Below is my understanding of general health insurance options. However, health insurance is outside my area of legal concentration. I encourage you to confirm this information with your health insurance agent, navigator and/or attorney.
The Affordable Care Act (ACA), often referred to as Obama Care, is a law, not a health insurance plan. It affects insurance plans offered by private companies, as well as free insurance provided by the states known as Medicaid (medical card or Public Aid). It also provides subsidies for those with too much household income to qualify for Medicaid, but not enough income to afford a private plan.
For anyone under age 65 who has not yet been entitled to Social Security Disability Insurance for two years, there are two broad categories of health insurance available: Medicaid and private insurance.
The ACA provides for Medicaid expansion to everyone below a certain threshold of assets and income. Prior to this expansion, states like Illinois had additional eligibility requirements, such as being blind, disabled, pregnant, or with minor children in the home. Now, needy Illinois adults who are able-bodied and childless also can obtain Medicaid.
Some states, such as Wisconsin, chose to opt out of Medicaid expansion. As a result, many childless, able-bodied or not-yet-proven disabled Wisconsin adults are unable to access health insurance. Because the ACA contemplated more people obtaining insurance, it discontinued much of the grant money provided to hospitals caring for the uninsured. In states like Wisconsin, the loss of such grant money, while continuing to have a large number of uninsured, has likely kept private health insurance costs high.
The best way to apply for Medicaid is through your state’s agency. [Health Insurance Resources page]
Private insurance companies like Blue Cross Blue Shield, Aetna and others, continue to offer health insurance plans. If you continue a plan that was in effect before January 1, 2014, it likely will stay on the annual rate hike schedule as before. However, if you obtain a new plan, it is subject to the ACA rules.
Perhaps the biggest advantage provided by the new plans is their inability to discriminate against those with pre-existing conditions. That is, a pre-existing condition cannot be used to deny coverage or to increase the premium. In fact, any given plan provides the same premium rate to all individuals of the same age, gender and smoking status. If you had a pre-existing condition in the past, and were only able to obtain Illinois Comprehensive Health Insurance Plan (I-CHIP), a new plan will likely cost less than your old plan.
The ACA provides subsidies to help those with modest incomes pay for private insurance. The best way to obtain such a subsidy is to apply for a health insurance plan on one of the government health insurance exchanges. You can do this online at the state or federal exchanges [Health Insurance Resources page]. If you would like help choosing a plan, a health insurance agent or navigator can help you for free [Health Insurance Resources page].
If your household income is too high to qualify for a subsidy, there is no need to use an online exchange to apply for insurance. You may apply as you did before 2014, directly with a health insurance company, or with the help of an agent [Health Insurance Resources page].
To request advice from a social security lawyer, please call 815-337-4540.