Last month, in a scene not unlike the pilot of Girls, my ever-patient mom & pop relieved me of my spot on their health plan. Having leeched the thing through college and well into young adulthood, there were no hard feelings. But that didn’t make the prospect of braving Obamacare any less daunting—it has, after all, had some issues.
As of February 1, more than 88,000 Illinoisans had signed up for federal healthcare. (Without an Illinois state exchange, residents only have the federal option.) It’s a decent turnout, given October’s dismal enrollment, but nowhere near the 486,000 originally forecasted. That number will likely skyrocket this month as people like me—young, healthy procrastinators—scramble to meet the March 31 enrollment deadline (March 15 for April coverage).
Since HealthCare.gov doesn’t have the greatest record with heavy traffic, you should probably not wait ’til the last minute. Here are a few things to figure out before you dive in.
Figure out if you qualify for Medicaid.
Before you even face the health insurance marketplace, you’ll want to determine whether you qualify for Medicaid in Illinois (this will affect the entire application process). Remember: Gov. Quinn signed a bill last July that expands Medicaid to any Illinoisan who earns less than 138 percent of the federal poverty line ($15,856 for an individual, $32,499 for a family of four). If you aren’t sure whether you qualify, visit GetCoveredIllinois.gov and fill out this quick survey.
If you do qualify for Medicaid (and want to go that route), you can apply online with Illinois Healthcare and Family Services and dodge the marketplace entirely. In the event that your application is denied, don’t worry—HFS will send it over to Get Covered Illinois, who’ll help you pick a plan on the federal exchange.
A note on the Medicaid v. marketplace conundrum: If you qualify for Medicaid but would rather buy a plan in the Marketplace—because, say, your specialist doesn’t accept Medicaid—you won’t qualify for an income-based subsidy (otherwise available to Illinoisans who earn 138-400 percent of the poverty line). This theoretically means that somebody who earns $15,000 a year but opts out of Medicaid could end up paying $2,000 for a health plan that would’ve cost $1,000 less had he or she earned $1,000 more. It’s unlucky math—but it’s possible.
Pick the right plan, then triple-check it.
If you don’t qualify for Medicaid (or want nothing to do with it), your next stop is the health insurance marketplace, where you’ll find dozens of cost-ascending health plans catering to your every ailment.
Based on how you’ll share medical costs with your insurer, each plan is categorized as bronze, silver, gold, platinum, or (if you’re under 30) catastrophic. Though every plan covers the same 10 essential health benefits (hospitalization, prescription drugs, check-ups, etc.), each one has a different premium (the amount you pay each month) and deductible (the max you’ll pay in a year before your insurer takes over).
If you’re young, healthy, and mostly guarding against some freak-expensive accident, you’re safe to choose a bronze plan. But if you’re chronically ill or have an expensive procedure on the horizon, a high-premium/low-deductible plan makes more sense. This chart lays it out pretty well:
illustration: Courtesy of Get Covered Illinois.
Even more important than forecasting future illnesses is checking your plan for any specialists or prescriptions you might need. You can do this under the “Details” tab of each plan. If you’ve got asthma, look for your inhaler under “List of Covered Drugs.” If you’re allergic to something new each season, be sure your immunologist is listed under “Provider Directory.” No dice? Try the next plan. This sounds like a pain, but remember: Before the ACA, insurers were legally allowed to deny coverage to people with pre-existing conditions. (Side note: I am one of those people).
Once you’ve picked a plan, leave the marketplace immediately.
Not to reinforce America’s resounding complaints re: HealthCare.gov, but the website truly is treacherous. In the course of writing this post/getting real-life covered, I tried and failed several times to apply for health care online. Even creating an account to log in was impossible—I tried twice, went to a troubleshooting chatroom, and was told to keep trying.
The online marketplace is great for browsing and comparing plans, but when it comes time to apply, do yourself a favor: Pick up the phone and have one of Illinois’s 1,200 trained Navigators walk you through the process (866-311-1119). If you’d rather talk to a Navigator face-to-face, there are more than 500 locations in Chicago. They’re trained, paid, and far more knowledgeable than me.