Individuals &

More than 1.5 million people in Illinois who were uninsured in 2013 are now are guaranteed access to affordable, quality health insurance coverage. Consumers now need to understand how to navigate the healthcare system and the new health insurance marketplace in order to access coverage, and make use of the healthcare protections and benefits now available.


 Q:   Should I use my past year's income to determine premium tax credits?

 A:   No- you should estimate the amount of money you will make next year. For the 2015 coverage year, the actual premium tax credit will be based on your reported income in your 2016 tax return. If you underestimate how much you will make, you may owe money. This question and answer from the IRS explains more on how to claim your premium tax credit.

 Q:   Why should I avoid auto-enrolling in the same health plan?

 A:   Even if your current plan is still being offered by an insurance company for the 2015 enrollment period, important elements, including your monthly premiums and the hospitals and doctors that are in network, could have changed. This means that consumers who choose to auto-enroll could encounter higher medical costs and a different network that does not include doctors they had been seeing. Auto-enrolling can be particularly harmful for consumers receiving premium tax credits or subsidies that help pay for insurance. When consumers auto-enroll, the marketplace will apply the same premium tax credit amount toward 2015 coverage. Consumers whose income has not changed would actually be eligible to receive a higher premium tax credit. This is because their income would represent a smaller percentage of the federal poverty line, which increases annually to account for inflation. Consumers should return the marketplace, update their income information, and compare options to confirm that their current plan is still the best fit. The Center on Budget and Policy Priorities has provided an informative fact sheet that explains the downside of auto-enrollment in more detail.

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What to Know About Provider Networks

This December 2014 fact sheet from the Illinois Department of Insurance explains how consumers can know the strength of their insurance plan’s doctor and hospital network. The fact sheet details how consumers can verify that a provider is network, what to do if a type of provider is not included in a plan, and what sufficiency standards all plans are required to follow.

Beware of Out-of-Network Benefits

This December 2014 fact sheet from the Illinois Department of Insurance describes how to read an insurance plan’s summary of benefits section for the costs of out-of-network care. The information can help consumers avoid paying unexpectedly high medical bills.

How 21-Year Olds Can Avoid Premium Hikes

Returning to the marketplace can mitigate cost increases due to aging. In a November 2014 blog post, Kaiser Health News explains how 21-year-olds can benefit from re-applying for coverage during the 2015 enrollment period.

Choosing Marketplace or Workplace Plans

Getting health insurance through the marketplace could be a better deal for individuals and families currently covered through their job. This October 2014 fact sheet from Families USA describes what factors to consider when making the decision. The fact sheet outlines who qualifies for marketplace plans and what types of financial assistance individuals and families could receive.

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