Care. Simplified.

Health care coverage has changed over the past few years. This guide from Blue Cross and Blue Shield of Illinois (BCBSIL) can help cut through the confusion and answer many of your questions. It's Care. Simplified.

Understanding the Law

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    The Basics of Health Care Coverage

The Basics

  • Almost all Americans are now required to have health care coverage.

  • Those who don't may receive tax penalties that continue to grow each year.

  • Everyone who qualifies can get insurance, regardless of age, gender or pre-existing health conditions.

  • Many people will get help paying for coverage. In 2016, 78% of all enrollees on the Health Insurance Marketplace in Illinois qualified for financial assistance.

Nearly All Plans Have These Essential Health Benefits

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  • Prescription Drugs
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    Hospitalization Services
  • Maternity and Newborn Care
  • Rehabilitative Services and Devices
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    Preventive and Wellness Services
  • Chronic Disease Management
  • Pediatric Services

Don't Wait

Dec
15
  • The open enrollment period to sign up for health care coverage starts on November 1, 2016.
  • You'll have to sign up by December 15, 2016 to have coverage that starts on January 1, 2017.
Jan
31
  • You'll have to sign up for coverage by January 31, 2017 to avoid having to pay a tax penalty.

Terms to Know


  • Exchange:
    Also called the Health Insurance Marketplace in Illinois, it's where you can shop for, compare and buy health care coverage each year during open enrollment. It can be accessed online or over the phone. It compares various health plans being offered in your area.
  • Individual mandate:
    This is the part of the health care law that requires most Americans to get and maintain health care coverage.
  • Tax credits:
    To help people better afford health care coverage, those eligible will receive tax credits to help lower monthly premium costs. Tax credits are sometimes called the APTC, "advanced premium tax credit," or premium tax credit.
  • Subsidy:
    Financial help from the government for individuals and families with incomes up to four times the federal poverty level to help buy coverage through the Health Insurance Marketplace. This comes in the form of a tax credit.

What it Costs

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Stay Informed
  • 1:19

    How to Save on Health Care Coverage

  • 1:22

    Understanding the Affordable Care Act (ACA) Tax Penalties

It's not worth it to go without health care coverage. If you don't get coverage you face the possibility of:

  • Having to pay a growing tax penalty of $695 or 2.5% of your income, whichever is higher. For example, if you earn $40,000, you could have to pay a $1,000 penalty. And the penalty amount grows every year.
  • Unexpected medical costs if you get sick or injured. It could impact personal finances for years to come.

Families should expect to spend between 6-10% of their annual income on health care.

Do you qualify for lower costs?

78%
of enrollees qualify for financial assistance

In 2016, 78% of all enrollees on the Health Insurance Marketplace in Illinois qualified for financial assistance to help pay for their coverage.

Understanding the real costs of your health care can be confusing. To help understand if you qualify for lower health care coverage costs, our estimator factors in your income and family size to determine if you're eligible for federal subsidies.

Estimated
Annual Salary

Number of people
in your family

YesNo

Could you qualify for lower premiums on a Marketplace health plan?

Great news! You may qualify for a health care coverage subsidy. Use our Tax Credit Estimator to find out how much you can receive.

It looks like you might not qualify for a health plan subsidy. However, you can use our Tax Credit Estimator or healthcare.gov to get more information.

Tax Credit
Estimator
$1,250

Based on your income, your possible tax penalty may be:

See if you qualify for federal assistance with our tax credit estimator.

Terms to Know


  • Coinsurance:
    Your share of the costs for a covered health care service. It's usually a percentage of an eligible expense.
  • Copay:
    A fixed amount you pay for a covered health care service, usually when you get the service.
  • Deductible:
    The amount you owe for covered health care services before your health plan starts to pay.
  • Premium:
    The amount that must be paid for your health care coverage plan. It is usually paid on a monthly basis.
  • Out-of-pocket costs (OOPC):
    Anything you have to pay in addition to your monthly premium is considered an out-of-pocket cost. Your copay and deductible are out-of-pocket costs, but you know what those are up front. Coinsurance may apply for some services. If you use a doctor, hospital or pharmacy that isn't in the HMO network, you can have a lot of unexpected out-of-pocket costs.
  • Out-of-pocket maximum (OOPM):
    Your plan will also have a maximum out-of-pocket amount for care when you use providers in your network. This is the most you will pay out-of-pocket each year, which helps protect you in case of serious or expensive medical conditions.

Getting Started

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What You'll Need to Sign Up

  • Proof of
    U.S. Citizenship or Legal Residency
  • Proof of
    Illinois Residency
  • Copy of
    Tax Returns
  • Income of
    Family Members
  • Method of
    Payment

How Much Coverage Do You Need

Just like any big purchase, you should be prepared before buying health care coverage:

  • Do you expect you and your family will need a lot of care in 2017?
  • How often do you go to a doctor?
  • Are you taking prescription drugs?
  • Are you planning to add to your family?
  • Do you also need dental coverage?

All should figure into how much coverage you might need.

Dates to Remember

  • Nov
    1
    November 1, 2016
    Open enrollment for 2017 plans starts
  • Dec
    15
    December 15, 2016
    Last day to sign up for coverage that starts January 1, 2017
  • Jan
    15
    January 15, 2017
    Last day to sign up for coverage that starts February 1, 2017
  • Jan
    31
    January 31, 2017
    Open enrollment ends

Terms to Know


  • In-network:
    Using the doctors and other health care providers that are in the plan's network.
  • PCP:
    Your primary care physician who coordinates care, with a focus on staying healthy and preventing disease.
  • POS:
    Point of Service (POS) benefits provide some coverage when you use a provider not in the plan's network, but at a higher out-of-pocket cost. You choose if you stay in network or to go outside of the plan's network and pay more. Not all plans offer POS benefits.

Care. Simplified.

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  • 1:08

    Managing Your Health Care with HMO's

  • 0:56

    Simpler Care with a Primary Care Physician

HMOs: Care. Simplified.

Health insurers provide access to health care benefits. Managed care through an HMO is meant to make health care simple.

HMO plans are priced based on a network of doctors and hospitals in your area. This results in lower premiums than plans that have larger networks.

Need help understanding an HMO? This page can help.


What You Get With an HMO

  • Value
    HMOs generally have lower monthly premiums than other types of plans.
  • Personal care
    This means you'll have a doctor who knows your health history and will coordinate your care within your plan's network to help you access the care and wellness programs suited to your needs.
  • Confidence
    Your PCP will help you get the care you need when you need it and directs you where you need to go. Your insurer will guide you, as well, with information about the provider network and care managers to help when you have a serious health issue.

Find the Right Plan

  • Bronze

    Lowest monthly costs, but higher out-of-pocket expenses

    Generally 60% paid by the
    plan and 40% paid by you

  • Silver

    Mid-range monthly costs and out-of-pocket expenses

    Generally 70% paid by the
    plan and 30% paid by you

  • Gold

    Highest monthly costs, but lowest out-of-pocket expenses

    Generally 80% paid by the
    plan and 20% paid by you

  • Platinum

    Highest monthly costs, but lowest out-of-pocket expenses

    Generally 90% paid by the
    plan and 10% paid by you

Terms to Know


  • HMO:
    Health Maintenance Organization (HMO), insurance plans usually offer lower premiums. Your primary care physician (PCP) manages your care, makes referrals and focuses on preventing disease, not just treating it.
  • Out-of-pocket-costs (OOPC):
    Anything you have to pay in addition to your monthly premium is considered an out-of-pocket cost. Your copay and deductible are out-of-pocket costs, but you know what those are up front. Coinsurance may apply for some services. If you use a doctor, hospital or pharmacy that isn’t in the HMO network, you may have a lot of unexpected out-of-pocket costs.
  • Out-of-pocket maximum (OOPM):
    Your plan will also have a maximum out-of-pocket amount for care when you use providers in the network. This is the most you will pay out-of-pocket each year, which helps protect you in case of serious or expensive medical conditions.
  • In-network:
    Using the doctors and other health care providers that are in the plan’s network.
  • PCP:
    PCP: Your primary care physician. With an HMO, you partner with a trusted primary care physician, with a focus on staying healthy and preventing disease. Your PCP coordinates all your medical care, including hospital admissions and referrals to specialists.
  • POS:
    Point of Service (POS) benefits provide some coverage when you use a provider not in an HMO plan’s network, but at a higher out-of-pocket cost. You choose if you stay in network or go outside of the plan’s network and pay more. Not all HMO plans offer POS benefits.