Medicare Clients: This information does not pertain to you. This is for my under 65 individual medical clientele.
We’re ready to work with you either on or off the PPACA Obamacare Exchange
Being UPDATED for 2016. This page represents our current understanding and opinions of the under-65 individual medical market in Illinois. See actual carriers for details, no guarantees of coverage or accessibility implied.
Important enrollment dates:
January 1st effective date you must sign up by December 15th.
February 1st effective date you must sign up December 16th – January 15th.
March 1st effective date you must sign up January 16th – January 31st.
Carriers are Merging/Going out of Business
2016 has seen the disappearance of Assurant from the healthcare landscape and the merger of Aetna & Humana. This leaves only 4 major players in the Illinois market.
- Aetna (Humana, Coventry)
- Blue Cross Blue Shield of Illinois
- United Healthcare
- Land of Lincoln (a PPACA Obamacare created “Co-op”)
Provider Networks are Shrinking
As PPACA Obamare rolls on, 2016 has brought a barrage of network limitations for individual insureds. The trend is control cost by forcing individuals into HMOs. This is being accomplished by removing or severely limiting their PPO Options.
- Aetna offers a PPO and HMO off-Exchange (on Exchange HMO only)
- Humana, United Healthcare only offer HMO plans.
- Blue Cross offers both HMO plans and a SEVERELY limited “Choice PPO”.
- Land of Lincoln (co-op) offers PPOs, hopes to cap membership at 70,000 for 2016.
- Coventry (owned by Aetna) offers PPO Plans.
Blue Cross Changes
Many of our clients are covered by Blue Cross Blue Shield of Illinois.
- Precision HMO: Contains both NorthShore University HealthSystem & Advocate.
- BlueCare Direct: Smaller HMO. Blue Cross has teamed up with Advocate Health Care, forming their BlueCare Direct HMO. It’s an interesting twist that may work for some.
- Choice PPO: A limited PPO.
New! Hospital Network Crib Sheet
Use this chart as a starting place when searching for hospitals. Provider networks change daily, the information provided is not guaranteed to be accurate.
Which Networks are your Doctors & Hospitals in?
The first goal is to figure out which (if any) network has your doctors & hospitals.
- Your doctor may not be listed, but call their office and ask, they may be listed under their physicians group.
- Additionally, the 2016 networks are still firming up – essential doctors should be contacted to make ensure they’re truly in the network.
- Finally, make sure that your hospital is is the network.
Healthcare.gov can be used by everyone for research, but enrollment only for those receiving a subsidy. Those not receiving a subsidy should use my carrier links below for enrollment.
Healthcare.gov has a new service that allows you to see what networks your doctors are in.
- Note – it doesn’t filter the results based on doctors chosen. You must scroll through all the plans to see if doctor is not “Out-of-Network”.
- Note – it admits itself that it’s data is incomplete – double check with your doctors.
- However, it is a great place to start.
- Go to https://www.healthcare.gov/see-plans/ and enter your data.
- When you arrive at the result set, you’re hoping to see “Your doctors and medical facilities” and a blue EDIT button at the bottom of each plan. Click that button to begin.
- Search for a doctor or hospital, check them off and click ADD. You can repeat this step multiple times.
As it is currently a beta service, use it as an overview, then double check its findings using per-carrier doctor lookups in the list below.
Do not use the network links to enroll – if you do, you’ll become an orphaned policyholder of the company. Use my personal enrollment links (listed below) to enroll.
After each plan we’ve listed some of the popular doctor networks it looks like they cover – this is just a guide – confirm with your doctors to ensure their 2016 participation. If you discover something wrong or missing, please contact us.
- Managed Choice Open Access / OAMS Savings Plus (Northwestern, Lake Forest Hospital, Swedish Covenant) – Off exchange only, no subsidies.
- Whole Health Chicago HMO (Advocate, NorthShore – Check for Hospitals!)
- Network Lookup Link (do not use for enrollment)
- My Aetna Enrollment Link
Blue Cross Blue Shield of Illinois
- BlueCare Direct HMO