Frimark/Keller & Associates Illinois Affordable Healthcare Act
Health insurance has never been simple, but now people have more questions than ever. We hope we can help answer some of your Illinois Affordable Healthcare Questions.
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What is the Illinois Affordable Healthcare Act?
The Illinois Affordable Healthcare Act is a health insurance Marketplace in partnership with the federal government. Whether you need health coverage or have it already, the Illinois Affordable Healthcare Act offers new rights and protections that make coverage fairer and easier to understand. You’ll be able to compare your options based on price, benefits, quality and other important features.
Who can apply for the Illinois Affordable Healthcare Act?
Everyone can apply for Illinois Health Insurance! The Health Exchange is made to help insure everyone with these essential health benefits:
- People who currently do not have insurance
- People who aren’t insured by their employer
- People who want to save money on their health insurance
- People with pre-existing conditions that have had trouble getting affordable health insurance in the past
- Small businesses
When can I apply for the Illinois Affordable Healthcare Act with my insurance provider?
Enrollment Starts November 1st to January 31st.
What is Included in My Illinois Affordable Healthcare Plan?
- Preventive and wellness services – along with managing chronic conditions
- Services for children, including dental and eye care
- Pregnancy and baby care
- Infertility Treatments
- Outpatient Services – Doctor visits and tests done outside of a hospital
- Emergency Services – Hospital visits
- Lab services – blood pressure, cholesterol tests
- Hospital stays – Including weight loss surgery
- Mental Health – substance abuse, behavioral health treatment
- Prescription drugs, generic and certain brand- name drugs
- Rehab – help people recover from an accident or injury
- Habilitative Services – Help people with developmental issues
- Note: Cosmetic surgery and long-term care not included.
What Types of Illinois Health Insurance Plans can I sign up for?
- Bronze Plan: You pay 40% and the plan pays 60%
- Silver Plan: You pay 30% and the plan pays 70%
- Gold Plan: You pay 20% and the plan pays 80%
- Platinum Plan: You pay 10% and the plan pays 90%
You must have at least a bronze-level plan in order to meet the minimum requirements for insurance under the Affordable Care Act and avoid the financial penalty for not having health insurance. All plans that meet these standards are known as Qualified Health Plans (QHPs). If you currently have health insurance your policy might already be a QHP and you should check with your insurance agent before switching.
What are Illinois Health Insurance Catastrophic Plans?
If you are under the age of 30 and healthy you should look into buying a catastrophic health plan. These plans do not have as much coverage which results in higher out-of-pocket costs, but they will cover preventive services and tree visits to your primary doctor per year at no additional cost.
How do I get Illinois Health Insurance Premium Subsidies (also known as Tax Credits)?
In general, you’ll be eligible for subsidy’s that can help you pay your health insurance premium each month if you’re single and make about $46,000 or less a year, or if you have a family of four and make about $94,000 or less a year. Depending on your income, you may also qualify for subsidies that will reduce your costs when you receive medical care.
You can also be eligible for a premium credit if you do not have the ability to secure minimum essential coverage elsewhere except by purchasing a plan in the individual health insurance market or enrolling in an employer sponsored plan that is “unaffordable” or does not meet the standards of the Qualified Health Plan.
An employee healthcare plan is considered affordable if the employee can contribute no more than 9.5% of their household income toward the premium for self-only coverage.
Will I be Fined?
You will be fined if you do not maintain minimum essential coverage for yourself and your dependents. Noncompliance fines will be applied to your federal income-tax return.
Can My Health Insurance Be Taken Away?
Illinois Healthcare Act stops insurance companies from canceling your coverage just because you made a mistake on your application. Unfortunately, your coverage can still be canceled if you put false or incomplete information on your insurance application on purpose. Your coverage will also be cancelled if you do not pay your premiums on time.
Can I Keep Going to My Family Doctor on the Illinois Affordable Healthcare Act?
Maybe, you have the right to choose your doctor from your health plan’s provider network. All emergency room visits are covered regardless if you are out-of-network. All OBGYN visits do not need to be referred from a primary care provider.
Can My Dependent Under 26 Stay on My Health Insurance Plan?
Yes, if your child (dependent) is under 26 years old they can stay on your plan even if they are:
- Attending school
- Not currently living with you
- Financially independent
- Eligible to enroll in their employer’s plan (except when a plan is purchased before March 23, 2010 is grandfathered in, but does not offer coverage up to age 26 if a young adult is eligible for job-based affordable coverage through their own employer.)
Where does my Illinois Healthcare Insurance Premium Go?
Another law of the Affordable Care Act is that all health insurance providers must spend 80% of the money they take in on premiums on your health care and quality improvement activities. Insurance companies must also publicly justify any rate increase of 10% or more before raising your premium.
What is my Illinois Healthcare Insurance Yearly Limit?
The Affordable Healthcare Act has stopped insurance companies from setting a dollar limit on what they spend on essential health benefits during the entire time you’re enrolled in that plan. Most insurance companies still set a yearly dollar limit of $2 million on what they spend on your health coverage’s not including essential health costs.