Affordable Care Act: What Illinois Needs To Know | WBEZ
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Morning Shift

Affordable Care Act: What Illinois Needs To Know

After the Affordable Care Act announced changes to its coverage options this week, Illinois residents shopping for insurance plans for 2017 might not like what they see.

Nationwide, costs are increasing an average of 22 percent, but in Illinois that hike is closer to 40 percent, Alexandra Eidenberg, president of The Insurance People, told Morning Shift.

She joined the show Friday and shed some light on what the changes mean for Illinois residents.

Why are premiums rising? Under the current system, insurance companies are struggling to stay profitable, so common business sense dictates they charge more and spend less. That means they’re raising prices on premiums, deductibles and out-of-pocket costs for consumers and paying doctors and hospitals less for services.

This in turn means that healthcare providers like the University of Chicago Medical Center and Rush University Medical Center are leaving the ACA network.

“We’re seeing exorbitantly priced coverage because the carriers have been so abused on the billions of dollars that they’re losing,” Eidenberg said. “This is the carriers throwing their arms up.”

But aren’t subsidies also rising? Federal subsidies—Eidenberg calls them “coupons for your insurance”— are also rising. Consumers are eligible for these breaks if they’re within 400 percent of the poverty line, and the average person will get about 50 percent off, Eidenberg said.

This year, about 20 percent of the population will be able to access free health care. But cashing in on these credits requires the consumer to buy "on-exchange" (through, rather than directly from the insurance company), which means options will be limited since many doctors have opted out of the ACA network.

What’s the difference between an HMO and PPO? Under an HMO plan, patients see one in-network doctor, who writes referrals to see other specialists. Eidenberg warns this makes it hard to get a second opinion. But HMOs are often the more affordable option. PPOs tend to have higher deductibles, but give patients the flexibility to see any doctor they’d like.

How can consumers advocate for themselves? Eidenberg recommends calling or writing to your local legislator.

“It is Congress and the Senate that made these decisions,” she said. “We need to put the pressure on them to understand that we can’t afford this.”

Dig Deeper: Press play to hear Morning Shift’s full conversation with Eidenberg, and her answers to listener questions about buying insurance as a small business owner and the benefits and drawbacks of buying through an agency.

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