Benefits for Young People
- The Basics
- Why Benefits Matter
- Key Programs
- SSI Eligibility for Young People
- Medicaid and All Kids Eligibility
- HBWD Eligibility
- Private Health Coverage for Young People
- Other Programs
- Next Steps
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Private Health Coverage for Young People
To get private health insurance, somebody — you, your employer, your parents, your parent’s employer — must pay for that coverage. This section introduces the basic ways you can get private health coverage and explains some of the health expenses you may encounter.
Coverage Through Work
Many employers offer health benefits. That’s why private health insurance through work is the most common way that Americans get their health coverage.
If you get health benefits through your job, your employer pays part of the cost, with the amount depending on the employer and the plan options they offer. You also probably have to pay some money each month to have coverage. This monthly expense is called the premium.
When you have health insurance, you generally do not have to pay additional fees for certain preventive care services, such as routine testing and vaccinations, but depending on your plan, you may have to pay a portion of the cost for other services.
In addition to the premium, these are some of the other expenses you may have to pay when you have health insurance:
- A copayment is a set amount you have to pay for a medical visit or service. The amount of the copayment can depend on the service you get, or the type of doctor you see, such as a primary care doctor or a specialist. Example: Your copay to see your primary care doctor might be $35, but you might pay $50 to see a specialist.
- Co-insurance is a set percentage of the cost of a visit or service that you pay. Example: If your insurance plan pays 70% of your health expenses, you would pay 30% as co-insurance.
- A deductible is 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. Once you have paid the deductible, you do not have to pay it again until the next calendar year. Example: If your insurance has a $2,500 deductible, you have to pay $2,500 of your medical expenses before your plan will start paying for covered health expenses. Note: After you pay the deductible, you will still have to pay copayments and co-insurance.
All plans have an annual limit on the total amount you have to pay in addition to your monthly premium. This limit is called the out-of-pocket maximum. Example: If your plan has a $4,000 out-of-pocket maximum, once you’ve paid a total of $4,000 in copayments and co-insurance, your plan will pay for covered health expenses for the rest of the year. Note: The monthly premium isn't included in this maximum and will still have to be paid.
Coverage Through Parents
Federal law says that parents who get health coverage through their jobs can add any children under the age of 26 to their plans. Usually, a parent adding a child to their employer-based coverage has to pay some or all of the child's monthly premium.
All ACA-compliant health plans, no matter who pays for them, must cover the Essential Health Benefits (EHBs). This means that they offer comprehensive coverage, including regular checkups, vaccinations, chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, among other things.
Buying Health Insurance on Your Own
Some people pay a health insurance company directly instead of getting it through their jobs or parents. If you get a plan on your own, you will pay a monthly premium, copayments, and a deductible, depending on your plan. Depending on your household income, you may qualify for help in paying your monthly premium, if you get your plan through Get Covered Illinois/HealthCare.gov.
Get Covered Illinois/HealthCare.gov is the official ACA Health Insurance Marketplace in Illinois. It helps you find the right plan for your needs and budget, and it is where you can see if you qualify for help paying your monthly premium. It used to be that health insurance companies could deny you coverage or charge you more if you had a disability, but that's not true anymore. Now, it's much easier to get private insurance.
You should only think about getting health insurance through Get Covered Illinois/HealthCare.gov if you cannot get health coverage through:
If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium via a tax credit if you get your plan on Get Covered Illinois/HealthCare.gov. If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($36,450 for an individual or $75,000 for a family of four), the government also offers a silver plan that has lower copayments and other 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.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$14,580 | |
$5,140 | |
Medicaid (138% FPG) | |
All Kids (318% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
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:
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Read more about how to sign up for individual coverage in DB101's How Health Benefits Work article.
Learn more
What Benefits Do I Get?
How to see which Social Security and state benefits you get.
ABLE Accounts
ABLE accounts help people with disabilities save money without losing benefits.
Programs That Support Work
Learn about programs that can help you prepare for and find work.
Get Expert Help
SSI and SSDI
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
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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
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