Illinois Health Insurance Exchange
Illinois operates a partnership exchange with the federal government; the state runs Get Covered Illinois, as well as a website, in-person assistance, and a help desk, and the federal government provides the IT platform — Healthcare.gov — that Illinois people use to enroll in coverage or make changes to their plan.
Starting in August 2015, the Illinois Department of Insurance started administering Get Covered Illinois, and 15 staff positions were removed in the move to “streamline program processes, improve efficiency, and align services resulting in increased access to health coverage for Illinoisans.”
To get Covered Illinois has a small team at this point, and the Trump Administration announced in mid-2017 that they would no longer fund community enrollment assistance programs in 18 cities across the United States, including Chicago. The federal government also radically reduced the advertising budget for HealthCare.gov. All of this has left consumer advocates in Illinois scrambling to attempt to fill in the gaps and ensure that there is enough outreach and enrollment assistance available to customers.
Bright Health Will Start Offering Individual Market Plans in Chicago Area In 2021
Open enrollment for 2021 health plans will start November 1, 2020, in Illinois, and continue through December 15, 2020. Outside of that window, people with qualifying events can enroll or make changes to their coverage for 2020.
For 2021, Bright Health plans to start providing individual market plans in the Chicago area (Bright Health presently only offers Medicare Advantage plans in Illinois). Insurers had to file proposed rates and health insurance plans for 2021 in late May, but they are not publicly available as of July.
Illinois Needs More Robust Coverage of Mammograms on State-Regulated Plans as of 2020
Illinois enacted legislation (SB162) in 2019 to expand on the scope of mammography coverage that must be provided at no cost to people enrolled in state-regulated plans (self-insured group plans are regulated under federal law rather than state law, so state regulations don’t apply them; most very large employers self-insure rather than buying commercial health insurance).
The new regulation took effect in January 2020. It necessitates health plans to go beyond the federal preventive care mandate for mammography, which only necessitates insurers to cover—with no cost-sharing for the patient—screening mammograms (that is, when there is no cause for concern, and the patient is merely having a routine mammogram).
Under the new act in Illinois, insurers have to continue to cover screening mammograms fully, but also have to cover breast ultrasounds and MRIs for women with dense breast tissue or women whose physician believes the ultrasound or MRI is medically necessary. Additionally, insurers will have to fully cover (with no cost-sharing) diagnostic mammograms, which are utilized when an abnormality is detected in the breast, either during a screening mammogram or otherwise.
The Illinois law does comprise an exception for plans that are HSA-qualified and would lose their HSA-qualified status if they provided pre-deductible coverage for anything beyond what the federal government considers preventive care. And as is the case with any insurance mandates, it only applies to state-regulated health insurance plans (i.e., plans that are not self-insured).
No Longer any Insurers Providing SHOP Plans in Illinois as of 2020(Small Group Plans Still Available from Insurers and Brokers)
BCBS of Illinois has announced that they would exit the small business (SHOP) exchange at the end of 2017, but would continue to provide exchange plans for individuals; Illinois had a total of 738 small businesses enrolled in SHOP plans as of early 2017, covering 3,512 people.
Health Alliance continued to provide SHOP plans for small businesses in some parts of Illinois and was the only insurer doing so in 2019. But as of 2020, Health Alliance is no longer providing SHOP plans. So, as is the case in most other states, small business plans are only available for businesses to buy directly from insurers or with the help of a broker; there are no longer any SHOP plans for sale.
Resources and References: