Frequently asked questions about health insurance coverage options in Illinois
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 use HealthCare.gov to enroll in health coverage and make changes to their plan.
But Illinois is considering the possibility of a fully state-run exchange, and legislation is under consideration in 2023 that would begin the process of creating a state-run exchange.
The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Illinois (if the state decides to start running its own exchange platform at some point in the future, they would have the flexibility to offer a longer enrollment window, which some state-run exchanges do). Outside of open enrollment, a special enrollment period is necessary in order to enroll or make a change to your coverage.
Most special enrollment periods are triggered by a qualifying life event, although some special enrollment periods (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) are not tied to a specific life event.
In Illinois, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.
Illinoisans may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Illinois.
Short-term health insurance is also a lower-cost coverage option in Illinois, where nine insurers offer short-term plans.
As of 2023, there are 11 insurers offering a total of 309 plans exchange plans in Illinois, with plan availability varying from one location to another:
- Aetna (new for 2023)
- Celtic Insurance Co. (Ambetter)
- Health Alliance Medical Plans, Inc. (HAMP)
- Health Care Service Corporation (HCSC, Blue Cross Blue Shield of Illinois)
- Cigna
- Quartz
- MercyCare HMO
- SSM Health Plan (WellFirst Health)
- Oscar (new for 2022 in Cook, DuPage, and Lake counties)
- Molina (new for 2022)
- UnitedHealthcare (new for 2022; UHC previously offered plans in the Illinois marketplace, but exited at the end of 2016)
Aetna is new for 2023, but Bright Health left at the end of 2022. So while the list of insurers changed slightly for 2023, the number of participating insurers did not.
And the number of participating insurers has grown significantly in recent years. Three insurers joined the Illinois exchange as of 2021 (Bright Health, MercyCare HMO, and SSM Health Plan/WellFirst Health) and three more joined for 2022 (Oscar, Molina, and UnitedHealthcare).
According to ratereview.healthcare.gov, the following average rate changes (mostly the same as the insurers proposed) were approved for 2023:
- Aetna: New for 2023
- Celtic Insurance Co. (Ambetter): 13.67% increase
- Health Alliance Medical Plans, Inc. (HAMP): 6.81% increase
- Cigna: 3.26% increase
- Quartz: 11.82% increase
- MercyCare HMO: 6.33% increase
- Health Care Service Corporation, (HCSC, Blue Cross Blue Shield of Illinois): 5.29% increase
- SSM Health Plan (WellFirst Health): 11.39% increase
- Oscar: 7.68% increase
- Molina: 4.19% increase
- UnitedHealthcare: 15.86% increase
The Illinois Department of Insurance noted that average premiums for the second-lowest-cost silver plan in each area increased by 11% for 2023. These plans’ premiums are used to determine premium subsidy amounts, so subsidies in Illinois are larger for 2023 than they were for 2022.
During the open enrollment period for 2023 coverage, 342,995 people enrolled in private plans through the Illinois exchange. This was the highest that enrollment had been since 2017 (nationwide, enrollment hit a record high in 2023, but that was not the case in Illinois, as it had been higher several years earlier).
Small business owners in Illinois can enroll in ACA-compliant small group health plans directly through the private health insurance companies that offer small group coverage in Illinois. But since 2020, there have not been any SHOP-certified small business health plans available in Illinois.
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 Illinois health insurance marketplace and gain coverage under expanded Medicaid. As of September 2022, there were more than 914,000 Illinois residents covered under expanded Medicaid
All of the people who have enrolled in plans through the Illinois marketplace and small group market are enrolled in plans that provide coverage for the ACA’s essential health benefits. These protections also extend to Illinois residents enrolled in ACA-compliant plans outside the exchange (directly through insurance companies).
12.7% of the population was uninsured in 2013, according to U.S. Census data, and that had fallen to 6.5% by 2016, due primarily to the ACA. At that point, the national average uninsured rate was 8.6%. By 2019, the state’s uninsured rate had crept back up to 7.4%, mirroring a nationwide uptick in the uninsured rate under the Trump administration.
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 was a CO-OP that began operations in 2013, offering coverage that began in 2014. But like most of the CO-OPs, Land of Lincoln struggled financially, and it ceased operations on September 30, 2016. The massive shortfall in risk corridor funding was partially to blame for the CO-OP’s failure. In 2020, the Supreme Court ruled that the federal government had to pay health insurance companies the money they were owed under the risk corridors program. Even though Land of Lincoln Health had shut down several years earlier, its estate received $129 million in risk corridors funds in the summer of 2020, to be distributed to creditors.
As of 2023, only three ACA-created CO-OPs remained operational, out of 23 that began offering coverage in the fall of 2013.
Medicaid expansion in Illinois was authorized in 2013 and went into effect in 2014. As of September 2022, there were 914,065 Illinois residents covered under expanded Medicaid
As of October 2022, more than 3.7 million residents of Illinois were covered by Medicaid/CHIP. That was 42% more than the enrollment total in late 2013.
Medicaid enrollment across the country has been trending upward since the start of the COVID pandemic, but is expected to decrease in 2023 and 2024 due to the return to normal eligibility redeterminations and disenrollments.
Read more about Medicaid expansion in Illinois.
Illinois enacted legislation in 2018 that limits short-term health plans to six-month terms and prohibits renewals. The legislation was vetoed by the governor, but lawmakers overrode the veto and the new rules took effect.
Legislation under consideration in Illinois in 2023 would also require short-term plans to end no later than December 31 of the year they take effect, even if that results in a term that’s shorter than six months.
Read more about short-term health insurance coverage in Illinois.
As of October 2022, there were 2,327,109 Illinois residents enrolled in Medicare. More than 89% of the state’s Medicare beneficiaries are 65 or older, while nearly 11% are under 65 and eligible for Medicare due to disability.
Medicare beneficiaries can choose between Original Medicare and Medicare Advantage. Compared with the national average, a smaller percentage of Illinois beneficiaries select Medicare Advantage plans. And as expected when Original Medicare enrollment is higher, a larger-than-average number enroll in stand-alone Part D prescription drug plans.
Read more about Medicare in Illinois, including details about the available private plans and the state’s rules for Medigap plans.
The Illinois Department of Insurance regulates individual, small group, and large group health plans in Illinois (but not self-insured health plans). The Department also regulates brokers and agents who sell private health insurance plans to individuals and groups. You can reach out to them for assistance with everything from sales and marketing practices, to pre-authorization requirements, to claims processing.
If you need help with Medicare in Illinois, you can contact the Illinois Senior Health Insurance Program with questions.
If you have questions about Medicaid eligibility or enrollment in Illinois, you can reach out to the Illinois Department of Healthcare and Family Services. HFS also has information about All Kids, the Children’s Health Insurance Program that covers 1.6 million children in Illinois, and FamilyCare, the state’s Medicaid coverage for parents with minor children. These plans provide excellent health coverage benefits to people for whom private health insurance would simply be too costly.
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. The program stopped offering coverage at the end of 2021, as high-risk pool coverage is no longer a necessity now that the ACA makes individual (self-purchased) coverage guaranteed-issue, regardless of medical history.
Under the ACA, all new health insurance policies became guaranteed-issue as of 2014, with all essential health benefits covered regardless of a person’s medical history. This reform measure has largely eliminated the need for high-risk pools, since medical history is no longer a barrier to obtaining private health insurance 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.
