Open Enrollment Health Insurance Exchange

When can I sign up for health insurance for 2020?

Illinois residents can sign up for health insurance during the annual open enrollment period which occurs once a year. The 2020 open enrollment period for the Affordable Care Act ended on December 15, 2019. Coverage for people who enrolled in the plan and paid their first premium, began on January 1, 2020.

Please note that there are several exceptions based on qualifying 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 to purchase health insurance outside of the open enrollment period.

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 expands access to affordable healthcare and protects people with pre-existing conditions from being denied health insurance coverage.

The Health Insurance Marketplace is also known as the Health Insurance Exchange. The Marketplace/Exchange is an online tool where individuals, families, and small business owners can find information about health insurance options and enroll/purchase health insurance coverage that best fits their needs.

Why use the Health Insurance Marketplace?

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

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 marketplace. The only way for individuals to apply for premium health care tax credits is through the marketplace. To get these credits, you must meet certain requirements and file 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 .

Who can get covered through the Marketplace?

To be eligible to enroll:

  • You must live in the United States
  • You must be a U.S. citizen or national
  • You cannot be incarcerated
  • If you don’t already have health insurance through an employer, Medicare, Medicaid, Children’s Insurance Program (CHIP), or other source that provides qualifying health coverage.

No one can be denied coverage on the market place for health-related reasons.

If I have Medicare, can I apply?

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

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 health insurance plans sold on the marketplace must cover. 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

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

Generally, yes. All 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.

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, regardless if you use any medical services. Premiums can vary from plan to plan. Out-of-pocket costs include costs you pay 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. It’s also important to look at how your plan share costs with you. Plans in the 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. In comparison, Platinum plans have the highest premiums but the lowest out-of-pocket costs when you need care. Most people base their decisions about what plans to choose based on their families’ overall health and specialty care needs.
You can view personalized price estimate before applying 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.

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 can’t afford coverage?

The state of Illinois Department of Insurance strongly encourages individuals to get health coverage for 2020. If you’re concerned about affording your health insurance, remember that there are options available to help. 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 2020 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.

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.