Macon Health Insurance

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Heath Care Reform

Small business tax credits.  194,000 small businesses in Illinois could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 151,000 Medicare beneficiaries in Illinois hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Illinois who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 174,000 people from Illinois retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 7.5 million Illinois residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 612,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Illinois peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 6.9 million residents of Illinois with health insurance from their employer, along with anyone who signs up with a new insurance plan in Illinois.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 47,200 individuals in Illinois who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $196 million federal dollars are available to Illinois starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 570 Community Health Centers in Illinois but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 17% of Illinois’s population who live in an underserved area.

New Medicaid options for states. For the first time, Illinois has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

State Government Insurance Programs Offered

Comprehensive Health Insurance Plan (CHIP) Can be covered in 6 ways: 1) Federal Eligibility: Most recent coverage must have been group plan lasting 18+ months with no break of 90+ days, and lost coverage not due to fraud or non-payment of premium, and exhausted all COBRA coverage. Not eligible for any group plans; HCTC: are TAA or PBGC Certified with at least three months of prior creditable coverage; 2) HIPAA Plan: Must be both Federal- and HIPAA-eligible; 3) HCTC Plan: Must be both Federal- and HCTC- eligible; 4) Traditional Plan: Must be denied coverage due to pre-existing conditions or have a similar plan but costs them more than CHIP, has one of the covered pre-existing conditions; 5) Medicare Plan: Must be enrolled in Medicare parts A and B; 6) Presumptive Condition: Must prove having a qualified medical condition and be under 65 years old

Pre-Existing Condition Insurance Plan(IPXP) – Must have been uninsured for at least 6 months prior to applying. Must prove being a U.S. citizen or legal U.S. resident, an Illinois resident, and having problems getting insurance due to a pre-existing condition


Medicaid: Different program variations covering Medical, Dental and Vision, Prescriptions, Hospitalization and more depending on program. Programs for people with either MS, nursing home needs, kidney dialysis, breast and cervical cancer, AIDS, TB, hyper-alimentation, pregnancy. Both: Must be U.S. citizens or qualified aliens and live in Illinois. Medicaid: Income limits: Children ages 1–18: 133% FPL. Pregnant women and infants: 200% FPL if the mother is enrolled in Medicaid at time of birth. If not, infants with family incomes of 133% FPL. Parents/caretakers living with children ages 0–18: 185% FPL. Aged, blind, disabled: 100% FPL. SSI recipients: 40% FPL. Medically-needy: 100% FPL.

FamilyCare FamilyCare: Covers doctor visits, dental care, specialty medical services, hospital care, emergency services, prescription drugs and more.

ALL Kids – Doctor visits, Hospital stays, Prescription drugs, Vision care and eyeglasses, Dental care, Regular checkups, Immunization shots, Medical equipment, Speech and physical therapy for children who need them.

Illinois Breast & Cervical Cancer Program (IBCCP)

www.cancerscreening.illinois.Gov – Offers mammograms, breast and pelvic exams, and Pap tests. If enrolled in the BCCP and diagnosed with cancer through the program’s screenings, can be eligible to receive treatment.

Healthy Women

(Health Benefits Hotline) www.illinoishealthywomen.Com – Healthy Women: Covers family planning (birth control) and patient education. Certain services provided such as physical exams, Pap tests, lab tests for family planning, testing and medicine for STDs found during a family planning visit, and sterilization. Also covers mammograms, multivitamins and folic acid if they are ordered by the doctor during the family planning visit.

Medicare – Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Illinois Cares Rx

(Health Benefits Hotline) – Provides state prescription drug assistance to people with and without Medicare.

Health Coverage Tax Credit (Search: HCTC)

VA Medical Benefits Package – Comprehensive preventive and primary care, outpatient and inpatient services.

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