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.
The open enrollment period for 2022 coverage ran from November 1, 2021 to January 15, 2022. 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.
- Celtic Insurance Co. (Ambetter)
- Health Alliance Medical Plans, Inc. (HAMP)
- Health Care Service Corporation (HCSC, Blue Cross Blue Shield of Illinois)
- Bright Health
- 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)
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 were implemented for 2022 by the insurers that offer health plans in the Illinois exchange:
- Celtic Insurance Co. (Ambetter): Average rate decrease of 3.21%.
- Health Alliance Medical Plans, Inc. (HAMP): Average rate increase of 10.09%.
- Cigna: Average rate increase of 1.57%.
- Quartz: Average rate increase of 16.45%.
- Bright Health: Average rate increase of 1.77%.
- MercyCare HMO: Average rate increase of 4.18%.
- Health Care Service Corporation, (HCSC, Blue Cross Blue Shield of Illinois): 4.92% increase
- SSM Health Plan (WellFirst Health): Rate filing details unavailable
- Oscar: New for 2022, so no applicable rate change.
- Molina: New for 2022, so no applicable rate change.
- UnitedHealthcare: New for 2022, so no applicable rate change.
The Illinois Department of Insurance announced that the average second-lowest-cost silver plan decreased by 3% for 2022. That’s the benchmark plan, which is used to determine premium subsidy amounts, so subsidies are slightly smaller in 2022, all other factors (age, income, location) being equal.
The Insurance Department also noted that the lowest-cost bronze, silver, and gold plan rates all decreased for 2022.
By December 15, 2021, with a month remaining in the open enrollment period for 2022 coverage, 310,489 people had signed up for 2022 coverage through the Illinois exchange.
Enrollment in the Illinois exchange peaked in 2016 and then declined each year through 2021. But by mid-December 2021, enrollment in 2022 plans had already surpassed 2020 and 2021 enrollment, and had nearly caught up with 2019 enrollment.
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 there are no longer any SHOP-certified small business health plans available in Illinois as of 2020.
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 August 2021, there were 789,974 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 2022, 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 August 2021, there were 789,974 Illinois residents covered under expanded Medicaid
As of July 2021, more than 3.36 million residents of Illinois were covered by Medicaid/CHIP. That was 27% more than the enrollment total in late 2013. Medicaid enrollment across the country has been trending upward since the start of the COVID pandemic as a result of the widespread job and income losses.
States are receiving additional federal Medicaid funding during the pandemic emergency period, on the condition that they not disenroll anyone from their Medicaid programs. So enrollment has continued to climb nationwide since early 2020, with no eligibility redeterminations during that time.
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.
Read more about short-term health insurance coverage in Illinois.
As of August 2021, there were 2,294,413 Illinois residents enrolled in Medicare. Eighty-seven percent of the state’s Medicare beneficiaries are 65 or older, while the other 13% are under 65 and eligible for Medicare due to disability.
Medicare beneficiaries can choose between Original Medicare and Medicare Advantage (you must live within the service area of a Medicare Advantage plan in order to select that plan; Medicare Advantage plans generally cover additional optional benefits that go beyond what Original Medicare provides, but they also come with more limited provider networks and other drawbacks; there are pros and cons either way). 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.