All Illinoisans should have access to affordable health care, but for too long the ability to secure quality care has been difficult for thousands of residents. The signing of the federal Affordable Care Act (ACA) provides Illinois with an opportunity to advance reforms that will ensure that we have a more efficient and cost-effective health care system.
Specific benefits of the Affordable Care Act include:
New Coverage for the Uninsured
By 2014, we anticipate that more than a million Illinois residents who are currently uninsured will receive health care coverage. About 200,000 to 300,000 of these will select coverage by commercial insurers that will be offered in a newly created Illinois Health Benefits Exchange
specifically for this purpose. Cost will be on a sliding fee basis according to income, and some individuals or households may be eligible to receive assistance with paying their premiums through federally-subsidized tax credits. About 500,000 to 800,000 will be covered under the restructured Medicaid program
at little or no cost to individuals.
New Protections for Individuals and Families
Beginning September 23, 2010, the ACA prohibits health plans from applying preexisting condition exclusions to children up to age 19, and all health plans must provide for both an internal appeals and external review process for denied health insurance claims.
High Risk Pool
Uninsured individuals with pre-existing conditions might be eligible for the high-risk pool, set up by Illinois with federal funds and currently in effect. More information for people who are uninsured because they have a previous medical problem is available at the Illinois Pre-Existing Condition Insurance Plan (IPXP) website
Improved Price Stability and More Value for Your Premium Dollar
The ACA restricts the basis upon which a premium may change and also provides the Illinois Department of Insurance
with the authority to review the amount of money an individual has to pay out of pocket from one year to the next.
Financial Security for Your Family
Current Illinois law limits annual out-of-pocket costs for HMO plans, but non-HMO plans can include deductible, co-pay and other cost-shifts to consumers without regard to the financial burden shifted to a family. Beginning in 2014, the ACA will limit out-of-pocket costs for policies sold on an Exchange. The most an individual can pay out-of-pocket each year will be $5,950 and the most a family can pay will be $11,900.
Transparency in the Marketplace
Currently in Illinois, shopping for health insurance can involve the completion of many different applications for different companies resulting in a comparison of apples to oranges. Illinois is establishing a state-based insurance exchange
that will include baseline coverage packages, standardized forms and transparent insurer comparisons so you will be able to compare apples to apples.
Health Care, Not “Sick” Care
The ACA will require all health insurance policies to provide immediate first-dollar coverage for a defined set of preventive benefits. In other words, insurers will be required to include these wellness and prevention benefits
without cost to the policyholder.
Many of the new provisions found in the ACA will not be implemented until 2014 but immediate benefits, particularly if you are uninsured by reason of a pre-existing condition or if you are a young adult (under age 26), are already being implemented.
The following benefits have taken effect already:
Small business tax credits (1/1/2010)
New benefits for Seniors (June 2010)
Additional information for consumers through easy-to-use website (7/1/2010)
Coverage for individuals with pre-existing conditions (9/1/2010)
Appeal rights (9/23/2010)
Elimination of lifetime dollar limits (9/23/2010)
Prohibition against unwarranted rescissions (9/23/2010)
Coverage for children with pre-existing conditions (9/23/2010)
Young adult children, up to age 26, will be able to receive coverage through a parent's health insurance policy. (9/23/2010)
Coverage for preventive services (9/23/2010 & 1/1/2011)
Premium value and transparency (2010)
Rebuilding the primary care workforce (2010)
Protection against premium increases (1/1/2011)
For information on other provisions and when they take effect, check out the timeline on healthcare.gov.