Health insurance in Illinois
- Illinois has a partnership health insurance exchange with the federal government.
- Open enrollment for 2019 coverage in Illinois ended on December 15, but enrollment is still possible for Illinois residents who have qualifying events.
- Short-term health plans are available in Illinois with initial plan terms up to 364 days.
- Five insurers offer 2019 coverage in the state’s individual market.
- The average premium increases for 2019 were flat.
- About 335,000 enrolled in 2018 coverage through the Illinois exchange.
- Illinois adopted the ACA’s Medicaid expansion in 2013.
- In Illinois, short-term plans are limited by new federal guidelines.
- The state’s CO-OP, Land of Lincoln Health, ceased operations in 2016.
The Illinois health marketplace
Illinois operates a partnership exchange with the federal government. That means the state runs Get Covered Illinois – which provides a website, in-person assistance, and a help desk – while Illinois residents enroll or make plan changes through HealthCare.gov.
Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for Illinois residents who have qualifying events.
Premium changes in the state’s individual market for 2019 were nominal. Among the highlights: :
- lowest-cost Silver plans decreased 6 percent,
- lowest-cost Gold plans decreased by 6 percent from last year, and
- lowest-cost Bronze plans modestly increased 6 percent (far less than the 20 percent increase reported for 2018 rates).
Together, those premium changes mean Illinois rates overall are “barely changing one way or another.”
Illinois enrollment in qualified health plans
About 23 percent of the estimated Illinois market – about 217,500 people – signed up for a qualified health plans (QHPs) during the 2014 open enrollment period. Seventy-seven percent of those enrolled in a QHP qualified for premium subsidies.
Enrollment continued a steady increase in the two open enrollment periods that followed. During the 2016 open enrollment period a total of 388,179 people enrolled in private plans through the Illinois exchange, an 11 percent increase over 2015 enrollment. The average premium subsidy amount was $237 per month, and 77.5 percent of Illinois exchange enrollees received premium subsidies as of March 31, 2016.
But for 2017 and again for 2018, enrollment in the Illinois exchange declined. 334,979 people enrolled during the open enrollment period for 2018 coverage, which was down 13.7 percent from the state’s peak enrollment in 2016.
Read more about the Illinois health insurance marketplace.
Medicaid and CHIP in Illinois
Medicaid expansion in Illinois was authorized in 2013 and went into effect in 2014. As a result, about 350,000 new enrollees were approved in just the first several months. A year later in 2015, total enrollments under Medicaid expansion in Illinois had reached 623,000. By August 2016, the total had exceeded 646,000.
As of July 2018, 2.95 million residents of Illinois were covered by Medicaid/CHIP in Illinois – an increase of 322,632 – or 12.3 percent – since 2013.
Read more about Medicaid expansion in Illinois.
Short-term health insurance in Illinois
Illinois does not regulate short-term plans and thus defaults to the new federal rules regarding short-term health insurance. Those rules allow plans to have initial terms of up to 364 days, and to be renewable (at the insurer’s discretion) for a total duration of up to 36 months.
Read more about short-term health insurance in Illinois.
How Obamacare is helping Illinois residents
Illinois has had relative success under the Affordable Care Act. Its uninsured rates have been nearly cut in half as more residents access coverage via subsidized private plans on the state’s exchange, and more than 600,000 people are covered under expanded Medicaid. 12.7 percent of the population was uninsured in 2013, according to U.S. Census data, and that had fallen to 6.5 percent by 2016, due primarily to the ACA. At that point, the national average uninsured rate was 8.6 percent.
According to a 2014 Kaiser Family Foundation analysis, about 67 percent of the uninsured, nonelderly people in the state were projected to be eligible for financial assistance to help them gain coverage through either Medicaid, CHIP, or Illinois’ health insurance exchange.
Other ACA reform provisions
The Affordable Care Act established a federal loan program, called the Consumer Operated and Oriented Plan (CO-OP) Program. The program is designed to increased consumer choice and expand competition by enabling new nonprofit health insurers to enter the market.
In Illinois, Land of Lincoln Health received more than $160 million in grant funds. It struggled in its first year and enrollment was only 4,000 in 2014. However, participation grew significantly in 2015, when premiums were cut 20 to 30 percent, and reached 50,000.
Nonetheless, after losing $7.1 million in the first quarter of 2016, Land of Lincoln Health announced its impending closure in 2016 and ceased operations September 30, 2016. As of early 2018, only four ACA-created CO-OPs remained operational, out of 23 that began offering coverage in the fall of 2013.
Does Illinois have a high-risk pool?
Prior to the reforms the ACA brought to the individual health insurance market, coverage was underwritten in nearly every state, including Illinois. People with pre-existing conditions often found themselves ineligible to purchase private plans, or only able to get coverage that excluded pre-existing conditions.
The Illinois Comprehensive Health Insurance Plan (ICHIP) was created in 1989 to provide a coverage option for people unable to obtain private plans because of their medical history. Due to budget shortfalls, the plan stopped enrolling new members in September 2000, and applicants were placed on a waiting list. The program was able to reopen to new enrollment in the spring of 2001. The pool also briefly suspended new enrollment in the summer of 2009.
In 2001, the risk pool had about 5,700 members, but that number had grown to more than 18,000 by the end of 2010.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This reform measure has largely eliminated the need for high-risk pools, since medical history is no longer a barrier to obtaining coverage in the individual market.
ICHIP was still enrolling eligible HIPAA pool applicants, but stopped renewing traditional risk pool members’ coverage after April 30, 2014. They notified members and posted extensive data on their website explaining how to transition to an exchange plan.
Illinois Medicare enrollment
In 2015, there were more than 2 million people enrolled in Illinois Medicare – about 16 percent of the state’s population, compared with 17 percent enrolled in Medicare nationwide. As of 2013, Medicare beneficiary eligibility was 85 percent based on age and 15 percent due to disability.
Illinois Medicare beneficiaries may choose a Medicare Advantage plan instead of original Medicare, a decision some make to gain additional benefits beyond what the traditional Medicare coverage offers. About 21 percent of Illinois Medicare recipients have selected a Medicare Advantage plan, much lower than the 33 percent who choose one nationwide.
Illinois Medicare beneficiaries can also select Medicare Part D plans for stand-alone prescription drug coverage, and 51 percent did so in 2017. Nationwide, 44 percent of Medicare enrollees selected stand-alone prescription plans. It makes sense that a higher percentage of Illinois residents would select stand-alone prescription plans versus the national average, since a smaller percentage of Medicare beneficiaries in Illinois select Medicare Advantage plans. Stand-alone Part D plans are for use with traditional Medicare rather than Medicare Advantage.
Health reform legislation in Illinois
Scroll to the bottom of the page to see what’s happening legislatively with healthcare reform in Illinois at the state level:
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.