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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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:
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).
back to top Why use Healthcare.gov?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.
back to top Who can get covered through Healthcare.gov?You can purchase a health plan and enroll if:
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.
back to top How can I sign up for health insurance?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.
back to top What information/documents do I need to apply as an individual or as a family?You will need the following information for each person in your household:
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/
back to top What Should I look for when choosing a plan?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.
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:
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.
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:
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
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.