Commercial Insurance

To Apply for Commercial Insurance

1. To apply for health insurance that is not Medicaid, Medicare, or provided by your employer, go to gov. If you are currently employed, talk to your employer about potential insurance options. Otherwise, you will need to apply via the government-run marketplace.
2. The time that you can enroll during is November 1st to December 15th. If it is outside of this period, you will need a special exemption to enroll.
3. Once you are on the website, enter your residence to look for plans.
4. Enter information on your household, yourself, and your income.
5. Explore the available plans and choose one that is right for you. For explanation on what is included in each plan, please refer to the “Understanding What My Insurance Covers” portion of this page.

What’s Covered?
A health insurance policy typically covers:

• Preventative care
• Diagnostic tests
• Hospital stays
• Surgeries
• Prescription drugs
• Mental health care
• Rehabilitation
• Maternity and pediatric services
• Costs and deductibles
• Premium: a monthly bill to keep insurance active
• Deductible: amount you pay for services before insurance kicks in
• Copay: fixed amount for specific healthcare services
• Out-of-pocket maximum: the maximum amount you pay for healthcare expenses in a year

Claim Process

1. Submit a claim to the insurance company.
2. The insurance company reviews and processes the claim.
3. The insurance company pays the provider directly or reimburses you.

Key Terms:

• Out-of-pocket maximum: the maximum amount you pay for healthcare expenses in a year.
• Copay: fixed amount for specific healthcare services
• In-network: providers with a contract with the insurance company for discounted rates
• Out-of-network: providers without a contract, may cost more.
• Pre-existing conditions: some policies cover, while others may have a waiting period or exclude coverage.

You can access your ID card information through your phone or mobile app. Additionally, you can view the back of your ID card to verify your insurance network and plan details. You can also contact your insurance provider directly or visit their website for more information. Some examples of insurance companies include United, Anthem, and Aetna, with Aetna also offering private insurance options.

Additional Info:

• Mental health services: check the policy to see what’s included.
• Consent: typically given through a signed document or electronic agreement
• HMO vs. PPO: HMO has a narrower network and requires a primary care physician; PPO has a broader network and allows you to see any provider.
  

Medicare

Part A: Hospital insurance

Part B: Medical insurance

Part C: Medicare Advantage plans

Part D: Prescription drug coverage

Eligibility and Enrollment

• Age 65 or older
• Younger people with disabilities
• People with End Stage Renal Disease

Enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at a local Social Security office.

Costs and Coverage

Part A: premium-free for most people

Part B: monthly premium (varies based on income)

Part C: varies by plan

Part D: varies by plan

Covers hospital stays, doctor visits, prescription medications, and preventative care.

Medicaid

• Eligibility and Enrollment
• Low income
• Limited resources
• Varies by state

Apply online at Medicaid.gov, by phone at 1-877-267-2323, or in person at a local Medicaid office.

Coverage and Benefits

• It covers doctor visits, hospital stays, prescription medications, and preventative care.
• It can help pay for Medicare premiums and out-of-pocket costs.
• It can provide additional benefits not covered by Medicare.

Medicaid

Step	Description	Link
1. Check Eligibility	Visit Medicaid Eligibility to see if you qualify	Medicaid Eligibility
2. Find Your State’s Medicaid Agency	Go to Beneficiary Resources and select your state	Beneficiary Resources
3. Create an Account	Log in or create an account with your state’s Medicaid Marketplace Agency	Medicaid Marketplace – Illinois Department of Healthcare and Family Services Medicaid Marketplace – MO HealthNet Medicaid Marketplace – KanCare
4. Apply Online, Phone, or Mail	Choose your preferred application method
5. Gather Required Documents	See the list of required documents below

 

Required Documents for Medicaid

• Proof of U.S. Citizenship (Driver’s license, ID, or passport)
• Bank records for the past five years
• Records of any property owned in the last five years
• Statements of any retirement accounts
• Copy of any insurance policies
• Records of any vehicles owned
• Medical records of disability (if applicable)

Medicare

Eligibility Requirements

• Age 65 or older
• Younger people with disabilities
• People with End Stage Renal Disease
• For those living in a medical facility
• For those receiving Social Security benefits

Enrollment Methods for Medicare

Method	Description	Link
Online	Visit Medicare.gov	Medicare.gov
By Phone	Call 1-800-MEDICARE (1-800-633-4227)
In Person	Visit a local Social Security office

Commercial Insurance

Step	Description	Link
1. Visit HealthCare.gov	Explore plans available in your area	HealthCare.gov
2. Enter Your Residence	Find plans available in your area
3. Enter Household and Income Information
4. Explore Available Plans	Choose a plan that suits your needs
5. Understand What’s Covered	Refer to the “Understanding What My Insurance Covers” section

Types of Commercial Insurance Plans

Plan Type	Description	Link
HMO	Explore different types of health insurance	Health insurance plan & network types
PPO	PPO (Preferred Provider Organization) has a broader network and allows you to see any provider but may cost more

Cost and Coverage of Commercial Insurance

Cost Category	Description	Link
Premium	Learn about costs and payment forms	Health Insurance Terms You Should Know
Deductible	A specific amount of money that the policyholder must pay out-of-pocket for healthcare expenses before the insurance company begins to pay its share of the costs
Copayment	A fixed amount for a specific healthcare service, such as a doctor’s visit or prescription medication
Coinsurance	Coinsurance is a type of cost-sharing in health insurance plans where the policyholder pays a percentage of medical expenses, and the insurance company pays the remaining percentage

 

Coverage Categories

• Doctor Visits
• Hospital Stays
• Prescription Medications
• Preventive Care

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Resources
Medicare.gov: A comprehensive resource for Medicare information and enrollment
Medicaid.gov: A  comprehensive resource for Medicaid information and enrollment
State Health Insurance Assistance Program (SHIP): Free, personalized counseling service for Medicare and Medicaid
What Is Commercial Health Insurance? – Forbes Advisor
Apply for Health Insurance | HealthCare.gov
HealthCare.gov: The Go-To Marketplace For Affordable Health Insurance