Frequently Asked Questions
Where can I sign up for health coverage?
How you sign up depends on the type of coverage you get:
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For Medicaid and Health Benefits for Workers with Disabilities (HBWD) you can apply:
- Online using the Illinois Application for Benefits Eligibility (ABE)
- By calling the ABE Customer Call Center at 1-800-843-6154
- For Medicaid, you can also apply by downloading a paper application (also available in Spanish), filling it out, and then returning it by mail or fax to your DHS Family Community Resource Center or in person at your local DHS Family Community Resource Center.
- For HBWD, you can also apply by downloading a paper HBWD application (also available in Spanish), filling it out, and then mailing it to the address listed on the form.
- For Medicare, you automatically get coverage if you’ve been getting Social Security Disability Insurance (SSDI) for two years. Otherwise, you may need to sign up.
- For employer-sponsored coverage, talk to your employer’s Human Resources department.
- For individual coverage, apply at Get Covered Illinois/HealthCare.gov. Get Covered Illinois/HealthCare.gov first checks if you qualify for Medicaid and, if not, lets you compare individual plans and see if the government will help with tax credits.
If my job offers me health coverage, can I still qualify for Medicaid or get subsidies for an individual plan on Get Covered Illinois/HealthCare.gov?
You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance.
You cannot get subsidies for purchasing an individual health plan through Get Covered Illinois/HealthCare.gov if your job offers you affordable insurance.
Does it matter how I qualify for Medicaid?
In most cases, no. The actual medical coverage you get from Medicaid is the same, no matter how you qualify. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and, if you have a disability and start working, you can earn more while still getting Medicaid coverage through HBWD.
What is the most money I can make and still get Medicaid?
For Medicaid based on having low to moderate income, the main income rules are:
- If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
- If you are 18 or younger and your family’s income is at or under 318% of FPG ($99,216 per year for a family of four), you may qualify for All Kids.
- If you are pregnant and your family’s income is at or under 213% of FPG ($66,456 per year for a family of four), you may qualify. The unborn baby is counted as a family member.
This way of getting Medicaid, sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most of your earned and unearned income. MAGI doesn't include some types of income, like Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.
If you have a disability, you may be able to get Medicaid coverage if your income is a lot higher than this, thanks to Health Benefits for Workers with Disabilities (HBWD). Learn more about HBWD.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Medicaid (138% FPG) | $20,783 |
All Kids (318% FPG) | $47,891 |
Subsidized private plans, reduced fees (250% FPG) | $37,650 |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
|
I’m an immigrant. Can I get Medicaid?
It depends on your situation:
- Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Emergency Medical Coverage. If they are 18 or younger, they may qualify for All Kids; if they are 42 to 64 years old, they may qualify for Health Benefits for Immigrant Adults; and if they are 65 or older, they may qualify for Health Benefits for Immigrant Seniors.
- Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government or for All Kids, Health Benefits for Immigrant Adults, or Health Benefits for Immigrant Seniors.
- Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements, may qualify for Medicaid or other Illinois health programs.
Note: Illinois has temporarily paused new enrollment in the Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs.
What happens to my Medicaid coverage if I go back to work?
There are different health coverage options as your income goes up:
- Depending on how much your income goes up, your Medicaid may continue, unchanged.
- If you got Supplemental Security Income (SSI) before you started earning more, you can usually keep Medicaid thanks to SSI’s 1619(b) rule.
- If you have a disability and work, you can also consider Health Benefits for Workers with Disabilities (HBWD), which offers Medicaid coverage (you may have to pay a monthly premium). With it, you could earn as much as $4,468 per month ($53,610 per year) and still qualify.
- If your employer offers it, you may be able to get employer-sponsored coverage.
- If your employer does not offer coverage, you should consider private individual coverage. You may get government help to pay for an individual plan on Get Covered Illinois/HealthCare.gov. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.
Who qualifies for Health Benefits for Workers with Disabilities (HBWD)?
To qualify for Health Benefits for Workers with Disabilities (HBWD), you must:
- Be 16 – 64 years old
- Live in Illinois
- Be a U.S. citizen or a qualified immigrant
- Be working and paying FICA taxes
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Have a disability that meets Social Security’s medical standards.
- For HBWD, SSA’s disability rules related to income do not apply.
- If you don't have a disability determination from Social Security, a disability determination will be done when you apply for HBWD.
-
Have countable income at or below $4,393 per month for individuals.
- To calculate your countable income, money you spend on some things, like work expenses, day care costs, transportation, and more may be deducted.
-
Have less than $25,000 in resources.
- HBWD does not count money that you have in retirement accounts or ABLE Accounts.
With HBWD coverage, you pay a premium of up to $500 each month (the higher your income, the higher your premium).
How many programs does Medicare offer?
Medicare has three main parts:
- Medicare Part A helps pay for medical care you get while you’re in a hospital.
- Medicare Part B helps pay for medical care you get outside of a hospital.
- Medicare Part D helps pay for prescription drugs.
Medicare Advantage (also called Medicare Part C) is a way to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower.
How do I become eligible for Medicare?
If you or your spouse worked enough time while paying Medicare taxes, you qualify for Medicare Parts A and B:
- When you turn 65
- When you’ve been getting Social Security Disability Insurance (SSDI) benefits for two years, or
- If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).
Note: If your disability began before you turned 22 years old and you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record, you start getting Medicare.
Does Medicare pay for all of my medical expenses?
No. Medicare only helps pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you have to pay for it yourself, unless you have other coverage, such as Medicaid, employer-sponsored coverage, or a Medicare supplement (Medigap) policy.
For certain services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage, you may have to pay a monthly premium.
You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Savings Programs help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage. Note: If you don't qualify for an MSP, but do qualify for AABD Medicaid, you may not have to pay a Part B premium.
Can I have Medicare and another health coverage at the same time?
Yes. Other types of coverage that you can have with Medicare include:
- Medicaid
- Health Benefits for Workers with Disabilities (HBWD)
- Employer-sponsored coverage
- Continued coverage through COBRA
- Retirement plans
- Veterans (VA) benefits
- Military (TriCare for Life) benefits, or
- Individual health insurance.
Learn more about how Medicare interacts with other types of coverage.
How much does employer-sponsored health coverage cost and who pays for it?
You may pay nothing, a percentage of the cost, or whatever amount your employer doesn't pay.
Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 8.39% of the employee’s household income for the monthly premium. Also, that coverage must meet bronze-level standards for copayment, co-insurance, and deductible expenses.
If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan.
Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Before 2023, the spouse or children of an employee would not qualify for subsidies on Get Covered Illinois/HealthCare.gov if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." This changed starting in 2023. Learn more about affordability rules for family members and how it affects eligibility for tax credits on Get Covered Illinois/HealthCare.gov.
Can I get coverage through my parent’s employer-sponsored insurance?
Yes, if you are under 26 and cannot get health coverage through your own employer. Employers who offer coverage to their employees must also offer it to their children under the age of 26.
Employers do not have to offer coverage to the spouses of employees, but many do.
Note: While employers must offer this coverage to children, the employee may be required to pay for all of it.
I have a disability. Can I really get insurance that covers my medical problems?
Yes. Plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.
How does the government help people pay for individual coverage?
Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:
- When you sign up at Get Covered Illinois/HealthCare.gov, you give details about your family's situation. Get Covered Illinois/HealthCare.gov reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Get Covered Illinois/HealthCare.gov tells you and lists insurance options for you.
- Your insurance options list the full cost of the monthly premium, how much of that premium the government pays each month, and how much you pay each month. The government helps pay for the premium by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
- In January or February, the government sends you a form listing your total health coverage tax credits for the previous year. You need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this is sorted out when you file your taxes.
Do I have to get a silver level plan on Get Covered Illinois/HealthCare.gov if I want government help paying for my insurance?
No, but depending on your income, you may get more help from the government if you get a silver-level plan:
- The government may help pay for your premium through tax credits. That means you would pay less each month. You might get this help no matter what metal your plan is.
- If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government does not help you with these expenses.
When Get Covered Illinois/HealthCare.gov looks at your income, they count most of your earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Medicaid (138% FPG) | $20,783 |
All Kids (318% FPG) | $47,891 |
Subsidized private plans, reduced fees (250% FPG) | $37,650 |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
|
What happens if I sign up for an individual plan and then my income changes and I can no longer afford it?
Usually, when you sign up for a plan through Get Covered Illinois/HealthCare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2024, then you can’t leave that plan until 2025.
However, in certain situations you may be able to change plans mid-year:
- If your income changes and you gain or lose eligibility for government help paying for your coverage
- If your health provider is not meeting its obligations
- If you move, or
- In other life-changing circumstances, such as having a child or getting married.
The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Get Covered Illinois/HealthCare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).
Note: American Indians do not have these restrictions and can change up to once a month.
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Get Expert Help
How Work Affects SSI and SSDI
- Contact a Work Incentives Planning and Assistance Program
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Call the DHS Benefits Planning Program
1-217-588-6326 -
Call the Ticket to Work Help Line
1-866-968-7842
Medicaid
- Contact your DHS Family Community Resource Center
-
Call the Illinois Department of Human Services (IDHS) Help Line
1-800-843-6154 -
Call a Health Benefits for Workers with Disabilities (HBWD) expert
1-800-226-0768
Medicare
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Call Medicare
1-800-633-4227 -
Call the Senior Health Insurance Program (SHIP)
1-800-252-8966
Work Preparation
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Contact your local Rehabilitation Services office
1-877-581-3690 -
Contact the Bureau of Blind Services (BBS)
1-217-785-3887 - Contact your local Illinois workNet Center