Obamacare in Illiniois

Health Insurance Marketplace in Illinois

If you live in Illinois, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Illinois will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Illinois 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

Genesis Health SystemG

Genesis Health System will implement a navigator program through the Genesis Visiting Nurses Association (GVNA). Genesis plans to use existing relationships to aid residents and small business in accessing new sources of coverage.

Sinai Health System

Sinai Health System, through its community-based corporation, the Sinai Community Institute (SCI), plans to operate a navigator program together with a consortium of public and community and faith based organizations to raise awareness about coverage options and assist individuals in enrolling in the Illinois Health Insurance Marketplace.

DuPage County Health Department

DuPage County Health Department’s (DCHD) plans to implement a navigator program targeting hard to reach populations. DCHD has identified younger adults 19 to 34 years of age and small businesses and their employees as the target populations.

Southern Illinois Healthcare Foundation

Southern Illinois Healthcare Foundation is a community-based, Federally Qualified Health Center network, with nearly 40 health centers located in seven counties in Southern Illinois. Southern Illinois Healthcare Foundation Navigators will meet with staff members of individual health centers throughout the service area to coordinate the sign-up and completion of Federal on-line training for additional health centers, to train and prepare additional staff members to be able to assist patients when they are visiting the health centers.

A Safe Haven Foundation

A Safe Haven Foundation is a non-profit organization that has provided housing and supportive services to homeless individuals and their families for 19 years. A Safe Haven will raise awareness about the Marketplace and coverage options for vulnerable populations.

Mercy Hospital and Medical Center

Mercy Hospital and Medical Center’s Community-based Insurance Navigator Consumer Health (CINCH) Project will focus on identifying and connecting eligible individuals, especially minorities and the newly eligible, to insurance enrollment services at Mercy Hospital’s main and satellite sites, Mercy Family Health Center’s sites, and in community-based settings using Enrollment Navigators. The CINCH Project’s Navigators will help facilitate enrollment in coverage and will educate consumers about available Qualified Health Plans.

The Puerto Rican Cultural Center, Inc.

The Puerto Rican Cultural Center is a non-profit community-based institution, which seeks to serve the social/cultural needs of Chicago’s Puerto Rican/Latino community. The Puerto Rican Cultural Center Navigator will focus on grassroots outreach, door-to-door canvasing, formal and informal popular education activities.

Illinois College of Optometry

The Illinois College of Optometry will work with partner organizations to leverage a coalition of providers who have experience working with uninsured and underinsured patient populations. Many of the populations served by these partners are African-American, Latino, below the poverty line, or transient. The College and its partners will work to educate this population about their coverage options and help t
hem evaluate those options and enroll in coverage.

VNA Health Care

VNA Health Care is the largest low income primary health care provider in Kane County, organized as the Visiting Nurse Association of Fox Valley. VNA Health Care will serve hard to reach populations and customers in their homes, following the successful model used in VNA’s skilled home nursing service.

The East Los Angeles Community Union

The East Los Angeles Community Union (TELACU) is a community development organization. For more than 40 years, TELACU has been improving the lives of individuals and families throughout East Los Angeles. TELACU will use Navigator funds in target markets in Illinois, paying special attention to the Hispanic community due to the high density of uninsured Hispanic residents in the state.

National Council of Urban Indian Health

National Council of Urban Indian Health is the only national, membership-based organization dedicated to outreach and education on behalf of Urban Indian Health. It provides training, technical assistance, outreach, and education to Urban Indian Health Programs.

Information for:

Individuals and Families

Small businesses

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Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP in Illinois:

Land of Lincoln Health

Accountable Care Organizations in Illinois

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Illinois

While Governor Pat Quinn (D) had considered establishing an exchange via executive order, he began moving in the direction of a state-federal partnership exchange in July 2012.1,2 The Governor’s staff noted it would be difficult to meet the federal timetable for implementation. While the state is pursuing a partnership exchange, the administration still intends to transition to a fully state-based exchange in 2015 and will continue with the necessary planning. A state opting for a partnership exchange can choose to operate plan management functions, consumer assistance functions, or both. The state can also elect to perform Medicaid and CHIP eligibility determinations or rely on the federal government to make those determinations.

In 2011, the Governor signed SB 1555 into law declaring the state’s intent to establish the Illinois Health Benefits Exchange and created the Health Benefits Exchange Legislative Study Committee.3 Legislation establishing a state-based health insurance exchange remains pending (HB 4574, SB 1729, SB 1313).4,5,6

The bipartisan Health Benefits Exchange Legislative Study Committee, composed of six appointed legislators from each chamber, completed a draft report in October 2011, which did not make specific exchange recommendations, but drew largely from reports commissioned by the Governor’s Health Reform Implementation Council.7 Released the month prior, the Health Reform Implementation Council reports analyzed the state’s insurance coverage, health insurance marketplace, and infrastructure needs associated with an exchange.8,9 Various stakeholder groups commented on the bipartisan Study Committee’s exchange report.10

Contracting with Plans: The state intends to pursue plan management functions in the partnership exchange. In December 2011, Illinois hired a subcontractor to propose a process for qualified health plan (QHP) certification, recertification, and decertification.11 The Department of Insurance also solicited input from carriers on the implementation of QHP standards. The state is awaiting further guidance from U.S. Department of Health and Human Services (HHS) before developing a quality rating system for QHPs.

Risk Adjustment, Reinsurance, and Risk Corridors (RRR): The Department of Insurance hired subcontractors in December 2011 to evaluate options for the state’s RRR programs. The final report will provide the state with a comprehensive work plan for the implementation of risk adjustment mechanisms. Based on preliminary results, the state has decided to defer to the federal risk adjustment program for 2014 (also a necessity for state-federal partnership exchanges); however the state is evaluating its capacity to run reinsurance at the state level in 2014.12

Consumer Assistance and Outreach: A final subcontractor’s report on design of the state’s Navigator program was released in June 2012 to the Department of Insurance.13Recommendations included adding expertise in Medicaid eligibility and enrollment to the Navigators’ responsibilities, allowing the Department of Insurance to maintain responsibility for the program until a state-based exchange entity is created, and restricting Navigator participation to organizations. This would prohibit Navigator participation by individuals with the exception of medical providers and insurance producers. The report also recommends the state use a competitive process to select Navigators and that for the initial phase of the program, Navigators serve consumers in the individual exchange but not the small-business exchange- in which producers would assist employers to purchase coverage for their employees.

Illinois plans to procure a multi-tier call center to manage and respond to all Exchange inquiries. The state anticipates that call center staff will be trained at various levels, ranging from simple questions to complicated lifestyle or medical needs questions.

Small Business Health Options Program (SHOP) Exchange: In December 2011, the state hired subcontractors to assist with SHOP-specific functions and anticipates deliverables including possible SHOP models and a work plan for the development of a SHOP Exchange by Spring 2012. The state also conducted a survey with potential users of the SHOP Exchange to identify market conditions and services and features important to potential users.14

Information Technology (IT): While Illinois will initially pursue a partnership exchange, the state intends to continue developing IT capacity for a transition to a fully state-based exchange in 2015. Illinois envisions two phases for technical infrastructure implementation. The state will build a front end portal to determine eligibility for Medicaid and the Exchange which will have connections to the Federal Hub. The second phase will replace the state’s underlying eligibility system. The Eligibility Modernization Oversight Group, an intergovernmental working group formed to address eligibility, verification, and enrollment requirements, continues to meet weekly to develop an Integrated Eligibility System (IES).15 Subcontractors have been hired to begin the necessary work. Additionally, key staff has been recruited to guide the IES and exchange operating systems development. Federal grant money awarded in May 2012 is being used to hire an exchange systems integration vendor, IES project management office staff, and an IES vendor. The Department of Healthcare and Family Services released a Request for Proposals for Independent Verification and Validation (IV&V) services for the IES and the exchange.16 A separate interagency team h
as been heavily involved in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.17

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Illinois Health Care Reform Implementation Council accepted public comments and planrecommended the BlueCross BlueShield of Illinois BlueAdvantage small group plan supplemented by the federal BlueVision package and the AllKids dental package as the benchmark package.18

Exchange Funding

In September 2010, the Illinois Department of Insurance received a federal Exchange Planning grant of $1 million. The Department has also received two federal Level One Establishment grants-one for $5.1 million awarded in August 2011 and a second for $32.8 million in May 2012. The grants will be used to conduct research on risk adjustment, reinsurance, the navigator program, the certification of QHPs, and the SHOP exchange as well as to build the Governor’s health reform website.19 The state will use the majority of the funds to support the design, building, establishment, and maintenance of the IT systems required for the exchange. Funds will also be used to set up a design management team, continue the development of a consumer assistance portal, and continue the development of a Navigator education and training program.

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Illinois is participating in Medicaid expansion.

 Next Steps

On February 13, 2013, Illinois received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange.20 The state intends to pursue both plan management and consumer assistance functions. Final approval is contingent upon the state demonstrating its ability to perform all required exchange activities on time; complying with future guidance and regulations; signing a memorandum of understanding (MOU) with CMS outlining the roles and responsibilities for the state’s operation of plan management and consumer assistance functions; and signing an MOU with Illinois’ Medicaid agency to define the roles, responsibilities, and coordinated work shared by both agencies until an exchange entity is created. The state must also retain a vendor to complete required Independent Verification and Validation activities for the exchange and procure vendor services by February 28, 2013 if it wishes to customize its System for Electronic Rate and Form Filing (SERFF) platform to assure operability with the Federally-Facilitated Exchange.

Illinois is also continuing its planning efforts to transition to a fully state-based exchange in 2015. In January 2013, the Health Care Reform Implementation Council released a survey, available to the public through the Illinois health care reform website, to seek stakeholder input on the functions of a state-based exchange. The survey asks respondents to prioritize functions meant to ensure that premiums are affordable, such as selective contracting, expanding on federally required certification criteria, piloting new delivery system and reimbursement strategies, and rate review.22

For more information on Illinois’ health insurance exchange planning, visit: http://www.insurance.illinois.gov/hiric/hie.asp


1. Johnson, Carla. “Ill. Governor mulls executive order on exchange.” May 14, 2012. Associated Press. http://www.businessweek.com/ap/2012-05/D9UOM1H80.htm
2. Olsen, Dean. “State to work with feds on health insurance exchange.” July 18, 2012. The State Journal-Register. http://www.sj-r.com/top-stories/x1798690424/State-to-work-with-feds-on-health-insurance-exchange?zc_p=0
3. Senate Bill 1555. Introduced February 9, 2011. http://www.ilga.gov/legislation/fulltext.asp?DocName=&SessionId=84&GA=97&DocTypeId=SB&DocNum=1555&GAID=11&LegID=57442&SpecSess=&Session=
4. SB 1313. Introduced February 8, 2011.http://www.ilga.gov/legislation/97/SB/PDF/09700SB1313.pdf
5. SB 1729. Filed March 17, 2011.http://www.ilga.gov/legislation/97/SB/PDF/09700SB1729sam001.pdf
6.  HB 4574. 2012 Regular Legislative Session. http://www.ilga.gov/legislation/BillStatus.asp?DocNum=4574&GAID=11&DocTypeID=HB&LegId=64295&SessionID=84&GA=97
7. Findings of the Illinois Legislative Health Insurance Exchange Commission: As required by SC 1555. http://www.ilga.gov/commission/cgfa2006/upload/ILHealthBenefitExchangeDRAFTReport.pdf
8. Illinois Exchange Strategic and Operational Needs Assessment Final Report. September 2011. Health Management Associates.http://www.ilga.gov/commission/cgfa2006/Upload/FINAL%20IL%20Exchange%20Needs%20Assessment%20091511.pdf
9. Review of the Current Illinois Health Coverage Marketplace: Background Research Report. September 2011. Deloitte.http://www.ilga.gov/commission/cgfa2006/Upload/ILCurrentHealthCovrgMktplc092011.pdf
10. Stakeholder Comments on Draft Report Findings of the Illinois Legislative Health Insurance Exchange Commission. October 6, 2011.http://www.ilga.gov/commission/cgfa2006/upload/StakeholderCommentsOnDraftReport.pdf
11. Level 1 Stage 2 Project Narrative. Demonstration of Past Progress in Exchange Planning Core Areas. http://insurance.illinois.gov/hiric/Level1Stage2AppProjectNarrative.pdf
12. Performance Progress report Illinois Level 1 Exchange Establishment Grant. 6/30/12.http://insurance.illinois.gov/hiric/ILLevelOneExEstGrantRpt073012.pdf
13.Illinois Navigator Program Design Final Report. Presented to the Illinois De
partment of Insurance by Health Management Associates. June 27, 2012.http://www2.illinois.gov/gov/healthcarereform/Documents/Health%20Reform%20Implementation/IL%20Navigator%20Final%20Report.pdf
14. Performance Progress report Illinois Level 1 Exchange Establishment Grant. 6/30/12.http://insurance.illinois.gov/hiric/ILLevelOneExEstGrantRpt073012.pdf
15. Illinois Planning Grant 4th Quarterly Report. October 31, 2011.http://www.insurance.illinois.gov/hiric/resources/q4grantreporthhs.pdf
16. State of Illinois Request for Proposals. Dept. of Healthcare and Family Services. IV&V Project for IES and HIX.http://www.purchase.state.il.us/IPB/IllinoisBID.nsf/all/D0E1E77EA0D32DE986257AAF007F2ECC/$file/RFP.pdf?OpenElement
17.  Enroll UX 2014 website. http://www.ux2014.org/
18. Illinois Health Care Reform Implementation Council. September 28, 2012, EHB Workgroup.http://www.statereforum.org/sites/default/files/report_on_ehb_recommendation_final.pdf
19. Illinois Level One Establishment Grant: http://insurance.illinois.gov/hiric/Project_Narrative.pdf
20. Letter from Secretary Sebelius to Governor Quinn. February 13, 2013.http://cciio.cms.gov/resources/files/il-blueprint-exchange-letter-02-13-2013.pdf
21. Health Care Reform in Illinois – What it Means for You.http://www2.illinois.gov/gov/healthcarereform/Pages/ExchangeMarketRole.aspx

Also of interest

Provided by the Henry J. Kaiser Family Foundation

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