Located in the heart of the country, Illinois is also middle of the pack when it comes to healthcare. According to US News, Illinois has the 27th best health insurance coverage in the country.
Health insurance options in Illinois
According to the Illinois Department of Insurance, you can get health insurance through multiple avenues:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Illinoisans get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 54% | ||
| Individual or family | 6% | ||
| Medicaid | 19% | ||
| Medicare | 13% | ||
| Military | 1% | ||
| Uninsured | 7% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Seven percent of Illinois residents are uninsured. That’s below the national average of nine percent. This is good news for policyholders. A high percentage of uninsured residents leads to higher rates for insured people.
Illinois health insurance companies
Illinois has several health insurance provider options. These companies offer both individual and family health care:
- Aetna
- Assurant
- BlueCross BlueShield of Illinois
- Ambetter
- Humana
Specific plan types depend on where in the state you live. Check each company's website to find more information.
Illinois health insurance costs and rate factors
Illinois residents spend an average of $8,262 on health insurance expenditures each year. That’s only a few hundred dollars more than the national average. What determines these costs? Prices differ depending on the person. Here are a few factors insurance companies consider:
Plan type
If you want more coverage, you're going to have to pay more in monthly premiums. Marketplace plans are sorted into metal tiers: bronze, silver, gold, and platinum.
So how much should you expect to pay for health insurance? These are the average costs for each plan type for a middle-aged Illinois resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $361 | $435 | $499 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
In Illinois, jumping from a bronze plan to a gold plan will cost you around 53 percent more. Bronze plans cover only 60 percent of health care costs, whereas gold plans cover 80 percent of costs.
The lowest level of coverage is the catastrophic plan. It’s available to people under 30 or with certain exemptions. Though the catastrophic plan has low monthly premiums, it also comes with a $8,150 deductible. Buying a bronze or silver plan instead may save you money when you need to use your health insurance.
Body mass index
Insurers commonly look at your BMI while pricing your policy. This is because, statistically, a high BMI leads to a number of serious diseases. A high BMI increases your risk-level to your insurer, spiking your insurance costs.
In 2017, Illinois had a 31.8 percent obesity rate, the 24th highest rate in the country. Out of the many Illinois residents who used QuoteWizard to compare health insurance plans, 33 percent have a BMI in the obese range.
Tobacco use
Due to the health risks from smoking, smokers tend to pay more for health insurance. About 15.5 percent of Illinois residents smoke according to a 2018 study. The state has the 15th lowest ranking in the country for tobacco use.
Age
According to HealthCare.gov, older people pay up to three times more for health insurance than young people do. IL residents who use QuoteWizard to shop for health insurance are, on average, 40 years old.
Location
The laws and regulations surrounding health insurance vary state to state. What does that mean? Your location plays a large role in how much you'll pay for health insurance.
Health insurance rates are generally community rated. That means if your neighbor files a lot of claims, your premiums could rise.
Living in a healthier state helps you get lower premiums. Illinois is ranked as the 27th healthiest state according to America's Health Rankings.
Illinois health insurance laws
Due to the Affordable Care Act, insurance companies can't use these factors when pricing your policy:
- Pre-existing conditions: After the enactment of the ACA, insurance companies can no longer charge more in premiums to people with pre-existing conditions. Those with pre-existing conditions used to pay considerably more for health insurance – if they could get any coverage at all.
- Gender: A study by Health Services Research found that women historically pay more for health care. However, the ACA mandates that insurance companies can't charge men and women different prices for the same plan.
- Insurance and medical history: Insurance companies used to analyze medical history and past insurance coverage before the ACA. Now, people with previous medical problems or lapses in insurance pay the same for insurance as those without.
Marketplace plans have out-of-pocket maximum limits. The 2018 out-of-pocket maximum is $8,150 for individual plans and $16,300 for family plans.
Illinois state law requires health insurance companies to offer at least some coverage for these services:
- Infertility
- Post-mastectomy care
- Alcoholism and substance abuse
- Cancer treatment- prescription drugs
- Breast exams
- Diabetes self-management
- Cancer clinical trials
- Organ transplants
There are additional services that companies must cover. Check out the full list and what limits apply here.
Medicare and Medicaid in Illinois
Medicare and Medicaid are both government programs that offer health care to many Americans. Medicare covers seniors while Medicaid assists low-income families and children.
Medicare
Medicare is a government-funded program that Illinois residents over 65 years can access. Medicare offers numerous options including parts A, B, C, D, and supplemental coverage plans. Illinois also offers qualifying residents a Medicare savings program based on these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Illinois Medicaid is an option for low-income families and children. These are the program requirements for Illinois households:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $17,609 |
| 2 | $23,792 |
| 3 | $29,974 |
| 4 | $36,156 |
| 5 | $42,339 |
| 6 | $48,521 |
| 7 | $54,704 |
| 8 | $60,886 |
Illinois Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Anne Melissa Dowling
- Insurance Hotline:
- (217) 782 – 4515
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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