We can help you choose among health care plans, determine your eligibility or apply for a plan.
Call our hotline at (773) 751-7062 for help with health care plans or visit us at one of our locations. Click here for days and times we can meet with you in person. You do not have to be our patient in order to receive services from our insurance counselors.
Affordable Care Act / Obamacare
The Affordable Care Act (ACA), also known as Obamacare, mandates that most lawfully present U.S. residents have minimum essential healthcare coverage or pay the shared responsibility payment (penalty) for not having health insurance for part or all of the year.
Health insurance can be obtained through Medicaid, Medicare, private insurance, employer-based coverage, or through the ACA Marketplace. If you already have one of these types of health plans, there is no need to get another plan. Some individuals are not subject to the ACA mandate. For instance, undocumented individuals and those under Deferred Action for Childhood Arrivals (DACA) and victims of domestic violence are not required to have health care coverage. They are not liable for the shared responsibility payment when they file their income taxes.They will, however, need to request an exemption prior to or upon filing income taxes depending on the type of exemption requested. You can also call our hotline for more information on exemptions.
The ACA Health Insurance Marketplace provides a place where consumers can purchase health care plans that offer minimum essential coverage at a subsidized cost depending on household size and income. In addition to subsidies, some individuals may qualify for cost-sharing reductions which lower their deductibles, co-payments and maximum out-of-pocket costs.
Citizens and lawfully present individuals who are not eligible for Medicaid or another type of minimum essential coverage may be eligible for a health care plan through the Marketplace. This would include, among others, those with green cards for less than five years, those under Temporary Protected Status (TPS), U visa, work visa, or student visa.
Healthcare coverage cannot be denied to an individual due to a pre-existing condition.
The Marketplace has an open enrollment period which will start November 1, 2017 and end December 15, 2017.
Open enrollment is the period of time when an individual can sign up for healthcare coverage for the first time or change to a different plan. Outside of open enrollment, individuals may sign up for a Marketplace plan within 60 days of certain life changes, such as:
- Obtaining lawful immigration status
- Loss of health insurance
- Permanent move to a new area*
Medicaid is, in general, free health care coverage available to US citizens and qualified immigrants. There are several health care plans available within Medicaid: All Kids, Moms & Babies, Adult ACA, etc. Eligibility criteria vary depending on the program. Enrollment is open all year if you qualify.
Adult ACA Medicaid– In Illinois, Medicaid was expanded to cover 19 to 64 year-olds who previously didn’t have access to health insurance. To qualify, an individual must meet certain immigration and income requirements. Adults must be US citizens, legal permanent residents for at least five years, victims of trafficking, have entered the US as refugees or asylees, currently under the Violence Against Women Act (VAWA), or special Iraqi/Afghan immigrants. In addition, a single person with no dependents must earn less than $1,387/month to qualify for this program. The income threshold varies depending on the individual’s family size.
All Kids and Moms & Babies Moms and Babies and All Kids is available to children under 19 and pregnant women regardless of immigration status. These two programs have higher income eligibility thresholds than Adult Medicaid. For instance, a single pregnant woman can make up to $2,883/month and qualify for full coverage. For a child to qualify for All Kids, a family of four can earn up to $6,519/month. There might be small fees (premiums, copays, etc.) for those on the higher end of this income scale.
To apply for Medicaid you will need the following:
- Picture ID
- Social Security card (if available)
- Immigration documents (if available)
- Proof of address
- Proof of income for the past 30 days, if any
- Most recent income tax return (if available)
Once an individual is approved for Medicaid, a managed care plan must be selected. A managed care plan dictates the network of providers someone has access to. See here for a list of Medicaid Managed Care Plans that Heartland Health Centers accepts.
Medicaid Presumptive Eligibility Coverage (MPE) MPE insurance is a type of temporary outpatient insurance for pregnant women while their Moms & Babies application is being processed. MPE coverage is awarded to individuals who have a pregnancy verification letter, attest to living in Illinois, and meet certain income criteria. Click here for days and times we can meet with you in person to assist you in requesting an MPE card.
If you are working for an employer that offers a health care plan, you generally don’t qualify for subsidies/discounts through the Marketplace unless the employee-only coverage is more than 9.69% of your estimated household income for the current year. You might also qualify for the free medical card (Medicaid) if you meet certain income guidelines. Medicaid would then become your secondary insurance and would cover what your private insurance doesn’t cover.