Health Insurance Options

If you work, find out if the employer offers group health benefits. The company may offer employer-sponsored health insurance or have a self-funded health plan administered by a third party company. Both options cover medical expenses for employees through payroll deduction.

Individuals can buy health insurance through the 'Get Covered Illinois Marketplace Exchange,' a health insurance agent, or directly from a health insurance company. Only the marketplace exchange offers subsidies based on income. Enrollment ends December 15.

Insurers offer a variety of insurance products. Indemnity plans offer the most flexibility in choosing health care providers. Preferred provider organizations (PPOs) have company-negotiated health care provider networks. You can get treatment outside the PPO network, but pay a larger portion of the bill. With an HMO (Health Maintenance Organization) plan you choose a primary care physician to manage your care and make referrals to other providers. Benefits may be significantly reduced or denied for medical car outside the HMO network. Point of service (POS) plans are a hybrid alternative. These plans have health care provider networks like PPOs plus primary care physicians like HMOs. Out-of-network health care is allowed, but you pay more out-of-pocket.

Evaluate your medical needs before choosing a health insurance plan. Keep in mind the plan with the most provider flexibility and lowest out-of-pocket cost will likely be the most expensive. In addition to premium, check out each plan's co-pay requirements, deductibles, co-insurance obligations, and out-of-pocket maximums. Find out if your doctor is included in the healthcare network. Consider the insurer's complaint record, financial stability, and licensing status. Companies not licensed in Illinois are not subject to state laws and regulations.