FAQs

The Get Covered Illinois staff answers the most requested questions below. Click on a question to show the answer, or to view all answers click on the "Expand All" button. If you don't see your question here, please submit it on the form below.

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General FAQs

• What is the Affordable Care Act (ACA) and Healthcare.gov?
• Why use Healthcare.gov?
• Who can get covered through Healthcare.gov?
• What are some of the key features of the Affordable Care Act?
• How do I get health insurance?
• How can I sign up for health insurance?
• What information/documents do I need to apply as an individual or as a family?
• What Should I look for when choosing a plan?
• What are the essential health benefits that are included under the Affordable Care Act?
• Do I have to pay deductibles and copayments for essential health benefits?
• When does my coverage start?
• How can I find assistance with plan enrollment in my local area?
• How much will health insurance on Healthcare.gov cost?
• What are premium health care tax credits?
• What if I can’t afford coverage?
• How do I file an appeal or complaint about my health insurance company?
• Can I have marketplace coverage and Medicaid (also known as: Medical assistance, Medical card, All Kids or Public aid) at the same time?
• When and where can I apply for Medicaid?

Enacted in 2010, the Affordable Care Act (ACA) expanded health insurance coverage to more than 20 million people by increasing benefits and lowering health insurance costs to make coverage more affordable.

Consumer protections and benefits provided by the ACA include:

• Providing coverage for people with pre-existing conditions
• Eliminating annual and lifetime dollar limits on health insurance coverage
• Providing free preventive care
• Allowing young adults to remain on their parents’ plans until they are 26 years old
• Allowing people to compare health insurance coverage options before selecting a plan
• Providing premium tax credits to people who qualify to help lower health insurance costs.
• Increasing access to Medicaid

Healthcare.gov, is the federal Health Insurance Marketplace where people shop for and enroll in health insurance provided through the Affordable Care Act (ACA). You can view health plan options and enroll in a plan at Healthcare.gov.

Get Covered Illinois also provides free assistance from Get Covered Illinois Navigators to help you shop and enroll in a health plan provided through the Affordable Care Act (ACA).

Healthcare.gov also known as the Health Insurance Marketplace, offers quality plans that provide comprehensive health coverage, including preventive care and coverage for pre-existing conditions. Additionally, Healthcare.gov plans must cover essential health benefits like hospitalization and emergency room visits, as well as coverage for prescription drugs, among others. You can compare plans, coverage options and prices to decide what's best for your needs and your budget.

Healthcare.gov is the only place where you may qualify for financial assistance through premium tax credits. Free enrollment assistance is also available from trained Navigators and assisters to answer your questions and help you enroll.

You can purchase a health plan and enroll if:

• You live in the United States
• You are a U.S. citizen or national
• You are not incarcerated
• You do not have health insurance through an employer, Medicare, Medicaid, Children’s Insurance Program (CHIP), or other source that provides qualifying health coverage

• People with pre-existing conditions, such as cancer, diabetes, and high blood pressure cannot be denied coverage or charged more for their health insurance.
• People who do not receive health insurance through their employer, or through federal programs like Medicare or Medicaid, can buy health insurance through online insurance exchanges.
• Provides free preventative care.
• Health plans must cover essential health benefits including cancer treatment and follow-up care.
• Ends lifetime and yearly dollar limits on coverage of essential health benefits.

If you live in Illinois, you can answer a few questions on Healthcare.gov/screener to find the coverage you need. You can also talk to a Navigator or Application Counselor. These are trained professionals available in your area that offer free assistance to help answer questions and enroll you in the right health plan for you and your family.

You can shop for coverage on Healthcare.gov during Open Enrollment to find a plan that meets the requirements of the Affordable Care Act (ACA). Open Enrollment is November 1, 2024 through January 15, 2025. You can apply for Medicaid any time of the year.

Please note that there are Special Enrollment Periods (SEP) that will allow you to purchase health insurance outside of the annual open enrollment period.

You will need the following information for each person in your household:

• Social Security numbers or document numbers for legal immigrants
• Birth dates
• Employer and projected income information
• Policy numbers for current health insurance policies
• Last year's tax information for you and your family
• Information on any health insurance plan that's available to your family through a job

For a detailed list of more information you may need, read the HealthCare.gov Application Checklist.

For more information for immigrant status and purchasing plans on the marketplace, please visit https://www.healthcare.gov/immigrants/immigration-status/

• Costs. It is important to understand how much your total cost for health care will be. Make sure you understand how much your premium and out of pocket costs are.
  • A premium is a monthly bill you pay to the insurance company, whether you use any medical services. Premiums can vary from plan to plan.
  • Out-of-pocket costs are payments to your health insurance provider for covered medical services you use. Out-of-pocket costs can include deductibles, copayments, and coinsurance. For example, if you go see your primary physician, you will likely pay a copayment, which is a fixed payment for the covered service.
  • Cost Sharing. Look at how your plan shares costs with you. Plans on Healthcare.gov are presented in 4 "metal" categories: Bronze, Silver, Gold, and Platinum. Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care.
    • Bronze plans offer the lowest monthly premiums but have the highest out-of-pocket costs when you need care.
    • Platinum plans have the highest monthly premiums but the lowest out-of-pocket costs when you need care.

    Most people choose plans based on their families’ overall health and specialty care needs. You can view personalized price estimate before purchasing a plan at HealthCare.gov/see-plans.

    • Network. Make sure you look at the plan’s network of physicians/services. A network is a health plan that contracts with doctors, hospitals, pharmacies, and other health care providers to provide members of the plan with services at a discounted price. Some plan types allow you to use any doctor or healthcare facility, while other plans limit your choices or charge you more if the providers you use are out of the plan’s network.
    back to top What are the essential health benefits that are included under the Affordable Care Act?

    Essential health benefits are services that must be covered by health insurance plans sold on Healthcare.gov. Essential health benefits ensure that everyone has access to the comprehensive coverage for the services they need. These essential health benefits fall into 10 categories:

    • Ambulatory patient services (outpatient services)
    • Emergency services
    • Hospitalization
    • Pregnancy, maternity and newborn care
    • Mental health and substance use disorder services, including behavioral health treatment
    • Prescription drugs
    • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services, including dental coverage and vision care
    back to top Do I have to pay deductibles and copayments for essential health benefits?

    Generally, yes. All Healthcare.gov plans have deductibles, copayments, and other out-of-pocket costs that apply to most covered services. Some preventive services are free, and some plans cover other services without out-of-pocket costs.

    • Deductible: The amount you pay before your insurance provider will begin paying for most health care services covered by your health plan. Some insurance providers will pay for services before you meet the deductible, so it is important to confirm the details of your coverage plan with the insurance company.
    • Copayment: A fixed amount that you pay for health care services covered by your plan, like a doctor visit, usually paid when you receive care.
    back to top When does my coverage start?

    The start date of your coverage will depend on when you enroll. Contact your insurer or call Healthcare.gov at (800) 318-2596 for details.

    back to top How can I find assistance with plan enrollment in my local area?

    You can search for local assisters here. Just enter your zip code to find application assisters near you.

    back to top How much will health insurance on Healthcare.gov cost?

    There are a few things that will affect the cost of insurance for you, including your:

    • Age
    • Household income
    • Household size
    • Where you live
    • Tobacco use
    • Type of insurance plan that you buy

    You may also be eligible for financial help from the federal government to help lower the cost of coverage. Your answers to the information listed above will help determine your eligibility for subsidies/financial help.

    back to top What are premium health care tax credits?

    A premium tax credit (also known as a PTC) is a refundable credit that helps eligible individuals and families lower their monthly premiums for their health plan through Healthcare.gov. The only way for individuals to apply for premium tax credits is through Healthcare.gov. To get these credits, you must meet certain requirements including filing a tax return. To see if you are eligible, visit: https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit.

    back to top What if I can’t afford coverage?

    If you think you can't afford coverage, there is help available. First, check out HealthCare.gov and see if you qualify for cost assistance or Medicaid based on your projected Modified Adjusted Gross Income (MAGI).

    You can use the Kaiser Family Foundation’s coverage calculator to figure out if you qualify for assistance and how much your monthly premium will cost before and after assistance.

    back to top How do I file an appeal or complaint about my health insurance company?

    If you enroll in a Healthcare.gov plan and you do not agree with a decision your insurance company makes about your coverage, we can help. The Illinois Department of Insurance - Office of Consumer Health Insurance (OCHI) can answer your questions about filing a complaint or an external review. File a complaint
    

    back to top

    Can I have marketplace coverage and Medicaid (also known as: Medical assistance, Medical card, All Kids or Public aid) at the same time?

    ​If you have Medicaid, you are already covered. You do not have to buy more health coverage.

    back to top When and where can I apply for Medicaid?

    You can apply for Medicaid anytime of the year. GetCovered Illinois Navigators and Certified Application Counselors are available near you to help you find coverage that meets your needs and your budget. Find assistance in your local area. You can fill out an application on Healthcare.gov and it will be assessed to see if you are eligible for Marketplace or Medicaid coverage. Your application will be referred to the Medicaid program as appropriate.