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Illinois Health Insurance

Illinois Medical Insurance Overview

Illinois has a lot of room for improvement when it comes to the overall health of the state’s residents.  The state ranks in 28th place in comparison to the health of other states in the country.  In order to receive insurance coverage, there are group, individual and state-funded insurance plans for residents who live in this state.  With the introduction of “Obamacare,” many Illinois residents are expected to obtain insurance coverage in addition to the numbers that will increase in the insured population nationwide.

Illinois’ Health Care Issues
Illinois was the 30th healthiest state in the U.S., but has since climbed to the 28th position with regard to the health of the state’s residents.  There are strengths with regard to the healthiness of the citizens in Illinois with a decrease in the rate of preventable hospitalizations along with the low rates of deaths associated with drug abuse and the high rate of HPV vaccinations for young women.  Weaknesses in the state include its high prevalence for those who drink excessively and the high levels of air pollution.

Understanding Illinois’ Uninsured Population
It is estimated by the Health and Disability Advocates that 1.7 million residents live in Illinois without any sort of health insurance benefits.  This high figure has a negative effect on the mortality rate in the state of Illinois and it is believed that insurance coverage reduces the mortality rate for those uninsured parties by as high as 15 percent.

Provided in the list below are some statistics regarding those persons who have no insurance coverage in the state of Illinois:

  • Poor adults comprise the highest rate of people who lack insurance coverage in Illinois.  Of the poor adults in the state, 45 percent earn less than 100 percent of the Federal Poverty Level and are currently uninsured.
  • Because of the large amount of smaller companies that don’t offer insurance benefits to their employees, many of the residents in this state lack coverage.
  • Unemployment is the culprit for many of the uninsured population in the state of Illinois.  The unemployment rate is sitting at 9 percent, which is one of the highest unemployment rates in the entire nation.

Group Health Plans
Under a group health insurance plan, you can receive coverage through a trade union or your place of employment.  Because insurance providers offering group health coverage cannot decline your application for benefits based on the presence of a pre-existing medical condition, this is one of the best options in the state for benefits.  Less than half of the corporations operating in Illinois offer medical benefits, but healthcare reform will work to increase those numbers overall.  The Division of Insurance regulates health insurance companies in the state of Illinois.

Signing Up
When looking to join your employer’s group health insurance plan, you should do a lot of careful research so you can evaluate each level of coverage offered.  Coverage options depend on the amount of insurance you need along with the amount of money you wish to pay.  Your workplace will cover a portion of the premium amounts, but the remainder will be deducted from your paychecks automatically.

When figuring out if you want to join your employer’s plan, consider the following:

  • What the plan covers as part of the benefits package.  You don’t want to regret your choice later, so be sure to explore the benefits in detail so no surprises pop up.
  • Talk with an HR rep about the various options included in your group plan.
  • Qualified dependents under the age of 26 should be covered under the terms of your group contract.

Pre-Existing Condition Exclusion Periods
Despite insurance companies not being able to deny your insurance application due to a pre-existing condition, they can subject you to an exclusion period.  This period of time can last no longer than 12 months in the state of Illinois and after this time has passed, your benefits will be available for use.  In addition to this exclusion period, insurance companies can also look into your medical records for six months to see if you have a pre-existing medical condition.

Dependents 19 and younger will not be subject to waiting out any exclusion periods under your group insurance plan.

Affiliation or Waiting Periods
Affiliation periods refer to the length of time it takes for covered people to begin using their benefits package.  Insurance companies cannot impose affiliation periods that last long than two months, unless you have joined the plan late.  Late enrollees may have to wait for three months before benefits become active.

Individual Health Plans
Individual health insurance policies are ideal for those who are unable to obtain coverage through any other means.  If you are self-employed, unemployed or working for a company that does not offer insurance benefits, then an individual policy may be the only way you can obtain coverage.  Five percent of the residents in Illinois are covered under individual policies.  This can prove to be a disadvantage because of the amount of underwriting done when making up these sorts of policies.  In addition, insurance providers are able to deny coverage to applicants who are found to have pre-existing conditions.  It is estimated that a healthy person living in Illinois can obtain insurance under an individual plan for $48 per month.

Continuation Coverage
If you are temporarily without insurance coverage because of loss of eligibility or employment, you can obtain coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).  Through this legislation, you are able to continue your benefits for another 18 months, but the company’s size determines your eligibility for this program.

Illinois Health Benefit Exchange
The state and federal governments both worked jointly to create and implement the health benefits marketplace in the state of Illinois.  The marketplace is called Get Covered Illinois and it works to provide access to affordable health insurance for residents of the state.  Now, the program is run strictly on a state level after moving away from its joint partnership with the U.S. government.

Illinois State Insurance Programs
State-funded insurance programs are available to those who qualify based on a number of factors like age, sex, health status and income.  Thirty-one percent of the population of Illinois is covered under a state-sponsored program.

Below is a list of the insurance programs offered that are funded on the state level.

Comprehensive Health Insurance Plan (CHIP)
CHIP is available to those people who have had issues with getting insurance coverage because of a pre-existing medical condition.  There are a number of factors involved in determining eligibility and premiums can range between $23.10 and $2,636 per month.

Pre-Existing Condition Insurance Plan (IPXP)
Through IPXP, people with pre-existing conditions can obtain insurance that covers medications, primary care services and more.  It is geared to help people with pre-existing medical conditions get covered and it is guaranteed if you have been uninsured for a period of six months prior to approval.

The Medicaid program exists to aid low income families with obtaining insurance benefits and eligibility is dependent on your level of income.

This program offers help with medical services for people who are limited by the amount they earn.  If you have had trouble getting affordable insurance because you’re not a high earner, then you can apply for coverage.  Co-payment amounts can cost up to $3.65 for doctor’s visits and medications, of which the participant is responsible.

All KidsCare
This program covers uninsured children and offers things like doctor’s visits, medications, dental care, vision care, shots and more.

Illinois Breast & Cervical Cancer Program (IBCCP)
Women can obtain early detection procedures for breast and cervical cancer under this program.  Uninsured women between 35 and 64 years of age are eligible for these diagnostic procedures.

Healthy Woman
For women earning wages that are equal to or less than 200 percent of the Federal Poverty Level, the Healthy Woman program offers STD testing, lab tests, pap smears, physical examinations and more.

Medicare and the Medicare Prescription Drug Program
In order to qualify for Medicare, you must be one of the following: a senior who is 65 or older, a person suffering from end-stage renal disease or a disabled person.  Seniors looking for their coverage options under the Medicare program should have worked in a job that was covered by the Medicare program for a minimum of ten years.

VA Medical Benefits Package
The VA offers health benefits to military vets who have served for 24 consecutive months in any branch of the service and have received an honorable discharged.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance is a free program that will connect you with nearly 475 programs to aid in covering the costs of your prescription medications.

Women, Infants, and Children (WIC)
The WIC program is a program run by the USDA Food and Nutrition Service and offers low-income mothers resources for infant care, infant safety and breastfeeding.  In addition, pregnant women, infants and children can obtain healthy food items through WIC.

Health Benefits for Workers with Disabilities
This program offers benefits to people between the ages of 16 and 64 who have a disability and continue to remain employed.  Eligible people can earn a monthly salary of $3,258 and couples can earn $4,413.

National Association of Mental Illness (NAMI) Helpline
The NAMI helpline offers resources and treatment options to people suffering from any kind of mental illness.  The helpline is staffed by a team of volunteers who are knowledgeable on topics concerning the mentally ill.

HIPPA and Conversion Health Plans
HIPAA was placed into legislation to afford consumers the ability to keep their medical records private and prohibit the free use or dissemination of their medical information.  When the Affordable Care Act was signed into law, HIPAA’s regulations extended to govern insurance companies.  Under this law, group insurance providers cannot deny coverage based on pre-existing medical conditions.  In addition, it regulates the amount of time that insurance companies can have you wait out affiliation or exclusion periods along with the costs of premiums and look back periods.  There is also a provision under HIPAA that regulates insurance benefits under COBRA, conversion plans and continuation coverage after COBRA benefits are exhausted.