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.
In Illinois, open enrollment for 2021 health insurance plans ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
A qualifying event is not necessary to use this enrollment window. It’s open to uninsured residents as well as existing enrollees who would like to switch to a different plan in the Illinois marketplace. This gives people a chance to best take advantage of the American Rescue Plan’s subsidy enhancements. Subsidies are larger and more widely available than usual in 2021, and some people will be better served with a different plan as a result of the new subsidies.
For 2021, three new insurers joined the exchange in Illinois:
- Bright Health is offering plans in the Chicago area (prior to 2021, Bright Health only offered Medicare Advantage plans in Illinois).
- MercyCare HMO is offering plans in the Rockford area (Boone and Winnebago counties). Prior to 2021, MercyCare offered plans in neighboring Wisconsin.
- SSM Health Plan (WellFirst Health) is offering plans in the East St. Louis area. SSM Health Plan began offering individual market coverage in Missouri ( the western part of St. Louis) as of 2020, and have further expanded, into Illinois, for 2021, thus covering the full St. Louis area.
They joined the five insurers that were already offering plans in the Illinois marketplace:
- Health Alliance Medical Plans (HAMP)
- Health Care Service Corporation (HCSC; Blue Cross Blue Shield of Illinois)
HSCS continues to be the only insurer offering plans statewide. Residents in DeKalb County can only select plans from HSCS, but all other counties in the state can select from at least two on-exchange insurers.
Celtic/Ambetter and Cigna both expanded their service areas for 2021: Celtic/Ambetter is available in 13 new counties, and Cigna is newly available in McHenry and Lake counties (here’s where insurers participated for 2020, versus where they’re participating for 2021).
The following average rate changes were approved for 2021:
- Celtic Insurance Co. (Ambetter): Average rate increase of 2.45% (Celtic initially proposed an average increase of 0.26%).
- Health Alliance Medical Plans, Inc. (HAMP): Average increase of 0.63% (1.27% increase for HMO plans, and 0.01% decrease for POS plans).
- Health Care Service Corporation, (HCSC, Blue Cross Blue Shield of Illinois): Average decrease of 0.12% (approved as-filed).
- Cigna: Average rate increase of 0.89% (approved as-filed).
- Quartz: Average rate decrease of 10.05% (approved as-filed).
- Bright Health: New for 2021, so no applicable rate change
- MercyCare HMO: New for 2021, so no applicable rate change
- SSM Health Plan (WellFirst Health): New for 2021, so no applicable rate change
For 2021 coverage, 291,215 people enrolled in qualified health plans (QHPs) through the Illinois health insurance marketplace during the open enrollment period. That was a little lower than 2020 enrollment, when 294,263 people signed up during open enrollment (nationwide, there was a small average increase in enrollment from 2020 to 2021).
Enrollment is likely to increase further in 2021, due to the COVID-related enrollment period. CMS reported that during the first month and a half of this window (through March 31, 2021), 14,496 people enrolled in plans through the Illinois marketplace. This was nearly double the number of people who had enrolled during the same time frame the year before, during special enrollment periods triggered by their own individual qualifying events.
As is the case in the majority of the states that use HealthCare.gov, enrollment peaked in Illinois in 2016, when 388,179 people enrolled. Enrollment has declined each year since then, due to a variety of factors, including reduced federal funding for exchange marketing and outreach, higher premiums for people who don’t get subsidies, the elimination of the ACA’s individual mandate penalty, and the expansion of short-term health plans as an alternative to ACA-compliant plans.
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 more than 600,000 people are covered under expanded Medicaid by 2018.
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 percent, 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 received more than $160 million in grant funds. But like most of the CO-OPs, Land of Lincoln struggled financially, and it ceased operations 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 2021, 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 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, although it had dropped back down to just over 600,000 by mid-2018.
As of November 2020, nearly 3.2 million residents of Illinois were covered by Medicaid/CHIP. That was 21% more than the enrollment total in late 2013. Medicaid enrollment across the country has been trending upward in 2020 as a result of the widespread job and income losses caused by the COVID-19 pandemic.
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.
Read more about short-term health insurance coverage in Illinois.
As of January 2021, there were 2,276,824 Illinois residents enrolled in Medicare. 87 percent of the state’s Medicare beneficiaries are 65 or older, while the other 13 percent 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.
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.