Illinois Health Insurance Consumer Guide

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

• You reside in the United States.
• You are a U.S. citizen or national.
• You are not incarcerated.
• You are not already covered Medicare.

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:

• Not have affordable health coverage available through your job or your spouse’s job. If you have access to employer-sponsored insurance, but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might be eligible for premium subsidies on the Marketplace.
• Not qualify for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.³
• If married, file a tax return jointly with your spouse⁴ (with very limited exceptions)⁵
• Not be able to be claimed by someone else as a tax dependent.⁶

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:

• If you’re eligible for premium tax credits and your income is not more than 150% of the poverty level, you can enroll anytime.⁹
• If you’re a Native American, you can enroll anytime.¹⁰

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

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

• Online: You can sign up directly through HealthCare.gov, federal Marketplace website.
• By Phone: Dial 1-800-318-2596 (TTY: 1-855-889-4325) to enroll over the phone with a Marketplace representative. The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
• In-person: Enrollment assistance is also available from trained Navigators and assisters who can answer your questions. Go to localhelp.HealthCare.gov or getcovered.illinois.gov to find in-person assistance in your area.
• With the help of a broker or via an approved enhanced direct enrollment entity.¹⁴ (Note that EDEs can also offer off-exchange plans and non-ACA-compliant plans. If you’re working with an EDE, be clear in specifying what type of coverage you want. Keep in mind that you can only get subsidies if you choose a Marketplace plan.)

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

• Premium subsidies: The ACA Marketplace is the only place where you can qualify for income-based subsidies known as Advance Premium Tax Credits (APTC) that help lower your monthly premiums. Nearly nine out of 10 Illinois exchange enrollees were eligible for subsidies on 2024 plans, saving an average of $545 monthly with premium tax credits in Illinois. As a result, the average after-subsidy monthly premium was $141 for people who qualified for APTC.¹⁵
  

Source: CMS.gov¹⁶

• Cost-Sharing Reductions: You may qualify for cost-sharing reductions (CSR) if your income is no more than 250% of the federal poverty level. CSRs help reduce your out-of-pocket costs, making coverage more affordable. Forty-seven percent of the people who enrolled via the Illinois Marketplace during the open enrollment period for 2024 coverage selected plans that included CSR benefits.¹⁶

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

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

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. 

Source: Illinois Department of Insurance²⁰

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.)

• 2015: Average increases ranged from 2.6% to 11%.²⁴
• 2016: Average increases ranged from 5.3% to 11.3%.²⁵
• 2017: Overall average increase of 45.1%.²⁶
• 2018: Overall average increase of 30%.²⁷
• 2019: Average rate changes generally ranged from -4% to +6%.²⁸
• 2020: Average rate decrease of 0.3%.²⁹
• 2021: Relatively flat rates for most insurers³⁰
• 2022: Average increase of roughly 5%.³¹
• 2023: Average increase of roughly 7%³²
• 2024: Average increase of 5.7%³³

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

Source: 2014,³⁷ 2015,³⁸ 2016,³⁵ 2017,³⁹ 2018,⁴⁰ 2019,⁴¹ 2020,⁴² 2021,⁴³ 2022,⁴⁴ 2023,⁴⁵ 2024⁴⁶

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
Assistance 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.