Ald. Cappleman Retired May 2023 – Visit to Connect with Alderwoman Angela Clay’s Office


If you are still seeking healthcare coverage for the new year, deadlines are swiftly approaching. Open enrollment for ACA Health Insurance Marketplace Plans will be open until January 15, 2022.

HOWEVER. If you are seeking coverage for January 1, 2022 the deadline for new year coverage will be December 15, 2021. 

Check out this message from the Illinois state government for more details.

Do you need health coverage for the 2022 plan year?

Whether you are looking for health coverage for the first time or planning to update your current plan, can guide you to find the right coverage. Get Covered Illinois (GCI) can help you navigate healthcare coverage with free enrollment help and quality coverage. It’s also the place to find out if you qualify for financial help to lower the cost of your coverage.

The ACA Marketplace is the place to go to find guaranteed essential health benefits such as free preventive and wellness care, treatment for mental health services, emergency services, prescription drug coverage and more. Now is the time to shop and compare plans. Just click on “Shop and Enroll” and answer three questions and we can help guide you to the ACA Marketplace or Medicaid.

Visit to learn how you may be able to save on quality health insurance. Please keep in mind that you need to enroll by December 15 for coverage starting January 1, 2022.

What do I need to enroll? 

Below is a checklist provided by the GetCovered Illinois website. You can visit the site HERE for additional details. Double check that website for information on various enrollment concerns as well as customer protections.

  • Make sure the health insurance plan covers everything you might need.
  • When shopping for health insurance, beware of overly aggressive marketing tactics being used to sell plans or of anyone who won’t let you see the details of what’s covered BEFORE you buy.
  • If you are thinking of purchasing short-term health insurance or an Association Health Plan, it is important to pay very close attention to the benefits that are covered. These plans may NOT meet the minimum Essential Health Benefit (EHB) requirements under the Affordable Care Act (ACA). Selecting the wrong plan can result in higher medical bills.
  • Remember that all ACA Health Insurance Marketplace plans accessed through and purchased on meet the requirements of the Affordable Care Act (ACA).
  • Look at the chart below to see how ACA Marketplace plans can provide you with quality, affordable health insurance coverage.
  • Consider the health care needs of your household when deciding which ACA Marketplace plan to buy. If you expect many doctor visits or regular prescriptions, you might want to consider a plan with lower out-of-pocket costs.
  • When you complete an ACA Marketplace application, you can compare plans side-by-side based on price and other important features. You may qualify for financial help to lower your monthly premium or out-of-pocket costs.

What if open enrollment is over? 

After open enrollment periods close, there are certain health issues and major life events that make you eligible for special enrollment. These include:

  • Losing your job-based health coverage
  • Moving to a new ZIP code or county
  • A student moving from the place they attend school
  • Getting married
  • Divorced or legally separated and lost health insurance
  • Having a baby
  • Adopting a child
  • Turning 26
  • On an ACA Marketplace plan with someone who dies and as a result, you’re no longer eligible for your current health plan
  • If you are no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

Individuals have up to 60 days after the event to receive coverage.

How do I choose a plan?

Our office is not qualified to determine what type of coverage is best for you and your family. There are several things to keep in mind while choosing which coverage is best for you.

  • How often do you visit the doctor? If your health care needs are moderate, are you concerned about being able to pay for services for an unexpected illness or injury if your plan has high out-of-pocket costs?
  • Do you have an illness or see the doctor often? If so, what costs are you comfortable paying out-of-pocket?
  • Through the ACA Marketplace, most Illinois residents will qualify for financial help to lower monthly premium costs or reduce cost-sharing.
  • Only Silver plans are eligible for financial help with cost-sharing, and sometimes this financial help makes the cost-sharing on the Silver plans lower than Gold or Platinum plans.
  • Are your doctors and pharmacy in the plan’s network? Is your preferred hospital in the plan’s network?
  • Where do you generally see the doctor? If you get health services in multiple places or travel often, does the plan cover out-of-network providers or have a national provider network?
  • Will the plan require a referral to see a specialist or get other services? Do you prefer having one doctor who recommends other providers for your total health care?

There are three options in coverage

  • HMO (Health Maintenance Organization)
    • With an HMO, you may have lower out-of-pocket costs than other plans.
    • These plans generally will not pay for out-of-network services, or have limited out-of-network coverage, except in emergency situations.
    • You will need to pick a regular doctor, called a primary care physician (PCP), who can refer you to see other doctors in your network, like in-network specialists.
  • POS (Point of Service)
    • On average, POS plans have higher out-of-pocket costs than HMO plans.
    • Like an HMO, you will need to pick a regular doctor, called a primary care physician (PCP), to help monitor your health care. However, you do not have to get permission before visiting other doctors in your plan’s network, like in-network specialists.
    • POS plans give you the option of going out-of-network for services, but you will usually have to pay more.
  • PPO (Participating Provider Option)
    • PPO plans often have higher out-of-pocket costs than other plans.
    • Usually, you do not have to pick a regular doctor or get referral to see specialists.
    • With a PPO plan, your insurance company will pay a portion of your out-of-network costs. This means you will have more freedom to choose doctors and hospitals regardless of network. However, you may pay more for services provided out-of-network.

If you have more questions please call 866-311-1119 OR visit the Illinois Healthcare Website HERE.

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