No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance June 2012

No Insurance? Health Care Options for Individuals Age 55-64 Without Insurance June 2012 This toolkit was created with generous support from The Chicago Community Trust.

Introduction In Illinois, more than 185,000 people between the ages of 55 and 64 do not have health insurance. This is generally because they have a job that does not offer coverage, lost their job, or cannot afford to buy insurance. Medicare coverage (for those who qualify) does not begin until at age 65; as a result, this group is more likely to forego medical care and wait until their Medicare coverage begins to seek medical care for a health condition. It is important not to wait to get essential preventive medical treatments. More than half of the people in this age group have limited incomes and cannot afford to buy private health insurance policies. Others are denied health insurance policies because of their chronic health conditions. According to a report from AARP, four out of five people age 55 and older have at least one chronic medical condition, such as heart disease, diabetes or arthritis. Having a chronic condition makes it difficult to buy insurance because pre-existing conditions often lead to higher premiums or denial of coverage from health insurance companies. This guide was created to help people age 55-64 learn about available public health care programs they can use until their Medicare coverage begins or many of the changes in the Affordable Care Act take place in 2014 - whichever happens first. The guide includes information about resources, such as community health centers, which provide people of all ages with primary care services (like a check-up or prescription) regardless of whether they have insurance or not. One out of sixteen people in the U.S. now rely on resources like community health centers for their care. In 2014, the Affordable Care Act (also referred to as health care reform) will allow everyone to purchase affordable coverage through the Affordable Insurance Exchange, a marketplace for health insurance. People with limited incomes who cannot afford insurance may be able to enroll in Medicaid, the state s public medical assistance program. Currently, the Medicaid program only covers children, families with children, people with disabilities and people age 65 and older. In 2014, states will have the option of expanding Medicaid coverage to include anyone with an income below 133% of the Federal Poverty Level. (See page 5 of this guide for 2012 Federal Poverty Levels.) How to use this guide The main goal of this guide is to provide a resource to identify options to help you access needed medical treatment or preventive services like mammograms or cholesterol screenings. These options range from public benefit programs with low cost co-pays and premiums to health insurance policies. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 2

Sections of this guide: Health Care Coverage Options This section includes information about health care programs in the state of Illinois, including local programs in the Chicago metropolitan area (Cook County). Each program description includes who the program serves, eligibility criteria, income and/or asset limits and the health benefits that the program includes. Programs in this section are organized by the following topics: Resources if you live in Illinois Resources if you live in Cook County Resources if you have a disability or a pre-existing condition and have been denied or cannot afford medical coverage Resources if you are uninsured and have a family Resources if you need dental services How the Affordable Care Act will Expand Health Care Coverage This section offers an explanation of changes included in the Affordable Care Act law and how it will expand coverage to help people age 55-64 gain access to affordable and quality health care. It contains information about how the Affordable Care Act will affect you if you are about to turn 65 soon or are uninsured. It also explains the changes already in place and future changes that will happen in 2014, when most of the big reforms in the Affordable Care Act will occur. Informational Resources Where to Go For Help This section provides contact information for agencies in the state of Illinois that may be able to help you by explaining different benefit programs available, as well as information about how to file a complaint against an insurance company or medical provider and what you need to know if you are buying insurance. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 3

Health Care Coverage Options AgeOptions on behalf of the Make Medicare Work Coalition June 2012 4

2012 Federal Poverty Levels Many programs have specific income guidelines that are based on what are called the Federal Poverty Levels (FPL). These income guidelines are determined by the U.S. Department of Health and Human Services and change every year. Each program listed in this guide has its own income and/or asset limits. In some instances, only a FPL percentage level is listed. The charts below will provide you with the 2012 income guidelines each time a percentage is listed. The FPL guidelines for 2012 are listed below: 2012 Federal Poverty Guidelines for the 48 Contiguous States and the District of Columbia Annual Income Guidelines Household Size 100% 200% 300% 400% 500% 600% 1 $11,170 $22,340 $33,510 $44,680 $55,850 $67,020 2 $15,130 $30,260 $45,390 $60,520 $75,650 $90,780 3 $19,090 $38,180 $57,270 $76,360 $95,450 $114,540 4 $23,050 $46,100 $69,150 $92,200 $115,250 $138,300 5 $27,010 $54,020 $81,030 $108,040 $135,050 $162,060 6 $30,970 $61,940 $92,910 $123,880 $154,850 $185,820 7 $34,930 $69,860 $104,790 $139,720 $174,650 $209,580 8 $38,890 $77,780 $116,670 $155,560 $194,450 $233,340 Monthly Income Guidelines Household Size 100% 200% 300% 400% 500% 600% 1 $931 $1,862 $2,793 $3,724 $4,655 $5,585 2 $1,261 $2,522 $3,783 $5,044 $6,305 $7,565 3 $1,591 $3,182 $4,773 $6,364 $7,955 $9,545 4 $1,921 $3,842 $5,763 $7,684 $9,605 $11,525 5 $2,251 $4,502 $6,753 $9,004 $11,255 $13,505 6 $2,581 $5,162 $7,743 $10,324 $12,905 $15,485 7 $2,911 $5,822 $8,733 $11,644 $14,555 $17,465 8 $3,241 $6,482 $9,723 $12,964 $16,205 $19,445 FPL guidelines for next year can be found at http://aspe.hhs.gov/poverty. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 5

If You Live in Illinois Community Health Centers Community health centers are not for profit medical providers or organizations that receive funding from the federal government to provide medical care to people with limited income or no health insurance. Community health centers serve people of all ages and charge for services on a sliding scale. A sliding scale means that fees and cost of services are based on the individual s annual income and family size. Community health centers can be found in most areas and provide primary care services, such as medical care when you are sick, check-ups and physicals, preventive care, prescription drugs, dental care, mental health services and counseling for substance abuse. In addition, community health centers provide pregnant women with prenatal care and children with check-ups and immunizations. To find a community health center near you, visit the U.S. Department of Health and Human Services website at http://bphc.hrsa.gov or call (877) 464-4772. Please visit http://www.healthcare.gov/using-insurance/low-cost-care/communityhealth-centers for additional information about community health centers. Illinois Hospital Uninsured Patient Discount Act The Hospital Uninsured Patient Discount Act is an Illinois law that puts a cap on hospital bills and offers discounts to uninsured patients living in Illinois who apply for the program. Prior to this law, uninsured patients paid higher rates for hospital care than insured patients, mainly because insurance companies would negotiate a lower rate with the hospital for their members. The law applies to any hospital bill that costs more than $300. It limits the amount hospitals can charge uninsured patients to the hospital s cost of the service plus 35%. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 6

The law also caps the amount hospitals can collect from an uninsured patient to no more than 25% of the patient s family income during a 12-month period. To apply for the discount and qualify, you must: be a resident of Illinois be uninsured apply within 60 days of your hospital discharge or service and have income and assets of no more than 600% of the Federal Poverty Level if you receive services in a metropolitan area and 300% of the Federal Poverty Level if you receive services at rural and critical access hospitals. (See page 5 for 2012 Federal Poverty Levels.) Note: Income and assets are not combined; they are counted separately. (In other words, if you live in a metropolitan area, your income must be below 600% FPL and your assets must also be below 600% FPL the two amounts will not be added together.) Contact the hospital in which you received the service to apply. Hospitals are required to include information on how to apply for the program along with any bill or statement they provide to patients. For additional information or to report a complaint, contact the Illinois Attorney General s Office (800) 386-5438 or visit www.ag.state.il.us/pressroom/2009_03/20090330.htmlb. Hill-Burton Free and Reduced-Cost Health Care Program The Hill-Burton Free and Reduced-Cost Health Care Program provides free or reduced-cost health care to individuals who cannot afford to pay. Note that only certain hospitals, health care facilities and nursing homes participate in the Hill- Burton program. To access a list of participating facilities call (800) 638-0742 or visit http://www.hrsa.gov/gethealthcare/affordable/hillburton/facilities.html. To qualify for the program, your income must be at or below 200% of the Federal Poverty Level. (Individuals in nursing homes may have income at or below 300% of the Federal Poverty Level. Please see page 5 for 2012 Federal Poverty Levels.) You must apply at one of the facilities that is a Hill-Burton AgeOptions on behalf of the Make Medicare Work Coalition June 2012 7

obligated facility before or after you receive services. You may apply for the Hill- Burton program even if the bill for your services has gone to a collection agency. If you are found eligible, the facility determines which services are free or at a reduced cost. Free and reduced-cost services only apply to facility costs, not private physician bills. For additional information please visit the U.S. Department of Health and Human Services website athttp://www.hrsa.gov/gethealthcare/affordable/hillburton or call (800) 638-0742. Illinois Breast and Cervical Program The Illinois Breast and Cervical Program is offered by the Illinois Department of Public Health and provides free mammograms, breast exams, pelvic exams and Pap tests to women who are eligible. Women who qualify for Medicare or Medicaid are not eligible for this program. To qualify for the program you must: be a resident of Illinois be uninsured and be between the ages of 35-64 Women who are diagnosed with breast and/or cervical cancer may also be eligible for free treatment. For more information or to apply, visit http://cancerscreening.illinois.gov or contact the Women s Health Line at (888) 522-1282 or TTY (800) 547-0466. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 8

If You Live in Cook County Access to Care The Access to Care program provides affordable primary health care services, including assistance paying for prescription drugs for low-income, uninsured individuals who live in suburban Cook County and Northwest Chicago (north of North Avenue and west of Pulaski Road.) To qualify for the Access to Care program your family income must be less than 200% of the Federal Poverty Level (See page 5 for 2012 Federal Poverty Levels.) you must be uninsured (or if you have insurance, you must have a deductible of $500 or more) you must be ineligible for Medicare, Medicaid, AllKids or Family Care Access to Care offers doctor office visits, prescription drugs, lab test and x-rays. You will pay a co-payment for each of these services. If approved for the program, Access to Care will assign you to a doctor. Any specialist referrals will be made by your assigned Access to Care doctor and arranged at John Stroger (Cook County) Hospital or Oak Forest Hospital. Applications may be submitted by mail or you may apply at a local registration site. Visit http://accesstocare.org/patient/application.php to print out an application or obtain a list of registration sites. To request an application be mailed to you, call (708) 531-0680. Cook County Health and Hospital Systems (CCHHS) Carelink Financial Assistance Program Carelink is a financial assistance program available to Cook County residents who are uninsured or underinsured. The program helps cover the costs of medical care received only at Cook County Hospital and Health Systems. To qualify for Carelink individuals must: AgeOptions on behalf of the Make Medicare Work Coalition June 2012 9

be a Cook County resident have an annual income of 600% of the Federal Poverty Level (see page 5 for 2012 Federal Poverty Levels) have no insurance or have private or public insurance that does not cover the cost of medically necessary care be screened for Medicaid Carelink counselors are available to help you determine if you are eligible and to apply for the program. Call (866) 223-2817 to make an appointment. You may also visit www.cookcountyhealth.net to print out an application and view the types of information you will need to bring along to your appointment. If you are found eligible for Carelink, the program will assist you by providing a discount between 25% and 100% off of medical costs received at Cook County hospitals and health centers only. The discount you receive will depend on your family size and annual income. Services include clinic visits, lab services, hospital stays, prescriptions, and urgent and emergency care. A few of the most common Cook County hospitals and health centers include John H. Stroger Hospital, Provident Hospital and Oak Forest Medical Center. To view a complete list of Cook County hospitals and health centers please visit http://www.cookcountyhhs.org/locations or call (312)864-6000. Individuals who do not live in Cook County and receive medical services at a Cook County hospital or health center are not eligible to receive full Carelink assistance but can request a discount under the Illinois Uninsured Patient Discount Act (see pages 6 and 7 for information). For more information about the Carelink Financial Assistance Program visit http://www.cookcountyhhs.org. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 10

If You Have a Disability or a Pre-existing Condition and Have Been Denied or Cannot Afford Medical Coverage Medicaid Medicaid is a program available to people age 65 and older, children, pregnant women, families with children under age 18, individuals who are blind and people with disabilities who need help paying for medical care. People in each of these groups must meet different criteria to qualify for Medicaid. The Illinois Department of Human Services (DHS) Family Community Resource Centers accept applications and determine eligibility for Medicaid; the Illinois Department of Healthcare and Family Services (HFS) administers the program by providing the health care coverage and paying medical providers. Both agencies work together to manage the Medicaid program in Illinois. To qualify for Medicaid, individuals age 65 or older and people with disabilities must: Be a resident of Illinois Be a U.S. citizen or qualifying non-citizen Have income less than 100% of the federal poverty level Have assets less than $2,000 if single or $3,000 if married Disclose on your application if you have other type(s) of health coverage If you are disabled and not receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits through the Social Security Administration, Medicaid will review your disability when you apply to determine if you qualify. You can obtain a Medicaid application by visiting http://health.illinois.gov/hfs.html. Applications may be mailed, faxed, completed online or submitted in person to a local Department of Human Services office. To locate your local office visit http://www.dhs.state.il.us/page.aspx?module=12 or call (800) 843-6154. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 11

Medicaid covered services include: Care at clinics Chiropractic care Dental care (limited for adults) Doctor's services Eye care Family planning (birth control) Help for alcohol and substance abuse Hospice care Hospital care Intermediate and skilled nursing care Laboratory tests & X-rays Medical equipment & supplies Medical transportation Podiatry (foot care) Prescription drugs Psychiatric care Rehabilitation assistance (physical therapy) Renal dialysis Second opinions for surgery Special appliances & devices *Source: http://www2.illinois.gov/hfs/medicalprograms/brochures/pages/hfs591.aspx Medicaid Spenddown If you apply for Medicaid and your income and/or assets are more than the amounts listed above, you will be notified by Medicaid of your Medicaid Spenddown amount. This means you may still qualify for medical benefits through Medicaid. Medicaid Spenddown works like an insurance deductible Medicaid will pay for medical care when you have medical bills (including health insurance premiums) in the amount of your monthly spenddown. To meet your spenddown and obtain a Medicaid card, bring your medical bills or receipts to your DHS caseworker. You can also choose to directly pay your spenddown amount by enrolling in Pay-In Spenddown through your local DHS office. Medicaid and Estate Recovery The state of Illinois may file estate claims against the property of some individuals who receive Medicaid assistance. These claims may only be filed after the person s death. For more information about estate recovery in Illinois, visit the following webpage: http://www2.illinois.gov/hfs/medicalprograms/brochures/pages/hfs3419b.aspx AgeOptions on behalf of the Make Medicare Work Coalition June 2012 12

Health Benefits for Workers with Disabilities The Health Benefits for Workers with Disabilities program allows workers with disabilities who are employed to purchase medical coverage. Individuals who qualify for the program can purchase medical and prescription drug benefits through the Illinois Medicaid program. Individuals with disabilities who are on the regular Medicaid program are not eligible for the Health Benefits for Workers with Disabilities program. To qualify for the program, you must: be a resident of Illinois be a U.S. citizen or legal permanent resident be between the ages of 16 and 64 be employed and provide proof of paying payroll taxes and have a disability. An applicant must meet Social Security s definition of disability. Disability status can be proven by submitting proof of Social Security Disability Insurance, Supplemental Security Income or a determination by the state s Client Assessment Unit. Individuals who qualify for the Health Benefits for Workers with Disabilities program may have substantially higher incomes and assets than people in the traditional Medicaid program In 2012, your monthly income must be less than: $3,258 for a family of one $4,413 for a family of two $5,568 for a family of three $6,723 for a family of four Note: income amounts change every year. You must also have countable assets of $25,000 or less. Countable assets include bank accounts, savings accounts, motor vehicles, property, stocks, bonds, etc. The value of your home and one motor vehicle is exempt. If you qualify, you must pay a monthly premium to receive benefits. You will then receive a monthly medical card and pay low co-payments for medical services. Premiums vary from $0 to $119 and depend on your income. Benefits include a AgeOptions on behalf of the Make Medicare Work Coalition June 2012 13

co-payment of $2 for each doctor s visit, $3 for each brand name prescription and up to $3 for inpatient hospital services. Estate Recovery and HBWD Assistance The state of Illinois may file estate claims against the property of some individuals who receive HBWD assistance. These claims may only be filed after the person s death. For more information about estate recovery in Illinois, visit the following webpage: http://www2.illinois.gov/hfs/medicalprograms/brochures/pages/hfs3419b.aspx For more information about the HBWD program, visit http://www.hbwdillinois.com or call (800) 226-0768. Illinois Pre-Existing Condition Insurance Plan (IPXP) The Illinois Pre-Existing Condition Insurance Plan (IPXP) is a temporary high-risk insurance pool for people with pre-existing health conditions who are unable to obtain health insurance. The program is run by the state Department of Insurance with federal funding and will remain in place until 2014, when the Health Insurance Exchange is implemented as part of the Affordable Care Act. To qualify for IPXP an individual must: be a U.S. citizen, national, or legal resident be uninsured for a minimum of 6 months (cannot have Medicare, Medicaid, private insurance or ICHIP) have a pre-existing condition and be able to pay the premium and out-of-pocket costs IPXP applications may be submitted online, by mail or fax. To access an online application and a Frequently Asked Questions (FAQ) list, go to the Illinois Department of Insurance website: http://www.insurance.illinois.gov/ipxp/. If you qualify for IPXP, you will have the option of choosing between four insurance plans. Each plan has a different deductible and premium you will be responsible for paying. To learn more about IPXP and the plans offered visit http://insurance.illinois.gov/ipxp or call (877) 210-9167. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 14

Illinois Comprehensive Health Insurance Plan The Illinois Comprehensive Health Insurance Plan, also called ICHIP, is a state health insurance plan for individuals who have been denied coverage from private companies because of a pre-existing medical condition. ICHIP is not an insurance company or benefit program. Individuals who are accepted into one of the plans must pay a monthly premium. ICHIP is similar to IPXP (see page 14), but is not a temporary program. ICHIP existed before the Affordable Care Act was passed and continues to provide coverage for many people with pre-existing conditions in Illinois. Note: Premiums for ICHIP plans are generally higher than premiums under IPXP, so it is a good idea to check to see if you are eligible for IPXP before applying for ICHIP. To qualify for ICHIP you must: have been denied individual health insurance because of a pre-existing condition have an individual policy that is similar to ICHIP but costs more than ICHIP have one of 31 medical conditions that would presumably make you uninsurable (a list of the medical condition may be found at http://www.chip.state.il.us/planfacts.html#presume) If you qualify for ICHIP, you will have the option of four different plans choices depending on how you qualified for ICHIP. Each of the four plans has its own eligibility criteria and various deductible options. Additional information about ICHIP plans can be found at http://www.chip.state.il.us or by calling (866) 851-2751. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 15

If You are Uninsured and Have a Family FamilyCare The FamilyCare program is health care coverage offered to parents living with their children who are 18 years of age or younger. The program also covers relatives who are caring for children in place of their parents. FamilyCare is a Medicaid program and offers the following medical benefits: doctor visits hospital care specialty medical services emergency services prescription drugs dental care and more To qualify for FamilyCare, you must: live in Illinois meet FamilyCare income limits be a U.S. citizen or meet immigration requirements To qualify for FamilyCare in 2012, your monthly income must be below: $1,677 for a family of two $2,116 for a family of three $2,555 for a family of four add $439 for each additional family member If you qualify for FamilyCare, you pay: $2 for each doctor or medical visit $0 for each generic drug or $3 for each brand name you fill Up to $3 per day for inpatient hospitalization and $0 for emergency room use in non-emergencies Visit http://www.familycareillinois.com or (866) 255-5437 for additional information or to find out how to apply. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 16

If You Need Dental Services If you are in need of dental care but do not have dental insurance, there may be services available to help you. Please note that services listed below are not guaranteed and are listed as a possible resource. Dental Clinics in Illinois Dental Clinics offer reduced cost or sliding scale dental care. Sliding scale means that fees and cost of services are based on the individual s annual income and family size. For a list of dental clinics in Illinois compiled by the IFLOSS Coalition, a group of community health departments and clinics dedicated to improving the oral health of Illinois residents, visit the following website: http://ifloss.org/pdf/clinicslist_2011.pdf Please note that not all dental clinics offer a full range of dental services and some clinics only serve specific populations or geographic regions. You should always contact the dental clinic first to find out if they offer the service you are looking for and accepting new patients. Community and Economic Development Association of Cook County (CEDA) Block Grant Emergency Dental Program The CEDA Block Grant Emergency Dental Program may be able to provide financial assistance for an oral health emergency. If you qualify, you may eligible to receive a dental service voucher up to $1,000 per household. To qualify you must: live in suburban Cook County not have dental insurance meet the income limits listed below complete an application form to determine income eligibility receive services from a participating dentist in the Dental Assistance Program Referral and Voucher System AgeOptions on behalf of the Make Medicare Work Coalition June 2012 17

CEDA will request proof of income for the three months prior to your application date. The income limits for the program are listed below. Note the amounts are for a three month period. $3,490.63 for a household of one $4,728.13 for a household of two $5,965.63 for a household of three $7,203.13 for a household of four $8,440.63 for a household of five $9,678.13 for a household of six $10,915.63 for a household of seven $12,153.13 for a household of eight (add $1,237.50 for each additional family member) Visit http://www.cedaorg.net/www2/csbgdental.html or call (800) 571-2332 for more information. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 18

How the Affordable Care Act Will Expand Health Care Coverage AgeOptions on behalf of the Make Medicare Work Coalition June 2012 19

How the Affordable Care Act Will Help You in the Future The Affordable Care Act (ACA), often referred to as health care reform, became law in March 2010. The law aims to improve access, quality and affordability of health care coverage for Americans. Changes and improvements to health care will take place through 2014. Many changes have already happened to help seniors, young adults, and individuals with pre-existing conditions obtain or maintain coverage. These early changes may have already assisted you. For example, the ACA has been strengthening and expanding community health centers by increasing funding to these centers, including 534 centers in Illinois. Funding is currently being used to create new community health centers, increase the centers ability to serve more people and expand preventive health services (such as annual doctor visits, screening for chronic diseases, and health education). The Affordable Care Act also requires changes to the health care system that will help you in the future. The majority of the changes will happen in 2014. If you will turn 65 soon: The Affordable Care Act has expanded coverage for people who are eligible for Medicare. This coverage includes: Free annual wellness visit with your doctor and additional preventive services, such as mammograms and colonoscopies. (For information about all of the preventive services covered by Medicare, visit Medicare s website: http://www.medicare.gov/navigation/manage-your-health/preventiveservices/preventive-service-overview.aspx.) Help paying for prescription drugs. Each year until 2020, people with Medicare will pay less for their brand name prescription drugs in the donut hole. The donut hole is a gap in Medicare s prescription drug coverage. In the past, once someone reached the donut hole limit, s/he had to pay the entire cost for prescription drugs until reaching a catastrophic coverage threshold. Now, because of the ACA, people with Medicare pay less for their drugs while they are in the donut hole. In 2012, people in the donut hole receive a 50% discount on brand-name drugs and a 14% discount on generic discounts. These discounts will continue to increase until 2020, when the donut hole will have disappeared completely. If you are currently uninsured: The Affordable Care Act will help people who are now uninsured to get insurance. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 20

Changes already in place: People who cannot obtain insurance because of a pre-existing condition may be able to obtain coverage through the Illinois Pre-Existing Condition Insurance Plan (IPXP). See page 14 for more information about IPXP. As of 2010, the ACA created an Early Retiree Insurance Program that provides financial assistance to employers so they continue providing health coverage to individuals age 55 and older who retire early but are not yet eligible for Medicare. Employers must apply and be approved for the program. Changes that may help if you have children: o Individuals less than 26 years old that do not have insurance offered to through an employer may obtain insurance coverage through a parent s insurance plan, if they have insurance. This rule applies to anyone who does not have employer insurance available to them, including students, people who are married, and people who are currently employed. Veterans may remain on their parents insurance until age 30. o Insurance companies may not deny coverage to children under age 19 due to a pre-existing condition. Changes that will take place in 2014: In 2014, states may choose to expand the Medicaid program (see page 11 for description) to all adults, including single adults with no children, who have incomes up to 138% of the Federal Poverty Level. This will mean many more people will be eligible to get health services through the Medicaid Program in states that elect to participate in this expansion. Every state will have an Affordable Health Insurance Exchange. The Exchange will be online and will let people compare and purchase health insurance plans. The Exchange will be available to any individual looking to purchase health insurance on their own. Small businesses will also be allowed to use the Exchange to purchase plans for their employees or dedicate funding toward their employees plan choices in the Exchange. If you are not eligible for Medicaid, but insurance is still too expensive for you to buy, the federal government will help you to pay the costs. They will help pay for part of the insurance premium if your income is between 100% and 400% of the Federal Poverty Level. The government will also help with costs of deductibles and copayments if your income is between 100% and 250% of the Federal Poverty Level. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 21

When you purchase health insurance, no insurer will be allowed to deny you coverage because of a pre-existing condition. They also may not base your premiums on whether you have a pre-existing condition or on gender. The only factors insurance companies will be able to consider in setting premium amounts are age, geography, and tobacco use. Insurers will not be allowed to impose annual or lifetime coverage limits on your insurance benefits. Even if you develop cancer or a chronic disease that costs a lot of money, the insurer cannot stop paying for your coverage as long as you continue to pay the premiums. While you will be able to purchase your own health insurance through the Exchange, the ACA encourages small businesses to provide employer health insurance plans to their employees. Small businesses will receive health care tax credits and lower rates in the Exchange so that they can cover employees. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 22

Informational Resources: Where to Go For Help AgeOptions on behalf of the Make Medicare Work Coalition June 2012 23

Informational Resources to Help You Explore Your Health Care Coverage Options Where do I go for Help? Resources are available to provide you with information about your health care coverage options currently available in Illinois. The resources listed below can help you start exploring the different options available until you become eligible for Medicare. The Illinois Department of Insurance The Illinois Department of Insurance makes sure companies selling insurance in Illinois follow certain laws and regulations. The Illinois Department of Insurance also investigates complaints against most types of insurance companies (health, auto, home, etc.) and provides educational resources that include state insurance and health benefits program information, an explanation of insurance terms, and how different types of private insurance policies work. In addition to regulating insurance companies, investigating complaints and educating consumers, the Illinois Department of Insurance also offers the Uninsured Ombudsman Program to help residents of Illinois with health insurance problems and explore available health care options. Uninsured Ombudsman Program The Uninsured Ombudsman Program provides education and assistance to Illinois residents who are uninsured, are about to lose their health insurance or cannot afford insurance. The Ombudsman provides information about available state and federal health care programs and which questions to ask when you are shopping for insurance. If you no longer have health care coverage through your employer, the program can help you by explaining the rights you have to continue your coverage through COBRA or mini-cobra. (COBRA is an opportunity to continue to purchase your employer s group health coverage on your own for a period of time after you lose your job.) Visit www.insurance.illinois.gov/healthinsurance/uninsured_ombudsman.asp or call (877) 527-9431 for more information. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 24

The Office of the Illinois Attorney General Health Care Bureau The Office of the Attorney General is the chief legal officer of the state and responsible for protecting the public interest of Illinois residents. One of the services the Attorney General provides is a Health Care Bureau to assist Illinois residents in filing health care complaints against medical providers or private health insurance companies. The Attorney General s Health Care Bureau helps with problems you may be having with an insurance company or medical provider. The Health Care Bureau can assist with problems such as billing issues, denial of coverage or treatment, unfair debt collection and practices or misleading and false advertising. The Health Care Bureau can also help you by explaining patient rights and what you need to know before you buy health insurance. Visit www.illinoisattorneygeneral.gov/consumers/healthcare.html or call (877) 305-5145 for more information. Public Health Departments The Illinois Department of Public Health, which is in charge of promoting the health of Illinois residents through the prevention and control of disease, also certifies 96 local health departments in Illinois. These health departments educate and assist residents at a local level in accessing health benefit programs and clinics. If you cannot afford insurance, county and local health departments may be able to provide you with information about health programs and services available in your area. Some health departments also provide medical services, such as immunizations and health screenings. Contact the Illinois Department of Public Health at (217) 782-4977 or visit http://www.idph.state.il.us/local/home.htm to find your local health department. Area Agencies on Aging The Illinois Area Agencies on Aging plan and coordinate services for older adults in Illinois. Most services are available to individuals age 60 or older, but some Area Agencies on Aging also offer resources and assistance to individuals under 60. To find your local Area Agency on Aging, visit the Illinois Department on Aging website here: http://www.state.il.us/aging/2aaa/aaa-main.htm. AgeOptions, a co-leader of the Make Medicare Work Coalition, is the Area Agency on Aging for suburban Cook County. Individuals in suburban Cook who are looking for health care options may contact AgeOptions for assistance at (800)699-9043. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 25

Online Resources Affordable Care Act Healthcare.Gov: www.healthcare.gov An official government website that provides consumer friendly information about the Affordable Care Act law (also known as healthcare reform). The website also includes information about health coverage options currently available to U.S. residents and information about what will be available in 2014, when most of the key features of the Affordable Care Act take place. Illinois Health Matters: www.illinoishealthmatters.org Illinois Health Matters provides up-to-date information about the Affordable Care Act and what it means for Illinois residents now and in the future. The website also provides resources and a blog for individuals, small businesses, community organizations, the media and policymakers. The website is created by Health & Disability Advocates, a policy and advocacy organization, in partnership with nine additional policy and community-based agencies, including AgeOptions. The Kaiser Family Foundation: http://www.kff.org The Kaiser Family Foundation (KFF) website provides in-depth information on important health care issues included Medicare, Medicaid, prescription drugs and the Affordable Care Act (health care reform). The website also has materials about health care reform and its impact on various population groups, including people without access to insurance. The website also has a consumer friendly video (http://healthreform.kff.org/) explaining the Affordable Care Act, how it works and what it means for Americans and their health care coverage options. The White House: http://www.whitehouse.gov/healthreform The White House website provides information about what the Affordable Care Act means for U.S. citizens. The website includes useful fact sheets that detail how health care reform will impact seniors, people with disabilities, veterans and early retirees. Additional resources on the website include responses to myths and misinformation surrounding the Affordable Care Act. AgeOptions on behalf of the Make Medicare Work Coalition June 2012 26

This Toolkit was produced by AgeOptions. AgeOptions is the Area Agency on Aging for suburban Cook County. Our mission is to improve the quality of life and maintain the dignity of older persons and those who care about them through leadership and support, community partnerships, comprehensive services, accurate information, and powerful advocacy. AgeOptions serves a population of more than 480,000 older adults. AgeOptions 1048 Lake Street, Suite 300 Oak Park, IL 60301 Phone: (708)383-0258 Fax: (708)524-0870 TTY: (708)524-1653 AgeOptions on behalf of the Make Medicare Work Coalition June 2012 27