPO. On a POS plan, you can see any doctor you want — but you can save money by staying within your network. You also usually need a referral before you can see a specialist.
What Does Health Insurance Cover?
The ACA established a number of essential benefits that every health insurance provider needs to cover. When you shop for a long-term insurance plan, you can rest assured that every choice in the Marketplace offers at least some form of coverage for the following medical treatments:
- Ambulatory patient services include care and services that you receive outside of a hospital.
- Hospitalization includes both overnight stays in a hospital and surgery.
- Prescription drugs for all major classes of prescription drugs — your coverage doesn’t need to cover every drug in every category.
- Emergency services at any hospital in the United States, regardless of whether or not they’re in your network.
- Rehabilitative and habilitative services include both services and devices you need to regain mental and physical capacity after an accident.
- Mental health services include both inpatient and outpatient treatments for mental illness and substance abuse disorders.
- Laboratory services include specialized tests you receive to diagnose specific conditions.
- Preventive care includes routine lab tests, annual checkups and other types of preventive care.
- Maternity services include care and treatments you need before, during and after pregnancy. It also includes breastfeeding support.
- Pediatric services must cover all of the above services and treatments for any children on your plan, plus vision and dental coverage.
Your insurance provider must also cover birth control if you buy your plan through the ACA Marketplace. This coverage must include hormonal methods, physical methods and emergency methods of birth control.
What Does Health Insurance not Cover?
The best health insurance plans won’t cover everything. Here are a few of the most common exclusions you’ll likely see on your insurance plan.
- Adult vision and dental services: Under the ACA, your health insurance provider only needs to cover these services for children on your plan. If you want adult coverage, you’ll typically need to buy a separate vision plan and a separate dental plan.
- Male birth control: The ACA only requires that female methods of birth control be covered.
- Cosmetic surgery: Your insurance will only cover reconstructive surgery if it’s deemed medically necessary.
- Travel vaccines: Your health insurance coverage must cover the CDC’s standard schedule of vaccines. If you need another vaccination for travel, you’ll usually need to pay for it out of pocket.
- Weight loss surgery: There is no federal mandate that compels insurance companies to cover bariatric surgery, even if deemed medically necessary.
Best Health Insurance Providers in Illinois
Now that you understand how to get health insurance and what your insurance will cover, it’s time to choose a plan. Let’s take a look at some of the best health insurance companies you’ll see on the ACA Marketplace in Illinois.
1. Blue Cross Blue Shield
Blue Cross Blue Shield offers a wide range of health insurance plans across Illinois. It offers both PPO and HMO coverage and multiple tiers of each plan to help you balance coverage and costs.
Its website clearly lists each of the prescription drugs included on each plan and you can search for drugs by plan to ensure that your prescriptions are covered. With statewide coverage and a multitude of plan choices, Blue Cross Blue Shield is our top choice for coverage in Illinois.
Looking for the most affordable way to protect your health? Be sure to consider an insurance plan from HealthAlliance. Its most affordable plan choices begin at about $333 a month for nonsmokers — more than $200 less than the average plan in Illinois. HealthAlliance offers both HMO and POS plans and many POS plans include 0% coinsurance percentages for the most common health services you might need.
Plans are available in most parts of Illinois, so chances are that you can find cheap coverage near you. Get a quote from HealthAlliance if you’re looking for a way to get coverage without breaking the bank.
Ambetter offers a selection of HMO plans throughout Illinois. Getting coverage through Ambetter is incredibly simple. All you need to get started is your Social Security number, income information, current health insurance information and some information about your employer.
Its online doctor search tool allows you to quickly find primary care providers and specialists near you who accept your Ambetter plan. Many plans even include $0 copays and coinsurance rates for preventive care.
Cigna’s coverage is only available in a few select counties in Illinois. However, its HMO coverage options are affordable and many plans include $0 preventive care. Cigna claims that 4 out of 5 people who enroll in a plan receive a waiver to help them cover premium expenses.
Cigna also offers exceptionally affordable dental coverage so it’s easy to add a dental insurance option to your health insurance with a few clicks. Cigna also offers 24/7 customer service, which can be an extra layer of comfort if this is your first time buying an HMO insurance plan.
Find the Right Health Insurance for You
Getting health insurance can be confusing. Before you enroll in a plan or choose a plan provider, be sure to create an account at Healthcare.gov. You might qualify for a waiver to help you pay for insurance, and you can view and compare all of your plan options on its site.