Illinois Health Insurance Consumer Guide

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Illinois runs a partnership exchange with the federal government. The state operates Get Covered Illinois, which has a website, in-person help, and a help desk, 1 but Illinois residents use the federally-run HealthCare.gov platform to enroll in Affordable Care Act (ACA) Marketplace health plans.

But starting in the fall of 2025, for coverage effective in 2026, Illinois will have its own state-run enrollment platform.

Use this guide to help you understand the Illinois Marketplace and choose the right health plan for you and your family. ACA Marketplace plans – or Obamacare or exchange – are affordable choices for many people. Enrolling on the exchange may make you eligible for financial assistance through an advance premium tax credit.

Explore our other comprehensive guides to coverage in Illinois

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Medicaid in Illinois

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Learn about Illinois' Medicaid expansion, the state’s Medicaid enrollment and Medicaid eligibility.

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Medicare coverage options and enrollment in Illinois

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Use our guide to learn about Medicare, Medicare Advantage, and Medigap coverage available in Illinois as well as the state’s Medicare supplement (Medigap) regulations.

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Short-term coverage in Illinois

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Short-term health plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage. Learn more about short-term plan availability in Illinois.

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Frequently asked questions about health insurance in Illinois

Frequently asked questions about health insurance in Illinois

Who can buy Marketplace health insurance?

You can buy a health plan through the exchange if: 2

Qualification for financial assistance, including premium subsidies and cost-sharing reductions (CSR), depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. This can vary based on where you live and your age. Moreover, to be eligible for financial aid for your Marketplace plan, you must:

When can I enroll in an ACA-compliant plan in Illinois?

In Illinois, open enrollment for ACA Marketplace individual and family health coverage is from November 1 through January 15. 7

You can sign up for an exchange plan — or make changes to your coverage — outside of open enrollment if you meet special enrollment period (SEP) requirements. 8 This generally means you must have a qualifying life event, such as losing your health insurance, getting married, or having a baby.

But some special enrollment periods don’t require a specific qualifying event. So if the open enrollment deadline has passed and you haven’t experienced a qualifying event, you may still be able to sign up for an ACA plan. For example:

For those who lose Medicaid or CHIP coverage between March 31, 2023 and November 30, 2024, an extended SEP allows you to enroll anytime during that window. 11

Illinois legislation (HB5142) was enacted in 2022 that created an easy enrollment program, which became available as of early 2023, when 2022 tax returns were being filed.

For the time being, Illinois cannot offer a special enrollment period for marketplace plans in conjunction with the easy enrollment program, because using the federally-run exchange means there cannot be state-specific SEP opportunities. That will change as of 2026, when Illinois is running its own exchange platform.

For now, Illinois residents can indicate on their state tax return whether they’d like their information to be shared with applicable state agencies (This is Step 12 on the 2023 Illinois state tax return).

If the person is found to be eligible for Medicaid or CHIP, the state can notify them and help them enroll, since those programs have year-round enrollment. 12

During the 2024 legislative session, Illinois lawmakers passed a bill (not yet signed into law as of late June 2024) that will create a special enrollment period triggered by pregnancy beginning in 2026, once Illinois is running its own Marketplace enrollment platform. 13

How do I enroll in a Marketplace plan in Illinois?

Here are the main ways to enroll in a Marketplace health plan in Illinois:

How can I find affordable health insurance in Illinois?

Individuals and families who enroll in Marketplace coverage in Illinois can take advantage of two different types of income-based financial assistance:

Here are the facts for Illinois’ insurance Marketplace: Average savings - $545/month. Average net premium - $141/month for a person receiving a subsidy through advance premium tax credits. Expanded subsidy help - 8 in 10 enrollees save money though premium tax credits. 24% of enrollees pay less than $10/month.

Medicaid: Illinois residents may qualify for affordable Medicaid coverage if eligible.

Short-Term Health Insurance: For people who are not eligible for subsidies, Medicare, or Medicaid, short-term health insurance may offer a more budget-friendly option. However, Illinois enacted legislation in 2024 that calls for a ban on the sale of short-term health insurance in the state, starting in January 2025. 17

How many insurers offer Marketplace coverage in Illinois?

Twelve insurers are offering exchange plans in Illinois for 2024, up from 11 in 2023. 18

Aetna Life Insurance is the new insurer that joined the exchange in Illinois for 2024 (Aetna Health already offered plans; there are now two Aetna entities). The Illinois Department of Insurance also noted that as of 2024, SSM Health Plan changed its name to Medica Central Health Plan. 19

But one of the existing insurers (Medica, formerly WellFirst/SSM) is not listed among the carriers that have filed rates and plans for 2025. 20

Are Marketplace health insurance premiums increasing in Illinois?

Illinois has historically had very little transparency in terms of rate filing details for health plans, and state regulators have not had the authority to modify or reject rate changes proposed by insurers. But that will change as of the 2026 plan year (for rates filed in 2025), due to a new law that was enacted in 2023. 21

And for the 2025 plan year, the Illinois Department of Insurance has debuted a new summary page that contains an overview of the rate changes that insurers have filed, along with some of the filing details. 20 Although summary pages like this have long been displayed on many states’ insurance department websites, that was not the case in Illinois before 2024.

Illinois lawmakers have also enacted legislation that will call for a state-regulated factor that will be added to all silver-level plans starting in 2026. 22 This is also known as “premium alignment” and it should result in gold plans becoming relatively less expensive than silver plans, for people who aren’t eligible for cost-sharing reductions. Texas, New Mexico, and Pennsylvania all have similar protocols, and Vermont will join them in 2025.

Illinois’ individual/family market insurers have proposed the following average rate increases for 2025, 20 amounting to a semi-weighted average increase of 4.6% 23

Final rates will be announced before open enrollment begins in November 2024.

Illinois’ ACA Marketplace Plan 2025 PROPOSED Rate Increases by Insurance Company

Source: Illinois Department of Insurance 20

For perspective, here’s how average individual/family health insurance premiums have changed in Illinois over the years (note that in Illinois, average rate changes have often been published based on rate changes for the lowest-cost plan at each metal level, rather than overall rate changes, which differs from how this information has typically been presented in other states. And weighted averages have not typically been available in Illinois, due to the lack of transparency in the rate filing process. This should change in future years, under the terms of the state’s new law.)

How many people are insured through Illinois’ Marketplace?

398,814 people signed up for private health coverage through the Illinois exchange during the open enrollment period for 2024 coverage, up from about 342,000 the year before. 34 This marked the highest enrollment Illinois has ever had; the previous record high came in 2016, when about 388,000 people enrolled. 35

Enrollment over time in the Illinois Marketplace is illustrated in the chart below. The increase in recent years is due in large part to the subsidy enhancements provided by the American Rescue Plan and Inflation Reduction Act. The increase for 2024 is also partially driven by the return to normal disenrollments for the Medicaid program, which was paused for three years during the pandemic. CMS reported that by March 2024, more than 99,000 Illinois residents had transitioned from Medicaid to a Marketplace plan during the “unwinding” of the pandemic-era continuous coverage rule. 36

Illinois’ ACA Marketplace enrollments - Since 2021, enrollments have grown each year.

Source: 2014, 37 2015, 38 2016, 35 2017, 39 2018, 40 2019, 41 2020, 42 2021, 43 2022, 44 2023, 45 2024 46

What health insurance resources are available to Illinois residents?

HealthCare.gov
Premium tax credits are available only through the ACA Marketplace.

Illinois Department of Insurance
The Illinois Department of Insurance regulates individual, small-group, and large-group health plans in the state (excluding self-insured ones). They also regulate brokers and agents selling private health insurance.

Illinois Senior Health Insurance Program (SHIP)
Contact them for assistance with Medicare questions.

Illinois Department of Healthcare and Family Services
A ssistance with Medicaid eligibility or enrollment in Illinois and with All Kids , the state’s Children’s Health Insurance Program, and Family Care , the state’s Medicaid coverage for parents with minor children.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

  1. ”Get Covered Illinois” getcovered.illinois.gov ⤶
  2. “ Are you eligible to use the Marketplace? ” HealthCare.gov, 2023 ⤶
  3. Medicare and the Marketplace, Master FAQ . Centers for Medicare and Medicaid Services. Accessed November 2023. ⤶
  4. Premium Tax Credit — The Basics . Internal Revenue Service. Accessed MONTH. ⤶
  5. Updates to frequently asked questions about the Premium Tax Credit. Internal Revenue Service. February 2024. ⤶
  6. Premium Tax Credit — The Basics . Internal Revenue Service. Accessed January 12, 2024. ⤶
  7. “ Get Covered Illinois FAQs ” getcovered.illinois.gov, Accessed September 2023 ⤶
  8. “ Special Enrollment Opportunities ” HealthCare.gov, Accessed June 24, 2024 ⤶
  9. “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program” U.S. Department of the Treasury Department / Centers for Medicare & Medicaid Services. April 15, 2024 ⤶
  10. “ Who doesn’t need a special enrollment period? “ healthinsurance.org, Accessed August 2023 ⤶
  11. ”Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or Children’s Health Insurance Program (CHIP) Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition Operations for Plan Year 2024” CMS.gov, Mar. 28, 2024 ⤶
  12. “House Bill 5142 ” Illinois General Assembly, enacted 2022 ⤶
  13. ”Illinois SB3130” BillTrack50. Passed May 15, 2024. ⤶
  14. “ Entities Approved to Use Enhanced Direct Enrollment ” CMS.gov, April 28, 2023 ⤶
  15. “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 22, 2024 ⤶
  16. 2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶⤶
  17. ”Illinois HB2499” BillTrack50. Enacted July 10, 2024 ⤶
  18. 2024 Analysis of Illinois On-Exchange Plans . Illinois.gov, 2023 ⤶
  19. 2024 Analysis of Illinois On-Exchange Plans. Illinois.gov, 2023 ⤶
  20. ”Affordable Care Act (ACA) – Illinois Rate Filings” Illinois Department of Insurance. Accessed July 29, 2024 ⤶⤶⤶⤶
  21. ”Illinois House Bill 2296” BillTrack50. Enacted 2023 2023 ⤶
  22. ”Illinois HB5395” BillTrack50. Passed May 24, 2024 ⤶
  23. ”Illinois: Preliminary Avg. Unsubsidized 2025 #ACA Rate Changes: +4.6%” ACA Signups. July 16, 2024 ⤶
  24. ”Obamacare rates in Illinois: Higher premiums, more options in 2015” Venteicher, Wes, et al. Chicago Tribune. November 7, 2014 ⤶
  25. ”UnitedHealthcare of Illinois, Inc. History” Zippia.com ⤶
  26. ”Avg. UNSUBSIDIZED Indy Mkt Rate Hikes: 25% (49 States + DC)” ACA Signups ⤶
  27. ”Illinois: RATE-HIKE-A-PALOOZA! Six More States Added At Once!” ACA Signups ⤶
  28. ”Illinois Department of Insurance releases ACA Exchange health care insurance rates for 2019” Illinois.gov. October 10, 2018. ⤶
  29. ”Illinois: *Final* Avg. 2020 #ACA Premiums: 0.3% Decrease” ACA Signups. October 30, 2019. ⤶
  30. ”Illinois: Preliminary Avg. 2021 #ACA Premiums: -1.8% Indy; +5.2% Sm. Group (Unweighted)” ACA Signups. October 15, 2020. ⤶
  31. ”*APPROVED* Avg. 2022 #ACA Rate Changeapalooza! AK, CA, GA, HI, IL, KS, LA, MA, MS, MO, NE, NH, TX, WY” ACA Signups. November 2, 2021. ⤶
  32. ”Illinois: Final Avg. Unsubsidized 2023 #ACA Rate Changes: +7.1% (Updated)” ACA Signups. August 5, 2022. ⤶
  33. So How’d I Do On My 2024 Avg. Rate Change Project? Not Bad At All! ACA Signups. December 2023. ⤶
  34. “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2023 ⤶
  35. “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016 ⤶⤶
  36. ” HealthCare.gov Marketplace Medicaid Unwinding Report ” Centers for Medicare & Medicaid Services. Data through March 2024; Accessed July 29, 2024. ⤶
  37. “ASPE Issue Brief (2014)” ASPE, 2015 ⤶
  38. “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015 ⤶
  39. “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017 ⤶
  40. “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018 ⤶
  41. “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019 ⤶
  42. “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020 ⤶
  43. “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021 ⤶
  44. “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022 ⤶
  45. “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023 ⤶
  46. HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶