How Health Benefits Work

Common Pitfalls

Not getting health coverage because you think it's too expensive

Almost everyone has a health coverage option, even if you have a disability. The exact coverage that’s right for you depends on things like your family’s income, whether you can get employer-sponsored coverage, your age, where you live, and whether you have a disability.

If you can get employer-sponsored coverage or public health coverage, like Medicare or Medicaid, they are probably your best options.

If you can’t, you should look into getting an individual plan through Get Covered Illinois/, where the government may help you pay a plan's expenses. 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.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

Getting an individual plan without using Get Covered Illinois/

Get Covered Illinois/ is the best way to get an individual plan. You are still allowed to get insurance through an insurance broker, but there are four big reasons it is better to use Get Covered Illinois/

  1. Get Covered Illinois/ is the only way to get government help paying for your premiums and other health expenses.
  2. It automatically checks if you or your family might qualify for a public health coverage program, like Medicaid, and lets you know how to apply for it instead of an individual plan.
  3. Get Covered Illinois/ has customer services representatives available over the phone at 1-866-311-1119. You can also get local help.
  4. It’s totally free — there are no commissions and no hidden fees.

Not understanding the expenses involved with private health coverage

When making decisions about health coverage and comparing different plans, make sure you understand all of a plan’s costs, which can include:

  • Premiums, a monthly amount that has to be paid whether or not you use medical services. If you have employer-sponsored coverage, your employer pays part or all of the premium and you pay whatever the employer doesn’t pay. If you have individual coverage, you pay the entire premium, though the government may help you pay through tax subsidies if your income is low enough.
  • Copayments, a set amount you have to pay for a medical visit or service. The exact amount of the copayment depends on the service you get: Medications, visits to specialists, lab tests, X-rays, emergency room visits, and other services can all have different copayment amounts.
  • Co-insurance, a set percentage of the cost of a visit or service that you must pay.
  • A deductible, a set amount of money that you pay out of your own pocket each year before the insurance company begins to pay for certain services, including hospital care, emergency room visits, and brand-name prescription drugs. After you pay the deductible, you do not have to pay it again until the next calendar year.

Not looking into Medicaid because you think you don’t qualify

Medicaid used to be mainly for people with disabilities, seniors, children, and pregnant women. Now, it is for anybody with low income (at or below 138% of the Federal Poverty Guidelines (FPG), $20,783 for an individual; $43,056 for a family of four). No matter how much money you have in the bank or what your health situation is, you could qualify.

Not working because you think you’ll lose Medicaid coverage

In the past, people feared that if they got a job while they were on Medicaid, they’d lose their coverage, because they would no longer have low enough income to qualify.

Now, if you lose one health coverage option, there should be another one you can get. If you lose your Medicaid coverage, you will become eligible for Health Benefits for Workers with Disabilities (HBWD), employer-sponsored coverage, or private individual coverage. And, if you can’t afford individual coverage, the government may help you pay for it.

The bottom line: There is a coverage option for most people. Do not worry that getting a job will leave you without health coverage.

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