With the new Marketplace insurance plans (under the Affordable Healthcare Act), we would like to provide our patients with the most up-to-date information about our participation. We contract through Rush University Medical Center for most of our private insurance policies and therefore follow their guidelines. Please find below an article that applies to Chicago Glaucoma Consultants Participation:
DOWNLOAD THE PDF of the 38/71 plans we will participate in:
Rush Health Participation in the Illinois Health Insurance Marketplace
With the enrollment period opening on October 1st for a January 1, 2014 effective date, people who have not had access to affordable health insurance can now go on the federal https://www.healthcare.gov/ or state http://getcoveredillinois.gov website and select a health insurance plan. There are six health insurance companies in Illinois currently offering benefit plans through this new marketplace (earlier referred to as the “Insurance Exchange.”) They are Aetna, Blue Cross Blue Shield, Coventry, Health Alliance Medical Plan, Humana, and Land of Lincoln. Other insurance companies are not offering any of their plans on the Marketplace for 2014.
What is unique about purchasing insurance through the Marketplace is the opportunity for people below certain income thresholds to qualify for federal subsidies to help pay the monthly insurance premiums. People who purchase health insurance outside of the Marketplace will not have access to the federal subsidy/assistance.
The benefit plan options fall into four basic categories that are identified by metal levels – Platinum, Gold, Silver and Bronze. These tiers or levels of benefit plans are based on the level of cost sharing required by the consumer. There are multiple plan options available in each level. The benefit coverage increases with metal level – platinum plans will offer the lowest out-of-pocket cost for the consumer while bronze the highest out-of-pocket. Based on this coverage level, the Platinum and Gold metal levels have a higher monthly premium while the Silver and Bronze level plans have lower premiums.
- Platinum – Insurance plan pays 90% of cost, consumer 10%
- Gold – Insurance plan pays 80% of cost, consumer 20%
- Silver – Insurance plan pays 70% of cost, consumer 30%
- Bronze– Insurance plan pays 60% of cost, consumer 40%
- The consumer cost sharing will be a combination of deductible, coinsurance and copayment
The Illinois Marketplace offers 71 different plans in Cook County. Rush Health, which includes RUMC, ROPH, Rush-Copley and all Rush Health physicians, participates in 38 of those plans offered:
- Rush Health is in all of the Land of Lincoln plans
- Rush Health is in some of the Blue Cross and Humana Plans
- Rush Health is in none of the Aetna and Coventry Plans
- Health Alliance is only offered downstate
The Marketplace listing attached indicates the 71 plans offered in Cook County and identifies the 38 plans that Rush participates in and is considered an in-network provider. All of the plans that Rush participates in are also offered in DuPage, Kane, Kendall and Will counties, except for the Humana plans. Humana does not offer coverage in these counties.
It is imperative to understand which plans Rush Health is an in-network provider. When patients select plans that Rush Health participates in, the in-network deductibles/coinsurance will apply. Out-of-network benefits, even when available in the various plans, offer less coverage and very high out-of-pocket costs to the patients. These out-of-network costs are much greater than what we are used to seeing with commercial insurance plans. Therefore, the message to the patient is that you will want to pick a plan Rush Health is participating in if you want to come to Rush Health physicians and hospitals.
Rush Health will continue to provide more information on the new Marketplace as it becomes available. Please contact your Provider Services Consultant with questions.