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The Affordable Care Act 

 

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 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.

Watch this video for more information about changes to health insurance under the Affordable Care Act.

New, Online Application System known as ABE, now open

As part of the implementation of the Affordable Care Act, the State of Illinois launched a new self-service website for new customers to apply for Medicaid, SNAP, and cash assistance.  The website is called ABE (Application for Benefits Eligibility) invoking a familiar Illinois theme. ABE replaces the current application for Medicaid, All Kids, the Medicare Savings Program, SNAP and cash assistance. The updated application system makes it easy and more convenient to apply and will allow for electronic signatures and document upload.  ABE also supports community partners and medical providers who are assisting clients or applying on their behalf.

Uninsured customers in need of health coverage should visit Get Covered Illinois. By answering a few simple screening questions, customers will be directed to the best health coverage option given their household size and income – to ABE for Medicaid coverage or to the Health Insurance Marketplace.  At the Health Insurance Marketplace website, customers can compare policies and prices and buy private insurance, potentially qualifying for financial help with premiums and cost-sharing. 

ABE launched on October 1, 2013, in time for the beginning of the ACA open enrollment period (October 1, 2013 – March 31, 2014) with health coverage begining on January 1, 2014. If you already have Medicaid (also known as medical assistance or public aid) you do not need to reapply.  If you have Medicare, these options do not affect you.

For more information on the State of Illinois’ efforts to prepare for health care reform, visit the Department of Healthcare and Family Services website.  

Specific benefits of the Affordable Care Act

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 through the Health Insurance Marketplace, specifically established 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.

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 in the Health Insurance Marketplace. The most an individual can pay out-of-pocket each year will be $6,350 and the most a family can pay will be $12,700.

Transparency

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 participating in the Health Insurance Marketplace 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 wellness and prevention benefits without cost to the policyholder.

Immediate Benefits

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.