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

Do I have to pay deductibles and copayments for essential health benefits?

Generally, yes. All ACA Marketplace 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.

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

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

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

If you enroll in a Marketplace 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

How do I get health insurance?

If you live in Illinois, you can answer a few questions on this site 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.

How much will health insurance on the ACA Marketplace cost?

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

  • Age
  • 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.

If I have Medicare, can I apply?

If you currently have Medicare, you are considered covered and are not eligible to purchase ACA Marketplace insurance. If you only have Medicare Part B, you can purchase health coverage through the ACA Marketplace. To learn more, visit healthcare.gov/medicare/.

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 cover the premiums for their health insurance purchased through the ACA Marketplace. The only way for individuals to apply for premium health care tax credits is through the ACA Marketplace. 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.

What are some of the key features of the Affordable Care Act?

  • People with pre-existing conditions, including 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
  • Health plans must cover essential health benefits including cancer treatment and follow-up care.

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 the ACA Marketplace. 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
  • 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

What documents do I need to apply as an individual or as a family?

You will most likely need the following information for each member of your family:

  • 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 HealthCare.gov’s Marketplace Application Checklist.

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

What if I already have Medicaid? Some people call this medical assistance, medical card, All Kids or public aid.

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

What if I can’t afford coverage?

The Illinois Department of Insurance encourages you to get health insurance for 2021.

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

Once the 2021 premiums are posted (about a week before November 1), 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.

What is the Affordable Care Act (ACA) and the Health Insurance Marketplace?

The ACA is a comprehensive health care reform law enacted in March 2010 that expanded access to affordable healthcare by protecting people with pre-existing conditions from being denied health insurance coverage. https://www.hhs.gov/healthcare/about-the-aca/index.html

The ACA Health Insurance Marketplace is also known as the Health Insurance Exchange. The ACA Marketplace/Exchange is an online "marketplace" where individuals, families, and small business owners can compare plans and shop for health insurance that best fits their needs. Health plans sold on the ACA Marketplace/Exchange meet the requirements of the Affordable Care Act.

What should I look for when choosing a plan?

  • 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 share costs with you. Plans on the ACA Health Insurance Marketplace 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.

When and where can I apply for Medicaid?

You can answer a few questions on this site which will help determine if you should apply for Medicaid. If so, you will be guided to the online application. You can apply for Medicaid anytime of the year. Trained counselors are available near you to help you find coverage that meets your needs and your budget. Find assistance in your local area.

When can I sign up for health insurance for 2021?

Illinois residents can sign up for health insurance during the annual open enrollment period which occurs once a year. Open Enrollment takes place from November 1 to December 15, 2020. You can shop for coverage on the ACA Health Insurance Marketplace to find a plan that meets the requirements of the Affordable Care Act (ACA).

Please note that there are several exceptions based on qualifying life events that will allow you to purchase health insurance outside of the annual open enrollment period. Check https://www.healthcare.gov/screener/ to see if you qualify.

When does my coverage start?

Coverage for people who enroll in a plan will begin on January 1, 2021. You pay your health insurance premium directly to the insurance company.

Who can get covered through the ACA Marketplace?

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

Why use the ACA Health Insurance Marketplace?

The ACA Health Insurance Marketplace is the only way for Illinois residents to purchase quality, subsidized insurance without the help of a broker. The ACA Marketplace makes it easy to purchase health insurance without the assistance of a broker, which makes coverage cheaper.