Last Updated on October 5, 2024 by Edward Harris
Affordable health insurance Exchange plans in Illinois for single persons, families, Seniors, and businesses is available. Many low-cost medical plans are now offered through Open Enrollment, and we help you find the policies that are within your budget and flexible to meet your needs. Our three decades of knowledge allow us to customize Obamacare Marketplace and Senior Medicare coverage, and make purchasing a plan simple and quick.
2025 low-cost options are also available if you apply for coverage after Open Enrollment ends. Cheap temporary contracts are typically offered along with separate enrollment periods (SEP) if you have a baby, lose existing group or private coverage, move to a different service area, reach age 26, or several other approved exceptions. These “qualifying life events” are offered at anytime of the year, regardless whether the Open Enrollment period has ended or is still active. Financial subsidies are applicable, if income qualifications are met.
Additional information regarding missing an OE period is listed below. Several approved exceptions allow you to choose any available plan, and receive federal subsidies, if you meet qualification guidelines. Our comparison guide helps you understand your options. “Get Covered Illinois” is a partnership Exchange with the federal government, and it provides assistance and a separate help desk. The maximum out-of-pocket expenses limit is $9,200 (individual) and $18,400 (family) for 2025.
Senior Illinois Medigap plans are available to most persons that have reached age 65. Medicare Supplement and “Advantage” contracts often lower potential out-of-pocket costs that are not covered by standardized contracts. Prescription drug coverage is available through Part D plans or many Advantage contracts. The Medicare Open Enrollment period begins on October 15th and concludes on December 7th. If you reach age 65 after the OE period, and are Medicare-eligible, a separate period is created.
Where Do I Find Rates?
We make it easy for you to view prices online. The quote box at the top of the page begins the quick and simple process of viewing rates. We typically show premiums in the monthly mode, although alternative billing is available with many companies. Almost instantly, you can compare prices for all types of plans. We customize recommendations so they provide the most cost-effective options.
Catastrophic, Copay, Student, HSA, Self-employed and Temporary options are available. Small business owners can also research and compare the best options through the SHOP portion of the Exchange, which is available at any time throughout the year. You can terminate your own policy at any time. NOTE: Short-term plans are not eligible for federal subsidies and also do not satisfy the legal requirement of maintaining qualified coverage.
Open Enrollment begins every November, so pre-existing conditions are covered and you can not be denied for medical underwriting reasons. More than 120 plans (all qualified) are available for individuals and businesses. Four “Metal” options are offered in the Marketplace along with a catastrophic policy for persons under age 30, or older adults that have no inexpensive contracts that they are able to buy. Proof of “financial hardship” may be required in these circumstances.
Illinois Health Insurance Proposed Rate Changes For 2025 (Under 65)
Aetna Health – 7.69% increase (HMO- IVL Exchange)
Aetna Life – 2.24% increase (HMO- IVL Exchange)
BCBS Of Illinois – 6.63% increase (Blue Precision HMO and BlueChoice Preferred)
Celtic – 4.05% decrease (Ambetter and Ambetter + Adult Dental and Vision)
Cigna – 6.35% increase (IL IND HMO)
Health Alliance – 10.05% increase (Individual HMO and Individual Point of Service)
MercyCare – 5.37% increase (MercyCare HMO)
Molina – 1.57% increase (Molina Healthcare and Molina Healthcare and Vision)
Oscar – 11.74% increase (Oscar Individual HMO and Oscar Individual HMO 2)
Quartz – 9.91% increase (Individual Product One and Individual Product Two)
What Happens If I Miss Marketplace Open Enrollment In Illinois?
You still will probably be able to obtain affordable medical coverage. A common scenario is that you qualify for a “life event” that allows you to participate in a Special Enrollment Period (SEP). For example, the following would be considered approved “life events”: Marriage, having a baby (only the baby qualifies), becoming a US citizen, relocating to a different service area, substantial change in income, getting out of prison, adoption or foster care, and becoming part of a recognized Indian Tribe.
Marriage Qualifies As An SEP (Special Enrollment Period)
Qualifying for any of these situations will not only give you 60 days to compare and enroll, but you also become eligible for federal subsidies. For income verification purposes, your current-year projection should be used. It is possible that a substantial reduction in household income may allow you to immediately become eligible for Medicaid. If you become eligible for Medicare, you can consider a Medigap plan.
What About The Federal Tax Subsidy?
Part of past legislation requires federal subsidies be provided to individuals and families based on the Federal Poverty Level guidelines, your age and number of qualified dependents. Listed below are some examples of the estimated amount of subsidies you could potentially receive. Dollars shown are monthly and we used the Chicago area (Cook County) for rating purposes. Other counties may result in higher or lower subsidies.
$328 – Family of one with $24,000 total income. Age 28 with no children.
$364 – Family of one with $42,000 total income. Age 50 with no children.
$759 – Family of two with $36,000 total income. Husband and wife ages 40, with no children.
$308 – Family of two with $33,000 total income. Age 27 with one child covered by CHIP.
$1,388 – Family of two with $60,000 total income. Husband and wife ages 60 with no children.
$1,508 – Family of three with $80,000 total income. Husband and wife ages 60 with one child.
$770 – Family of four with $50,000 total income. Husband and wife ages 40 with two children covered by CHIP.
These subsidies are in the form of instant credits to help pay your health insurance premium in Illinois. You also may be able to buy a health insurance plan with a zero deductible. These contracts will minimize costs for many major claims, and are often ideal if surgery is scheduled.
However, it may have to be a Platinum, Silver or Gold plan to have no deductible, instead of a lower-priced plan. Occasionally, HMO plans also offer no deductible. However, the “maximum out-of-pocket cost” must always be considered. Silver plans offer a “cost-sharing” feature that allows you to substantially reduce the deductible and out-of-pocket costs, depending on your income. The lower the income, the higher the “cost-sharing.”
For instance, a 45-year old that makes $35,000 per year, will qualify for a $4,200 yearly credit, or about 75% of the cheapest available Silver plan premiums. If that person is married with two children, and the household income is $75,000, the credit will be much more, although the children would be eligible for Illinois CHIP benefits.
If the household income exceeds the maximum allowed amounts, then no subsidy will be available. In that scenario, policies will be purchased at full price or a better “deal” may be available by not using the Exchange. It is possible premiums may actually be slightly lower by selecting a plan that does not include the 10 required essential benefits. However, a tax penalty will be imposed, pre-existing conditions may not be covered, and benefits may be limited.
Which Companies Offer Under age-65 Coverage In The State?
The 12 participating carriers in the state are Aetna Health, Aetna Life, Ambetter (Celtic), Blue Cross Blue Shield of Illinois, Cigna, Health Alliance Medical Plans, MercyCare, Quartz, Oscar, Molina, Medica, and UnitedHealthcare. Companies that previously offered private individual plans are Humana, Harken, Coventry, and Land of Lincoln Health. Additional carriers offer “short-term” coverage (maximum six-month duration) and “limited benefit” options. In 2025, additional carriers may offer private individual and family plans, depending upon possible changes in legislation. BCBS is the only carrier that offers coverage in all counties.
What Are the 13 Geographic Rating Areas?
Each service area is required to offer plans in a geographic area that includes a minimum of one county. Typically, several counties are included. Participating companies must ensure there are an acceptable number of available providers. If the entire area is not covered, an exception must be approved. The 13 areas are listed below:
Area 1 – Cook County
Area 2 – McHenry and Lake Counties
Area 3 – Kane and DuPage Counties
Area 4 – Will, Kendall, Kankakee, and Grundy Counties
Area 5 – Winnebago, Stephenson, Ogle, Lee, Jo Daviess, DeKalb, Carroll, and Boone Counties
Area 6 – Whiteside, Warren, Rock Island, Mercer, Henry, Henderson, Hancock, and Bureau Counties
Area 7 – Woodford, Tazewell, Stark, Putnam, Peoria, McDonough, Marshall, LaSalle, Knox, and Fulton Counties
Area 8 – Mclean, Livingston, and Dewitt Counties
Area 9 – Vermilion, Piatt, Iroquois, Ford, Edgar, Douglas, Cumberland, Coles, Clark, and Champaign Counties
Area 10 – Shelby, Scott, Schuyler, Sangamon, Pike, Moultrie, Morgan, Menard, Mason, Macon, Logan, Christian, Cass, Brown, and Adams Counties
Area 11 – Washington, Randolph, Montgomery, Macoupin, Jersey, Greene, Clinton, Calhoun, and Bond Counties
Area 12 – St. Clair, Monroe, and Madison Counties
Area 13 – Williamson, White, Wayne, Wabash, Union, Saline, Richland, Pulaski, Pope, Perry, Massac, Marion, Lawrence, Johnson, Jefferson, Jasper, Jackson, Hardin, Hamilton, Gallatin, Franklin, Fayette, Effingham, Edwards, Crawford, Clay, and Alexander
Note: For 2024, Aetna Life entered rating areas 1, 2, and 3, Celtic (Ambetter) entered rating area 11, MercyCare expanded to McHenry County, and Molina now offers in Kendall County.
Which Companies Offer Age-65 And Over (Senior) Coverage In The State?
Medicare Supplement, Advantage, and Part D Prescription Drug coverage is offered by many companies, including major carriers that don’t offer options to persons under age 65. A comprehensive list of carriers offering MedSup contracts is listed near the bottom of this page. Companies offering Advantage contracts include AARP/UnitedHealthcare, Aetna, BCBS Of Illinois, Cigna, Clear Spring, Devoted Illinois, Humana, Longevity Health Plan, Meridian, Molina, Provider Partners, UnitedHealthcare, Wellcare, and Zing.
The least expensive Part D drug prescription plans offered are: Wellcare Value Script, Wellcare Classic, SilverScript SmartSaver, Cigna Saver Rx, Cigna Secure Rx, Mutual Of Omaha Rx Essential, Blue Cross MedicareRx Choice, SilverScript Choice, Humana Walmart Value Rx, Humana Basic Rx, and AARP Medicare Rx Walgreens from UHC.
Safety and financial stability of each carrier is investigated by the Department of Insurance. In addition to financial and ratings information, you can also view proposed premium increases and the decision of the DOR regarding approving the rate increase.
Affordable Illinois Healthcare Is Available
How Much Does Illinois Health Insurance Cost? See Several Scenarios Below. Rates Are Monthly:
45 year-old residing in the Rockford area and Winnebago County, with household income of $36,000
$28 – Quartz Performance Bronze 1201-01 Value Tier
$29 – Quartz Performance Bronze1206-01Standard
$31 – BCBS Blue Precision Bronze HMO 701
$43 – Quartz Performance Bronze 1203-01 HSA
$43 – BCBS Blue Precision Bronze HMO 205
$52 – Quartz Performance Bronze 1204-01
30 year-old married couple with two children (4 persons) residing in the Peoria area and Peoria County, with household income of $97,000
$155 – BCBS Blue Precision Bronze HMO 701
$188 – BCBS Blue Choice Preferred Bronze PPO 701
$193 – BCBS Blue Precision Bronze HMO 205
$220 – Health Alliance 2024 POS HSA 7100 Elite Bronze
$229 – BCBS Blue Precision Bronze HMO 205
$243 – Health Alliance 2024 POS 7500 Elite Bronze
35 year-old married couple (2 persons) residing in the Chicago area and Cook County, with household income of $54,000
$15 – BCBS Blue FocusCare Bronze 209
$99 – Aetna Bronze S
$107 – Aetna Bronze 1
$121 – Oscar Bronze Classic Standard
$128 – Oscar Bronze Classic PCP Saver Plus Rx Copay
$134 – Ambetter Standard Expanded Bronze
40 year-old residing in the Springfield area and Sangamon County, with household income of $40,000
$28 – BCBS Blue Choice Preferred Bronze PPO 701
$47 – BCBS Blue Choice Preferred Bronze PPO 705
$53 – BCBS Blue Choice Preferred Bronze PPO 601
$54 – Health Alliance 2023 POS 8000 Elite Bronze
$64 – BCBS Blue Choice Preferred Bronze PPO 201
50 year-old and one child (2 persons) residing in the Joliet area and Will County with household income of $63,000
$147 – Ambetter CMS Standard Bronze
$185 – Ambetter Clear Bronze
$240 – Ambetter Choice Bronze HSA
$240 – Ambetter CMS Standard Expanded Bronze
$252 – Ambetter Central Bronze
55 year-old married couple (2 persons) residing in the Naperville area and Dupage County, with household income of $68,000
$121 – Oscar Simple Standard
$173 – Ambetter CMS Standard Bronze
$175 – Oscar Bronze Classic
$230 – Oscar Bronze Simple
$237 – Oscar Bronze Standard Choice
60 year-old and one child (2 persons) residing in the Aurora area and Kane County with household income of $70,000
$246 – Ambetter CMS Standard Bronze
$307 – Ambetter Clear Bronze
$345 – Cigna Simple Choice 9100
$380 – UnitedHealthcare Bronze Standard
$385 – Cigna Simple Choice 7500
Which Plans Are The Most Affordable?
Ambetter Essential Care 1
Ambetter Essential Care 2 HSA
Ambetter Essential Care 5
Ambetter Essential Care 22
BCBS Blue FocusCare Bronze 209
BCBS BlueCare Direct Bronze 401
Bright Health Bronze 8700
Bright Health Bronze 7200
Bright Health Bronze 5300 HSA
Cigna Connect 8700
Cigna Connect 5000
Cigna Connect 7500
Cigna Connect HSA 7000
Health Alliance 2022 POS 8000 Elite Bronze
Health Alliance 2022 POS 6000 Elite Bronze
MercyCare HMO Bronze Option C
MercyCare HMO Bronze Option A
MercyCare HMO Bronze Option B
Molina Constant Care Silver 7 250
Molina Constant Care Silver 4 250
Oscar Bronze Super Simple
Oscar Bronze Classic
Quartz One Bronze 1202
Quartz One Bronze 1201
UnitedHealthcare Bronze Essential +
UnitedHealthcare Bronze Virtual First
UnitedHealthcare Bronze Value+
Can I Cancel My Policy At Any Time?
You can terminate coverage by simply submitting a request. Typically, email, fax or letter is sufficient with all carriers. If there are unused benefits that you have paid for, a refund will be calculated and promptly sent. You will also receive a letter indicating the dates you were covered under that specific policy. This information was previously needed to verify you met the ACA legal requirements on IRS form 1095-A. This form provides information regarding your qualified healthcare plan, and the premium tax credit.
If you only need benefits for less than 90 days, perhaps a “temporary” policy is your best option. The price is cheap, and you can cover the catastrophic types of claims until you are insured under a different policy. Typically, applications are approved within 24 hours. However, you can not receive federal government subsidies to pay for these types of policies. Coverage up to 12 months can be purchased, without having to medically qualify for a new plan. Policies are offered at all times throughout the year.
What About Medigap Coverage?
Although prices can vary, in most areas of the state, many choices are available for Medicare Supplement, Advantage, or Part D prescription drug coverage. Listed below are the companies approved to offer Medicare Supplement plans in Illinois.
AARP (UnitedHealthcare)
Aetna
American Republic
American Retired Life (Cigna)
Americo
Assured Life
Bankers Fidelity
BCBS
Colonial Penn
Combined
Country Life
CSI
Equitable
Gerber
Globe
Government Personnel
Health Alliance
Humana
Individual Assurance
KSKJ Life
Liberty National
Medico
Mutual Of Omaha
Oxford Life
Pekin Life
Physicians Mutual
Reserve National
Sentinel Security
Standard Life And Accident
State Farm
Order Of United Commercial Travelers
Thrivent
Unified Life
United American
United National Life
USAA
Sample Illinois Medicare Supplement Rates
Illustrated below are current estimated monthly male (age 65) rates for popular Medigap plans. Prices and plan availability typically vary depending on your age, plan, and county of residence. Female rates are generally lower.
Cook And DuPage Counties
Plan A
$103 – AARP-UnitedHealthcare
$124 – BCBS Of Illinois
$124 – Physicians Select
$126 – Omaha Insurance
$129 – Ace Property And Casualty
$129 – Elips Life
$129 – Medico
$136 – Woodman Of The World
$139 – Humana
$139 – American Home Life
$142 – American Benefit Life
$145 – Allstate
$148 – Cigna
$151 – Aetna
$162 – Manhattan Lfe
$167 – AFLAC
$160 – United American
$170 – Cigna
$179 – New Era Life
$221 – GPM Health
$260 – Bankers Fidelity
Plan C
$181 – New Era Life
$191 – AARP-UnitedHealthcare
$297 – Bankers Fidelity
$302 – United American
Plan F
$151 – Medico
$152 – Ace Property An Casualty
$158 – Elips Life
$161 – Humana
$164 – Cigna
$165 – AFLAC
$167 – American Home Life
$169 – Woodman Of The World
$169 – Physicians Select
$170 – BCBS Of Illinois
$175 – Omaha Insurance
$180 – AARP-UnitedHealthcare
$181 – Allstate
$183 – American Benefit Life
$183 – Bankers Fidelity
$197 – Manhattan Life
$214 – Aetna
$323 – GPM Health
$331 – Guarantee Trust Life
$343 – New Era Life
$361 – United American
Plan F (High Deductible)
$47 – Great Southern Life
$49 – BCBS Of Illinois
$50 – United World Life
$53 – New Era Life
$61 – Medico
Plan G
$113 – Accendo
$116 – Lumico
$118 – Aetna
$119 – AARP-UnitedHealthcare
$122 – Oxford Life
$123 – Western United Life
$124 – Humana
$129 – United World Life
$129 – Union Security
$130 – Great Southern Life
$135 – BCBS of Illinois
$143 – Thrivent
$162 – Medico
Plan G (High Deductible)
$43 – United World Life
$45 – United States Fire
$49 – BCBS Of Illinois
$49 – Humana
$50 – Aetna
Plan N
$86 – Accendo
$90 – Aetna
$92 – Capitol Life
$95 – United States Fire
$97 – Humana
$97 – Union Security
$98 – United World Life
$100 – Lumico Life
$107 – Thrivent
$111 – Great Southern Life
$111 – AARP-UnitedHealthcare
$113 – Western United Life
$117 – Cigna
$122 – BCBS Of Illinois
$136 – Medico
$172 – Oxford Life
Lake County
Plan A
$83 – AARP-UnitedHealthcare
$105 – Accendo
$108 – BCBS Of Illinois
$109 – Aetna
$115 – United States Fire
$120 – Capitol Life
$124 – Lumico Life
$129 – Western United Life
$129 – United World Life
$133 – Humana
$136 – Union Security
$144 – Thrivent
$151 – Great Southern Life
$151 – Cigna
$156 – Medico
$193 – Oxford Life
Plan C
$146 – AARP-UnitedHealthcare
$172 – BCBS
$177 – Western United Life
Plan F
$147 – AARP-UnitedHealthcare
$151 – Aetna
$162 – Lumico Life
$163 – Great Southern Life
$164 – Guarantee Trust Life
$167 – Humana
$169 – United World Life
$172 – BCBS
$174 – Union Security
$178 – Cigna
$178 – Western United Life
$179 – Thrivent
$192 – Continental Life
$194 – Greek Catholic Union
$234 – Medico
$260 – New Era Life
$326 – Oxford Life
Plan F (High Deductible)
$47 – Great Southern Life
$49 – Cigna
$49 – United World Life
$50 – BCBS
$56 – New Era Life
$58 – Humana
$58 – Medico
$75 – Continental Life
Plan G
$115 – AARP-UnitedHealthcare
$125 – Lumico
$127 – Aetna
$127 – United World Life
$130 – Great Southern Life
$131 – Union Security
$132 – Western United Life
$133 – Oxford Life
$137 – Cigna
$141 – Thrivent
$145 – Humana
$148 – BCBS
$151 – Greek Catholic Union
$154 – Medico
$211 – New Era Life
Plan N
$97 – Aetna
$103 – Greek Catholic Union
$104 – Union Security
$105 – AARP-UnitedHealthcare
$105 – United World Life
$102 – Lumico
$102 – United World Life
$110 – Guarantee Trust Life
$103 – Mutual Of Omaha
$103 – Greek Catholic Union
$104 – Americo
$109 – Loyal Christian Benefit
$109 – BCBS
$112 – AARP-UnitedHealthcare
$112 – CSI Life
$112 – Thrivent
$117 – Cigna
$130 – Humana
$142 – Medico
$169 – Assured Life
$172 – New Era Life
$179 – Oxford Life
Illinois Medicare Stand-Alone Part D Drug Prescription Plans
WellCare Value Script – $0 per month with $545 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $2 (Tier 2), 25% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 3,387 formulary drugs. 128,857 state members. 3.5 Star Summary Rating. 962 Tier 3 drugs available.
WellCare Classic – $27.90 per month with $545 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $5 (Tier 2), 22% (Tier 3), 46% (Tier 4), and 25% (Tier 5). 3,020 formulary drugs. 45,752 state members. 3.5 Star Summary Rating. 887 Tier 3 drugs available.
WellCare Medicare Rx Value Plus – $79.00 per month with $0 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $4 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 3,384 formulary drugs. 19,716 state members. 3.5 Star Summary Rating. 1,000 Tier 3 drugs available.
Cigna Saver Rx – $18.00 per month with $545 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $7 (Tier 2), 19% (Tier 3), 50% (Tier 4), and 29% (Tier 5). 3,268 formulary drugs. 15,020 state members. 2.5 Star Summary Rating. 1,032 Tier 3 drugs available.
Cigna Secure Rx – $42.30 per month with $545 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $3 (Tier 2), 17% (Tier 3), 48% (Tier 4), and 25% (Tier 5). 3,139 formulary drugs. 50,602 state members. 2.5 Star Summary Rating. 664 Tier 3 drugs available.
Cigna Extra Rx – $78.40 per month with $145 deductible. Preferred Pharmacy cost-sharing: $3 (Tier 1), $12 (Tier 2), 20% (Tier 3), 50% (Tier 4), and 31% (Tier 5). 3,356 formulary drugs. 15,045 state members. 2.5 Star Summary Rating. 843 Tier 3 drugs available.
Humana Walmart Value Rx Plan – $30.60 per month with $505 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $2 (Tier 2), 16% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 3,173 formulary drugs. 47,678 state members. 3.0 Star Summary Rating.
Humana Premier Rx Plan – $77.30 per month and $300 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 49% (Tier 4), and 28% (Tier 5). 3,239 formulary drugs. 31,181 state members. 3.0 Star Summary Rating.
Humana Basic Rx Plan – $28.80 per month and $505 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $1 (Tier 2), 19% (Tier 3), 45% (Tier 4), and 25% (Tier 5). 3,130 formulary drugs. 47,775 state members. 3.0 Star Summary Rating.
Elixir RxSecure – $29.60 per month with $480 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $4 (Tier 2), 15% (Tier 3), 28% (Tier 4), and 25% (Tier 5). 3,085 formulary drugs. 20,041 state members.
AARP MedicareRx Saver Plus – $27.40 per month with $480 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $9 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 3,165 formulary drugs. 53,712 state members.
AARP MedicareRx Walgreens – $27.60 per month with $310 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $10 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 27% (Tier 5). 3,166 formulary drugs. 34,907 state members.
AARP MedicareRx Preferred – $94.30 per month with $0 deductible. Preferred Pharmacy cost-sharing: $5 (Tier 1), $10 (Tier 2), $45 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 3,583 formulary drugs. 70,940 state members.
SilverScript Plus – $88.10 per month with $0 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50 % (Tier 4), and 33% (Tier 5). 3,278 formulary drugs. 4,751 state members.
SilverScript Choice – $27.10 per month with $480 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $5 (Tier 2), 17% (Tier 3), 45% (Tier 4), and 25% (Tier 5). 3,108 formulary drugs. 121,425 state members.
SilverScript SmartRx – $6.90 per month with $480 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $19 (Tier 2), $46 (Tier 3), 49% (Tier 4), and 25% (Tier 5). 3,601 formulary drugs. 54,579 state members.
Mutual Of Omaha Rx Premier – $23.00 per month with $445 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $2 (Tier 2), 23% (Tier 3), 45 % (Tier 4), and 25% (Tier 5). 2,943 formulary drugs. 8,108 state members.
Mutual Of Omaha Rx Plus – $73.90 per month with $445 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $2 (Tier 2), 20% (Tier 3), 39 % (Tier 4), and 25% (Tier 5). 2,899 formulary drugs. 3,518 state members.
Blue Cross MedicareRx Basic – $61.40 per month with $445 deductible. Preferred Pharmacy cost-sharing: $1 (Tier 1), $4 (Tier 2), 16% (Tier 3), 45 % (Tier 4), and 25% (Tier 5). 2,794 formulary drugs. 41,047 state members.
Blue Cross MedicareRx Value – $80.00 per month with $445 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $8 (Tier 2), $40 (Tier 3), 46 % (Tier 4), and 25% (Tier 5). 3,457 formulary drugs. 89,755 state members.
Blue Cross MedicareRx Plus – $147.80 per month with $0 deductible. Preferred Pharmacy cost-sharing: $0 (Tier 1), $2 (Tier 2), $30 (Tier 3), 40 % (Tier 4), and 33% (Tier 5). 3,457 formulary drugs. 15,578 state members.
Illinois Medicare Advantage Plans
Illinois Medicare Advantage (MA) coverage is offered through many private insurers as an alternative to original Medicare benefits. Most plans cover prescription drugs, and also offer dental, vision, or hearing benefits. HMO, PPO, Special Needs, Fee-For-Service, and Medical Savings Accounts (MSA) are available. Listed below are many of the plan options offered (with prescription drug benefits, unless specified) by licensed companies in Cook County, including the Chicago area. Plan availability and premiums can differ, depending upon your county of residence.
AARP Medicare Advantage Access (HMO) – $0 monthly premium, and $0 deductible with $2,500 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $195 for the first 6 days, and the outpatient hospital copay is $0- $195 per visit. Office visit copays are $0 and $20, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $0 and $15. Outpatient mental health group and individual copays are $15 and $25. Occupational, physical, and language therapy copays are $20. Comprehensive dental benefits are provided subject to policy provisions. $0 copay for routine vision exams.
AARP Medicare Advantage Plan 1 (HMO-POS) – $0 monthly premium, and $0 deductible with $2,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $250 for the first 6 days, and the outpatient hospital copay is $0-$250 per visit. Office visit copays are $0 and $30, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $0 and $15. Outpatient mental health group and individual copays are $15 and $25. Occupational, physical, and language therapy copays are $20. Comprehensive dental benefits are provided subject to policy provisions. $0 copay for routine vision exams.
AARP Medicare Advantage Walgreens (PPO) – $0 monthly premium, and $150 deductible with $5,700 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 30% (Tier 5). The inpatient hospital copay is $320 for the first 6 days, and the outpatient hospital copay is $0-$320 per visit. Office visit copays are $0 and $45, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $210. Lab service and outpatient x-ray copays are $0 and $15. Outpatient mental health group and individual copays are $15 and $25. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions. $0 copay for routine vision exams.
AARP Medicare Advantage Choice (PPO) – $38 monthly premium, and $195 deductible with $3,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $3 (Tier 1), $10 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 29% (Tier 5). The inpatient hospital copay is $275 for the first 6 days, and the outpatient hospital copay is $0-$275 per visit. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $0 and $15. Outpatient mental health group and individual copays are $15 and $25. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
AARP Medicare Advantage Patriot (PPO) – $0 monthly premium with $5,900 maximum out-of-pocket expenses. Prescription benefits not included. The inpatient hospital copay is $275 for the first 6 days, and the outpatient hospital copay is $0-$275 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $0 and $15. Outpatient mental health group and individual copays are $15 and $25. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
Aetna Medicare Value Plan (PPO) – $0 monthly premium, and $0 deductible with $3,950 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $300 for the first 7 days, and the outpatient hospital copay is $0-$395 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $65.
The ground ambulance copay is $280. Lab service and outpatient x-ray copays are $0-10 and $15. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
Aetna Medicare Prime (HMO) – $0 monthly premium, and $0 deductible with $3,950 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $175 for the first 7 days, and the outpatient hospital copay is $0-$175 per visit. Office visit copays are $0 and $20, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $275. Lab service and outpatient x-ray copays are $0 and $10. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
Aetna Medicare Premier Plus (PPO) – $39 monthly premium, and $0 deductible with $3,475 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $250 for the first 7 days, and the outpatient hospital copay is $0-$200 per visit. Office visit copays are $0 and $25, and the ER and Urgent Care copays are $90 and $55.
The ground ambulance copay is $265. Lab service and outpatient x-ray copays are $0 and $10. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
Aetna Medicare Eagle (PPO) – $0 monthly premium and $5,500 maximum out-of-pocket expenses. Prescription drug benefits are not included. The inpatient hospital copay is $290 for the first 7 days, and the outpatient hospital copay is $0-$350 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $45.
The ground ambulance copay is $290. Lab service and outpatient x-ray copays are $0 and $20. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Comprehensive dental benefits are provided subject to policy provisions.
Ascension Complete AMITA Health Secure (HMO) – $0 monthly premium, and $0 deductible with $2,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $2 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $175 for the first 7 days, and the outpatient hospital copay is $175 per visit. Office visit copays are $0 and $20, and the ER and Urgent Care copays are $120 and $20.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $20. Occupational, physical, and language therapy copays are $20.
Blue Cross Medicare Advantage Basic – $0 monthly premium, and $0 deductible with $3,400 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $8 (Tier 2), $39 (Tier 3), $93 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $225 for the first 7 days, and the outpatient hospital copay is $250 per visit. Office visit copays are $0 and $25, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $200. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $35.
Blue Cross Medicare Advantage Basic Plus – $0 monthly premium, and $0 deductible with $3,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $8 (Tier 2), $39 (Tier 3), $93 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $220 for the first 7 days, and the outpatient hospital copay is $250 per visit. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $200. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $35 and $40.
Blue Cross Medicare Advantage Choice Plus – $79 monthly premium, and $445 deductible with $6,700 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $13 (Tier 2), $40 (Tier 3), $93 (Tier 4), and 25% (Tier 5). The inpatient hospital copay is $295 for the first 6 days, and the outpatient hospital copay is $300 per visit. Office visit copays are $10 and $40, and the ER and Urgent Care copays are $90 and $40.
The ground ambulance copay is $250. Lab service and outpatient x-ray copays are $5 and $10-$100. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $40.
Blue Cross Medicare Advantage Premier Plus – $83 monthly premium, and $0 deductible with $4,500 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $8 (Tier 2), $39 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $190 for the first 8 days, and the outpatient hospital copay is $225 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $225. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $35.
Blue Cross Medicare Advantage Choice Premier – $142 monthly premium, and $0 deductible with $5,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $13 (Tier 2), $40 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $250 for the first 7 days, and the outpatient hospital copay is $275 per visit. Office visit copays are $15 and $50, and the ER and Urgent Care copays are $93 and $40.
The ground ambulance copay is $225. Lab service and outpatient x-ray copays are $5 and $5-$100. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $40.
Cigna Preferred Medicare – $0 monthly premium, and $0 deductible with $3,450 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $195 for the first 7 days, and the outpatient hospital copay is $0-$175 per visit. Office visit copays are $0 and $20, and the ER and Urgent Care copays are $120 and $0-$25.
The ground ambulance copay is $260. Lab service and outpatient x-ray copays are $0 and $0-$25. Outpatient mental health group and individual copays are $0. Occupational, physical, and language therapy copays are $20.
Cigna Premier Medicare – $0 monthly premium, and $0 deductible with $4,500 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $235 for the first 7 days, and the outpatient hospital copay is $0-$210 per visit. Office visit copays are $0 and $30, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $260. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $0. Occupational, physical, and language therapy copays are $30.
Cigna True Choice Medicare – $0 monthly premium, and $0 deductible with $4,400 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $300 for the first 6 days, and the outpatient hospital copay is $0-$300 per visit. Office visit copays are $0 and $30, and the ER and Urgent Care copays are $90 and $30.
The ground ambulance copay is $225. Lab service and outpatient x-ray copays are $0 and $10. Outpatient mental health group and individual copays are $0. Occupational, physical, and language therapy copays are $30.
Clear Spring Health Community Advantage Plan – $0 monthly premium, and $0 deductible with $3,950 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $12 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $220 for the first 7 days, and the outpatient hospital copay is $225 per visit. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $35.
The ground ambulance copay is $200. Lab service and outpatient x-ray copays are $0 and $0-$100. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $20.
Clear Spring Health Community Flex Plan – $19 monthly premium, and $0 deductible with $3,950 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $12 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $220 for the first 7 days, and the outpatient hospital copay is $225 per visit. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $35.
The ground ambulance copay is $100. Lab service and outpatient x-ray copays are $0 and $0-$100. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $20.
Clear Spring Health Essential – $0 monthly premium, and $0 deductible with $2,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $12 (Tier 2), $42 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $225 for the first 8 days, and the outpatient hospital copay is $30-$200 per visit. Office visit copays are $0 and $30, and the ER and Urgent Care copays are $120 and $35.
The ground ambulance copay is $225. Lab service and outpatient x-ray copays are $0 and $0-$100. Outpatient mental health group and individual copays are $30. Occupational, physical, and language therapy copays are $30.
Humana Gold Plus – $0 monthly premium, and $0 deductible with $2,650 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $150 for the first 7 days, and the outpatient hospital copay is $25-$150 per visit. Office visit copays are $0 and $25, and the ER and Urgent Care copays are $120 and $0-$25.
The ground ambulance copay is $200. Lab service and outpatient x-ray copays are $0 and $25. Outpatient mental health group and individual copays are $25. Occupational, physical, and language therapy copays are $20.
HumanaChoice – $88 monthly premium, and $0 deductible with $3,750 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $6 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $295 for the first 6 days, and the outpatient hospital copay is $40-$250 per visit. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $0-$40.
The ground ambulance copay is $290. Lab service and outpatient x-ray copays are $0-$40 and $0-$90. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40.
Humana Gold Choice – $145 monthly premium, and $380 deductible. Preferred pharmacy 30-day drug copays are $6 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 26% (Tier 5). The inpatient hospital copay is $360 for the first 5 days, and the outpatient hospital copay is $45-$95 per visit. Office visit copays are $15 and $45, and the ER and Urgent Care copays are $90 and $15-$45.
The ground ambulance copay is 20%. Lab service and outpatient x-ray copays are $0-$40 and $15-$95. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40.
MeridianCare Essential – $0 deductible with $3,750 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $0 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $250 for the first 5 days, and the outpatient hospital copay is $200 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $0. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $35. Occupational, physical, and language therapy copays are $35. Preventative dental coverage is included with a $0 copay.
Sunrise Advantage Plan – $0 deductible with $3,820 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $4 (Tier 1), $15 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $250 for the first 5 days, and the outpatient hospital copay is $0-$350 per visit. Office visit copays are $0 and $0-$50, and the ER and Urgent Care copays are $90 and $50. Lab service and outpatient x-ray copays are $0 and $10. Outpatient mental health group and individual copays are $15. Occupational, physical, and language therapy copays are $20. Preventative dental coverage is included with a $0 copay.
WellCare Advance – $0 deductible with $3,900 maximum out-of-pocket expenses. The inpatient hospital copay is $372 for the first 5 days, and the outpatient hospital copay is $200 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $30. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Prescription drug coverage is not included. Preventative dental coverage is included with a $0 copay. Limited comprehensive dental benefits are included.
WellCare Value – $0 deductible with $3,900 maximum out-of-pocket expenses. Preferred pharmacy 30-day drug copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). The inpatient hospital copay is $450 for the first 4 days, and the outpatient hospital copay is $175 per visit. Office visit copays are $0 and $35, and the ER and Urgent Care copays are $90 and $30. Lab service and outpatient x-ray copays are $0. Outpatient mental health group and individual copays are $40. Occupational, physical, and language therapy copays are $40. Preventative dental coverage is included with a $0 copay. Limited comprehensive dental benefits are included.
Counties With Most Available MA Plans
83 – Cook County
80 – Will County
78 – DuPage County
74 – Kane County
69 – Kankakee County
64 – McHenry County
62 – Madison County
60 – Lake County
60 – Winnebago County
60 – St. Clair County
59 – Boone County
57 – Clinton County
56 – Ogle County
56 – Kendall County
54 – Bond County
Counties With Least Available MA Plans
14 – Massac County
21 – Williamson County
24 – Alexander County
24 – Pulaski County
25 – Champaign County
26 – Hardin County
29 – Saline County
30 – Effingham County
30 – Lawrence County
31 – Gallatin County
31 – Johnson County
32 – Franklin County
32 – Jefferson County
32 – Hamilton County
33 – Clay County
33 – Coles County
33 – Cumberland County
How Do I Apply For Medicaid If I Am Eligible?
If you are eligible, you have a choice of picking your own physicians for the services you receive, or choosing a “primary care physician,” that will be part of a managed care program. Either a PHP or HMO type of coverage will be offered. The HMO will likely have a broader network, but you will have to verify that they accept Medicaid patients. If your household income falls under 100% of the Federal Poverty Level, you will likely automatically qualify. You can also purchase conventional plans, but you can not utilize a federal subsidy if you are Medicaid-eligible.
What Are The Cheapest Cities In Illinois To Buy Healthcare?
Although premiums are subject to change, and each situation is different, some of the cities that offer the most affordable rates are: Aurora, Naperville, Waukegan, Evanston, Schaumburg, Palatine, Glenview, Quincy, Pekin, Danville and Park Forest. Don’t panic if your city is not on this list! There are many other low-cost areas in the state.
Illinois Health Exchange plans for 2017 are very affordable, especially if you qualify for the government subsidy. Our website will make it easy for you to view the best online quotes for these plans. We also provide expert help and guidance with choosing the best plan, calculating and applying the subsidy, and enrolling for coverage.
News From The Past:
“Get Covered Illinois” has a new Executive Director. Karin Zosel will replace Jennifer Koehler who resigned in February to pursue other potential job opportunities. Zosel has a unique background including working more than a decade for the CIA as an intelligence specialist. She will now focus on available federal grant and aid programs that lower the cost for state residents to purchase coverage.
Rate filings have been submitted by Illinois carriers. Although yet to be approved, some of the requested rate increases are listed below:
53.2% – Time Individual Medical
33.6% – Aetna POS-PD
28.5% – Aetna HMO Individual
19.5% – UnitedHealthcare Off-Exchange
18.4% – Consumer’s Choice CC PPO Individual
14.4% – Coventry Carolinas SC Small Group PPO