Illinois health insurance Marketplace guide

You can buy a health plan through the exchange if:⁸

• 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.⁹
• If married, file a tax return jointly with your spouse¹⁰ (with very limited exceptions)¹¹
• Not be able to be claimed by someone else as a tax dependent.¹²

In Illinois, open enrollment for ACA Marketplace individual and family health coverage is from November 1 through January 15.¹³ 

(Starting with the open enrollment period in the fall of 2026, open enrollment will have to end no later than December 31.)

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.¹⁴ This generally means you must have a qualifying life event, such as losing your health insurance, getting married, or having a baby. Native Americans can enroll anytime without a specific qualifying life event. 

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.

Prior to 2026, however, Illinois has not been able to offer a special enrollment period for Marketplace plans in conjunction with the easy enrollment program, because using the federally-facilitated exchange means there cannot be state-specific SEP opportunities. That will change as of 2026, when Illinois is running its own exchange platform.

However, it’s unclear whether Section 71304 of the One Big Beautiful Bill Act, which prohibits Marketplace subsidies if a person enrolls via a SEP that isn’t tied to a specific qualifying life event, might effectively eliminate this SEP by making Marketplace subsidies unavailable to people who use it.¹⁵

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 2024 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.¹⁶

During the 2024 legislative session, Illinois enacted a bill that will create a special enrollment period triggered by pregnancy beginning in 2026, once Illinois runs its own Marketplace enrollment platform.¹⁷ Several other state-run exchanges also offer a SEP triggered by pregnancy.

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

• Online: You can sign up directly through Get Covered Illinois (for a plan with a 2026 effective date), starting November 1, 2025.
  If you’re using a special enrollment period to sign up for a plan with a late 2025 effective date, you’ll use HealthCare.gov. But understand that your coverage will need to be renewed for 2026 regardless of how late in 2025 it takes effect, and you’ll use Get Covered Illinois for the renewal or to pick a different plan for 2026.
• By Phone: Dial 1-866-311-1119 to reach the Get Covered Illinois call center for enrollment assistance over the phone.
  If you need to contact HealthCare.gov for coverage effective in late 2025, their call center can be reached at 1-800-318-2596.
• In-person: Enrollment assistance is also available from brokers and Navigators who can answer your questions.¹⁸

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 2025 plans, saving an average of $540 monthly with premium tax credits in Illinois. As a result, the average after-subsidy monthly premium was $190 for people who qualified for APTC.¹⁹
  

Source: CMS.gov²⁰

• 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. Fifty-one percent of the people who enrolled via the Illinois Marketplace during the open enrollment period for 2025 coverage selected plans that included CSR benefits.¹⁹

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

Short-Term Health Insurance: Short-term health insurance is no longer available in Illinois, due to legislation the state enacted in 2024.²¹

Seven insurance companies offer Marketplace coverage in Illinois for 2026:⁵

• Celtic Insurance Co./Ambetter (no Bronze plans offered in 2026)²²
• Cigna HealthCare of Illinois, Inc. (no plans offered in Cook County)²²
• Health Care Service Corporation (Blue Cross Blue Shield of Illinois)
• MercyCare HMO
• Molina Healthcare of Illinois, Inc.
• Oscar Health Plan, Inc.
• UnitedHealthcare

Eleven insurers offer Marketplace plans in Illinois in 2025, but four of them (including two Aetna entities) will exit the market at the end of 2025,⁷ leaving seven participating insurers for 2026.⁵

Illinois residents with 2025 coverage from Aetna CVS, Health Alliance, or Quartz need to select a new plan for 2026, during the open enrollment period that begins November 1, 2025.²²

In addition, people with Bronze coverage from Celtic will need to select a new plan, as Celtic will not offer Bronze plans in 2026 in Illinois. And Cigna will not offer plans in Cook County after the end of 2025. So Cigna enrollees in Cook County must also select new coverage for 2026.²² 

In any year, the number of carriers offering plans varies quite a bit from one part of the state to another,²³ since each carrier sets its own service area.

The following average premium changes have been approved for 2026 for the insurers that offer Marketplace coverage in Illinois, amounting to an overall average rate increase of 30.1%.⁵

Source: Illinois Department of Insurance⁵

The average rate increase of 30.1% is applicable to full-price premiums, for people who aren’t eligible for premium subsidies. But average net premium increases will be even larger (on a percentage basis) if the federal subsidy enhancements that have been in place since 2021 are allowed to expire at the end of 2025.²⁴

Illinois historically had very little transparency in terms of rate filing details for health plans, and state regulators did not have the authority to modify or reject rate changes proposed by insurers. But that has changed as of the 2026 plan year (for rates filed in 2025), due to a new law that was enacted in 2023.²⁵

And starting with the 2025 plan year, the Illinois Department of Insurance debuted a new summary page that contains an overview of the rate changes that insurers have filed, along with some of the filing details (final rates were added as open enrollment got underway).²⁶ 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 also enacted legislation calling for a state-regulated load factor that is being added to all silver-level plans starting in 2026.²⁷ 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. Some other states, including Texas, New Mexico, Pennsylvania, and Vermont, have similar protocols.

For perspective, here’s how average individual/family health insurance premiums have changed in Illinois over the years:

• 2015: Average increases ranged from 2.6% to 11%.²⁸
• 2016: Average increases ranged from 5.3% to 11.3%.²⁹
• 2017: Overall average increase of 45.1%.³⁰
• 2018: Overall average increase of 30%.³¹
• 2019: Average rate changes generally ranged from -4% to +6%.³²
• 2020: Average rate decrease of 0.3%.³³
• 2021: Relatively flat rates for most insurers³⁴
• 2022: Average increase of roughly 5%.³⁵
• 2023: Average increase of roughly 7%³⁶
• 2024: Average increase of 5.7%³⁷
• 2025: Average increase of 4.6%³⁸

465,985 people signed up for private health coverage through the Illinois exchange during the open enrollment period for 2025 coverage,³⁹ which was a new record high.

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 (scheduled to sunset at the end of 2025). The increase in 2024 and 2025 was 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 more than 105,000 Illinois residents transitioned from Medicaid to a Marketplace plan during the “unwinding” of the pandemic-era continuous coverage rule.⁴⁰

Source: 2014,⁴¹ 2015,⁴² 2016,⁴³ 2017,⁴⁴ 2018,⁴⁵ 2019,⁴⁶ 2020,⁴⁷ 2021,⁴⁸ 2022,⁴⁹ 2023,⁵⁰ 2024,⁵¹ 2025⁵²

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.