A state that is home to the third largest city in the U.S., our current President (a famous former one as well), the world’s largest public library, and the tallest building in North America, Illinois has been a place of innovation for the past few centuries. An unfortunate innovation was the first McDonald’s arriving in Illinois, with its corporate headquarters still in Des Plaines to this day. Regardless of the fast food entity’s presence, many great attractions and other businesses are spread throughout the state. Though much of Illinois may seem a bit farm-heavy to an onlooker compared to Chicago, there are several other cities with fairly dense populations, such as Aurora, Joliet, Naperville, Springfield, Rockford and Peoria.
If you are a resident of Illinois, you have a variety of quality health insurance companies to decide between. East Coast Health Insurance offers the most reputable health insurers in your state, including Aetna, Blue Cross Blue Shield of Illinois, Coventry, Humana, UniCare and UnitedHealth Care. To determine availability and pricing of these companies and the plans they offer, enter your zip code in the quote engine below. If you have any questions or need help deciding between all of the companies at your disposal, feel free to consult one of our licensed Illinois experts at 888.803.5917. East Coast Health Insurance also has a location in Illinois, so our brokers truly know the market in your state.
In Illinois, the level of health is somewhat average, though there is a very high population to take into account. Some key areas of improvement are a decrease in the number of adult smokers (though 1.6 million adults still smoke), availability of primary care doctors, and moderate amount of high school graduates. Though 14.5% of the population may not sound like much, 1.8 million is a lot of Illinois residents without health insurance. There are also a number of negatives involved with the health status of Illinois, including an increase in diabetes, obesity and infectious diseases.
Those who live in Illinois are susceptible to poor air quality, which also thwarts some effort to be in good health. The population of Illinois needs to take initiative to improve its health condition, quality of air and life, which can start with a few small steps. If you are uninsured, get a health plan, and use preventive care and wellness services to make sure you are conscious of your current health status and what measures to takes to maintain or improve it. If you cannot afford health insurance, the state provides many programs to help people stay healthy or get well (see below). Even if you decide to take measures into your own hands, do a bit of research, eat well and get active, it will help over time.
Health Insurance Plans
- Open Access Managed Choice Value plans in the state of Illinois provide necessary coverage for a lower monthly rate. With Value plans, you can choose between $5,000 and $10,000 deductibles. Value plans are connected to Aetna’s Preferred network of providers for a bigger price break, or the option of non-network care for slightly more. From the day your plan starts, these plans offer preventive care for no charge when using in-network providers. Value plans come with a basic set of benefits, including your first three primary care doctor’s visits for a $40 copay, as well as prescription drug benefits before deductible. Once you have met the deductible, you can receive inpatient and outpatient hospital care for either 20% or 40% of coinsurance.
- Open Access Managed Choice PPO plans feature a greater amount of coverage from the Value plan, with a wider range of deductibles. In Illinois, these plans have deductible options of $2,500, $3,500, $5,000 and $7,500 (for individuals) with additional benefits of unlimited primary care visits and dental coverage. Preventive care is covered in full as soon as your plan begins, including immunizations, routine physicals, GYN exams, well-child care and more. After you meet the deductible, your plan will cover 80% of your costs on medical services such as hospitalization, lab work, diagnostic testing, skilled nursing and physical therapy. When you select a higher deductible, more services including unlimited primary care visits and dental coverage are also available.
- Open Access Managed Choice High Deductible plans are also PPOs, with the capability of seeing in-network or out-of-network doctors, as well as adding a health savings account. HSAs help you gain more control over your health care spending by providing you with tax-advantaged funds for use on medical expenses, including deductibles and cost sharing. These plans offer a very comprehensive level of benefits, including either 90% or 100% coverage after deductible on most health care such as doctor’s office visits, prescription drugs, inpatient and outpatient hospital care and surgery. Before your deductible has been reached, you can receive preventive services for no cost with a preferred network provider. These plans are ideal for those who wish to manage their health care costs, save for the future, and wants access to as many services as possible.
Blue Cross Blue Shield of Illinois
- SelectBlue Premier plans from BCBS of Illinois provide members with two network options and three plan types. You can choose between SelectBlue, SelectBlue Advantage and BlueChoice, which offer deductibles ranging from $0 – $5,000. Immediately when your plan starts, you can receive non-preventive care physician services (such as a doctor’s office visit) for a copay of either $20 or $30, depending on your plan. Generic prescription drugs are available for a $10 copay, and outpatient emergency services are $75. These plans cover either 80% or 100% of your major medical expenses, including surgery, inpatient hospital stays, outpatient services, home health care and urgent care. Preventive care is covered at 100%, whether you use the PPO network or the cost-efficient BlueChoice network.
- BlueValue plans also give you access to either the PPO (BlueValue and BlueValue Advantage plans) or BlueChoice (Blue Choice Value plans) networks, for a lower monthly premium and a more basic set of benefits. These plans offer preventive care such as annual physicals, cancer screenings, pap tests, and vaccinations for no charge immediately when your plan becomes effective. The PPO network includes 90% of all doctors in Illinois, and over 200 hospitals in the state. Based on the plan you choose, you can receive 80% or 100% coverage on most health care services including hospitalization, surgery, physician and specialist visits, physical therapy and more. There is also optional maternity coverage available.
- BlueEdge Individual HSA plans have high deductibles and provide a wide array of medical services for no charge after you have met the deductible. These plans are optimized for use with a health savings account (HSA), with which you can save for retirement, or pay for qualified medical cost-sharing and deductibles. Preventive care is covered at 100% as soon as your plan starts, including well-child care, GYN exams and routine physicals. After you have met your deductible, most medical costs will be covered in full or at 80% by the plan, such as doctor’s office visits, specialist visits, hospital care, surgery, diagnostic testing (X-rays, lab work) and more. You have the choice between both PPO and BlueChoice networks, and additional benefits such as maternity and dental.
- Individual PPO plans have two coinsurance options, 80% or 100% for in-network providers, both of which cover 50% of costs out-of-network. These plans are offered in a range of deductibles, from $1,000 to $5,000 for individuals, and $2,000 to $10,000 for families. Both types give you a convenient copay for doctor’s office visits, $30 for non-specialist and $60 for specialists, as soon as your plan starts. These plans cover emergency care, urgency care, chiropractic, home health care, and inpatient and outpatient hospital services after your deductible has been met for the chosen amount of coinsurance. Also, prescription drugs of all tiers (as long as they are included int he formulary) are available for a copay as soon as your plan begins.
- QHDHP plans are high deductible PPO plans that give you the ability to open a health savings account (HSA) for ultimate control over your health care expenses. HSAs are tax-free, so you can pay for your deductible and coinsurance without an additional fee, and also receive an income tax break. These plans have a comprehensive set of benefits, including primary care doctor and specialist visits for a copay as soon as your plan starts. After your deductible is met, you can receive hospital care, X-rays, diagnostic services, emergency care, surgeries and more at no cost. Preventive care is covered in full immediately, including mammograms, physicals and well-child care.
- Copay plans from HumanaOne are available in three types: Enhanced Copay 80, Copay 80 and Copay 70. These plans provide a great deal of convenience when it comes to paying for health care expenses, with predictable copays on doctors office visits, prescription drugs and more. Non-preventive visits to a primary care physician are $35, and there is a $60 copay for urgent care and specialists. As soon as your plan starts, you can receive preventive care services (physicals, flu shots, cancer screenings, etc.) at no cost with a provider from HumanaOne’s network. Annual deductibles range from $1,000 to $5,000 for individuals in-network, and your percentage of cost-sharing is either 20% or 30% after deductible. After your deductible is met, you can receive emergency care, inpatient services and outpatient hospital care.
- 100% After Deductible plans are very comprehensive, as the name suggests, covering all of your medical expenses after deductible. These plans are available in Value, Enhanced HSA and HSA types, with a variety of high deductibles to fit your budget. Once you have reached your deductible, you can receive most medical care for no cost. A few of the services included are doctor’s office visits for illness or injury, inpatient hospitalization, outpatient care, lab work, surgery and emergency care. 100% After Deductible plans have additional benefit options such as dental, term life and supplemental accident, as well as incentive plans that give you rewards for being healthy. Preventive care is available from the start date of your plan, covered in full. The HSA plans are qualified for use with a health savings account for greater management abilities over your health care spending.
- Solaura Health Incentive Account plans are funded by the reward credits received from living a healthy lifestyle. Through this plan, members can pay for certain health care costs with the money they earn from completing a health assessment, taking part in UniCare’s Health Management Program, tobacco cessation and weight management programs. These plans cover preventive care at 100% as soon as your plan begins, including immunizations, well-child care, GYN exams, routine physicals and more. Once you have used up the money in your HIA, you pay an out-of-pocket cost called a bridge until you meet your annual deductible. After meeting your deductible, all major medical expenses are covered at 100%.
- Solaura Health Savings Account plans have a deductible of $3,000 for individuals and $6,000 for families and can be used in conjunction with a health savings account to help pay for cost sharing, or be saved for the future. These plans cover 80% of all medical expenses once you have reached the deductible amount when using in-network providers, and 60% with out-of-network providers. The out-of-pocket maximum for individuals is $5,000 for individual and $10,000 for families per year. Preventive care such as well baby and well child care, immunizations, breast, prostate and colorectal cancer screenings and contraceptive management are available for no cost with your HSA plan.
- Copay plans are convenient and easy to use, with set prices for primary care and specialist visits, as well as prescription medications. These plans have higher premiums than other plans, but once you meet the deductible, your plans covers most medical services in full. Such services include emergency care, inpatient hospital stays, outpatient services like surgery, lab work, X-rays and tests, mental health care and physical therapy. As soon as your plan becomes active, preventive services are no cost to you and your dependents.
- High Deductible plans are available with a variety of deductibles and several different plan types, including Plan 100, Plan 80 and Saver 80. If you choose Plan 100, the plan will cover 100% of your medical expenses after deductible, including emergency room care, diagnostic work, inpatient hospital care and outpatient services. Plan 80 and Saver 80 require you pay 20% coinsurance on such services once your deductible has been met. These plans cover preventive care at 100% with an in-network provider, and is available at any time before meeting the deductible.
- Health Savings Account plans have multiple high deductibles to choose from, and can be paired with a health savings account for greater health care cost management. These plans are available with either 100% or 70/30 coverage after meeting the deductible on a broad range of medical services. Such services include doctor’s office visits, prescription drugs, inpatient hospital care, outpatient services, surgery, lab work, X-rays and care for several serious physical injuries and disorders. Preventive care is available from the day your plan starts at no cost to you. Deductibles start at $1,250 for individuals and $2,500 for families with HSA 70 plans, and $2,500 for individuals and $5,000 for families with HSA 100 plans.
Public Health Options
Illinois has an array of public health care solutions, funded by the state for many different needs and groups of individuals. Residents who have a low-income, are seeking free family planning services, or have medical needs are provided with access to health care coverage, prevention services, immunizations, and an assortment of programs to help improve overall health. Medicaid is a huge part of the state-funded health care system, and there are many other types of help in addition to this program. The Illinois Department of Human Services offers state-funded care for developmental and physical disabilities, mental health and addiction, children, nutrition, pregnant women and more. For a full list of services administered by the DHS, visit their site. Below is a collection of some of the most frequently used and important public health programs for residents of Illinois.
- Medical Assistance/Medicaid: health care coverage for Illinoisians with low-income, disabilities, children, and those who are pregnant or have high medical bills. For more about eligibility for Medical Assistance programs, locate Illinois on our Medicaid Eligibility by State page.
- Illinois Comprehensive Health Insurance Plan: medical coverage for high risk individuals who live in Illinois, in a variety of plans including Medicare, HIPAA and a PPO plan.
- All Kids: medical assistance for children in families of any income in Illinois, including doctor’s office visits, dental care, prescription drugs, hospitalization and more.
- FamilyCare: health care coverage for parents and caretaker relatives living with children under 18, which covers doctor’s visits, vision, dental, hospital care and are often used with All Kids.
- Health Benefits for Workers with Disabilities: full Medicaid benefits for individuals with disabilities who want to work in Illinois.
Health Insurance Laws
In the state of Illinois, health insurance is regulated in certain areas for the protection of the insured and the insurance company. Pre-existing conditions are defined by insurance companies for conditions for which a person either has or could have sought medical advice, treatment or care. Once an individual is determined by the insurer as having a pre-existing condition, the insurer is legally allowed to deny them a plan or increase premiums based on risk. If the individual is accepted for coverage, health insurance companies are permitted to not pay for care related to that condition by giving an exclusion period of up to 24 months. The insurer is also allowed the right to use elimination riders, which excuses the insurer from ever paying for treatment of the pre-existing condition.
The Affordable Care Act is changing the way insurance companies handle pre-existing conditions, as they will no longer be able to legally reject anyone for a policy based on health as of 2014. Insurers will also not be permitted to issue exclusion periods or elimination riders, therefore offering an equal level of care to all individuals. Despite the level of risk, private insurance companies will be required to accept all adults and charge them no more than a healthy adult for a plan.
Until the provision for pre-existing conditions and equal availability of coverage is effective in 2014, high-risk individuals can join high risk pools (see Illinois Comprehensive Health Insurance Plan above), and those with pre-existing conditions can apply for a Pre-Existing Condition Insurance Plan (PCIP). Like plans on the private market, PCIP plans have a monthly premium to pay for a set of essential benefits. Illinois’ PCIP plan is state-funded, and is well organized for delivering quality health care to individuals who have been charged too much or rejected for a plan by health insurance companies.
Health insurance companies in Illinois follow the laws of HIPAA, which includes the guaranteed renewability provision. This provision requires insurers to offer to renew an individual’s plan for another year when their annual term has ended. The same law also protects the right of the policy-holder to keep their plan, regardless of becoming sick or coming down with a condition during the course of the year. Guaranteed renewal is only applicable to those individuals who are responsible with their health plan payments, who do not violate their policy or commit fraud. HIPAA laws also protect the transfer of information from providers to health insurance companies, and vice versa, ensuring the individual is aware of the information being used.