IlliniCare Health Insurance Review & Complaints: Health Insurance (2023)

IlliniCare Health is an Illinois-based insurance company that focuses mainly on government-contracted plans providing managed care to Medicaid recipients. Aside from Medicaid, they also offer health insurance on the marketplace.

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What is IlliniCare Health?

Based in Westmont, Illinois, IlliniCare is a managed care organization (MCO) that contracts with the government to provide health insurance services to those who qualify for Medicaid. The health care plan provides health coverage through a variety of health and medical care providers. They offer several Medicaid health insurance policies as well as a Medicare-Medicaid option for those who qualify for both.

IlliniCare also has an individual health plan called Ambetter, offered on the health insurance marketplace.

The company contracts with several healthcare systems throughout the Chicago area. IlliniCare’s parent company, Centene Corporation, is a large company that also owns a number of other health insurance companies, particularly those who contract with the government to provide Medicare and Medicaid services.

What plans does IlliniCare Health offer?

IlliniCare offers several Medicaid programs as well as the Ambetter marketplace plans for individuals and families. Medicaid is only available to those who qualify based on government standards for income.

Medicaid Plans

IlliniCare offers several Medicaid programs, all of which require that the insured meet income and other qualifications.

The Integrated Care Program is available to older adults or adults with disabilities who have no insurance and qualify for Medicaid but do not qualify for Medicare. It covers office visits, prescriptions, and more.

The Family Health Program is available to a larger range of people, including families with children under the age of 19, pregnant women, and anyone aged 19-64 that meet the income qualifications.

The Medicare-Medicaid joint plan is available to those who qualify for both Medicare and Medicaid. The plan offers access to the benefits of both government-sponsored programs in one.

Managed Long-Term Services and Supports is the final plan offered to those who qualify for Medicaid and Medicare. This plan is designed for those who live in a long-term care facility or receive waiver support services.

Ambetter Individual Health Plans

The IlliniCare website lists Ambetter as their marketplace plans, but the link leads visitors to a separate site where the plan is named Ambetter Insured by Celtic. There is no explanation offered as to the connection between Celtic and IlliniCare, but further research reveals they are sister companies. It is again unclear who services the plans, although IlliniCare is listed as the provider network on all of them.

Only two plan levels are listed, a Gold and a Silver option, although the website indicates that there is a Bronze level plan elsewhere. When clicking through the Gold plan to get details, a variety of sub-plans appear, all separated by income level and all appearing to have different deductibles and copays.

This confusing setup on the website is likely to cause difficulty for insurance plan shoppers. After navigating through to the plan summaries page, there are four different plan categories listed. Within these categories, there are in some cases dozens of different coverage levels.

The Balanced Care products have a whopping 56 different plan levels, ranging from the Care 1 to Care 4 plans, and offering various cost-sharing choices. Coinsurance amounts range from 0% to 30%, with deductibles ranging from $0 to $7,050. These all appear to be Silver level plans.

The Platinum Care plan, on the other hand, comes with just one option, carrying a 30% coinsurance and a $400 deductible.

Secure Care has four options, with one that carries a 0% coinsurance and $0 deductible, and the rest at 20% coinsurance and a $1,000 deductible. These appear to be the Gold level plans.

There is another product listed, the Balanced Care Standardized, but returned no results when we opened that section.

Are IlliniCare rates affordable?

We were unable to locate the option to obtain a quote for health insurance plan online, which is not surprising given the many levels of income qualifications and the fact that this company’s main market is government-sponsored insurance.

Most customers are probably unclear as to what percentage of federal poverty level ranking they meet, so it is difficult to state which of the insurance plan options is the correct one. With so many plans to choose from, finding the correct choice will likely require help from a representative to get an accurate quote.

How are claims processed?

IlliniCare likely handles all claims directly and internally and pays providers without any effort from the insured. IlliniCare has run into some issues with failure to pay providers in a timely manner, resulting in contract terminations, as we will address in the next section.

Are the ratings and consumer reviews positive?

IlliniCare has a surprising D+ rating from the Better Business Bureau (BBB). There is only one complaint on file in the past three years, although the BBB has only had a file open since 2016. The site indicates that failure to respond to the complaint as well as the duration of time the company has been in business affect the rating.

IlliniCare is ranked by the National Committee for Quality Assurance only under Medicaid plans and has an overall rating of 3.5. While that does make it the top-ranked Medicaid plan in Illinois, a 3.5 out of 5 overall is not a very impressive score. The middle-of-the-road rankings in specific areas include 3 ratings nearly across the board in consumer satisfaction categories.

In recent years, IlliniCare has lost contracts, in some cases due to failure to pay providers. In August of 2017, the University of Chicago Medicine ended its contract with the company citing outstanding payments due. They were not the first; Northwestern Health and Advocate Health Care had also ended contracts, as had Cook County Hospitals.

This trend impacts the ability of insured members to access health care, and the more contracts that end, the more limited the provider network becomes. This can be especially difficult for Medicaid recipients who may not have the resources or ability to travel to find care.

We were unable to find any direct reviews of IlliniCare from actual members, which is not entirely surprising given their market and the confusion in the naming of their individual health plans.

We did find 106 complaints on Pissed Consumer for Ambetter, the health plans served by the IlliniCare network but appearing to be serviced by sister company Celtic. These complaints appear to come from a variety of different states, and not from IlliniCare’s Chicago area market directly. Many complaints center on difficulty finding providers.

What’s the bottom line?

When it comes to Medicaid coverage, IlliniCare is likely one of the few options for those in its service area, but the provider network appears to be shrinking rapidly. In terms of individual plans, it’s very difficult to make sense of this company’s entwined plans and provider networks with Celtic, apparently a sister company. Either way, ratings and rankings, as well as the issues with paying providers and losing contracts, all add up to a company we are unable to recommend at this time.

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