Illinois Health Insurance Consumer Guide

You can buy a health plan through the exchange if:⁷

• You reside in the United States.
• You are a U.S. citizen or national.
• You are not incarcerated.
• You are not already covered by health insurance from a job, Medicare, Medicaid, Children’s Insurance Program (CHIP), or another approved health coverage provider.

Qualification for financial assistance, such as 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. If your workplace provides insurance, but you find it 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.

In Illinois, open enrollment for ACA Marketplace individual and family health coverage is from November 1 through January 15.⁸ 

You can sign up for an exchange plan or make coverage changes outside of open enrollment if you meet special enrollment period (SEP) requirements.⁹ This means you must have a qualifying life event, such as losing your health insurance, getting married, or having a baby. 

If the open enrollment deadline passes and you don’t meet the SEP requirements, you can still sign up for an ACA plan. However, you must meet certain conditions, such as:

• If you’re eligible for premium tax credits and your income is not more than 150% of the poverty level, you can enroll anytime until at least 2025.¹⁰
• If you’re a Native American, you can enroll whenever necessary.¹¹

For those who lose Medicaid or CHIP coverage between March 31, 2023 and July 31, 2024, an extended SEP allows you to enroll.¹²

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.

Individuals and families have several options to find affordable health insurance coverage in Illinois:

• ACA Marketplace (HealthCare.gov): 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 2023 plans, saving $540 monthly with premium tax credits in Illinois. As a result, the average after-subsidy monthly premium was $147.¹³
  

Source: CMS.gov¹⁴

• Cost-Sharing Reductions: You may qualify for cost-sharing reductions (CSR) if your income is below 250% of the federal poverty level.¹⁵ CSRs help reduce your out-of-pocket costs, making coverage more affordable.
• 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.

Eleven insurers are offering exchange plans in Illinois for 2023.¹⁶ Available plans vary across the state and include the following:

• Aetna (new for 2023)
• Celtic Insurance Co. (Ambetter)
• Cigna Healthcare of Illinois, Inc.
• Health Alliance Medical Plans, Inc. (HAMP)
• Health Care Service Corporation (Blue Cross Blue Shield of Illinois)
• Quartz Health Benefit Plans Corporation 
• MercyCare HMO
• Molina Healthcare of Illinois, Inc. 
• Oscar Health Plan, Inc. 
• SSM Health Plan (WellFirst Health)
• UnitedHealthcare

Illinois’ individual market insurers have proposed the following average rate increases for 2024:¹⁷ 

Source: HealthCare.gov¹⁷

More than 342,000 people signed up for private health coverage through the Illinois exchange during the 2023 open enrollment period.¹³ This marked the highest enrollment point since 2017.

Source: 2014,¹⁸ 2015, ¹⁹ 2016,²⁰ 2017,²¹ 2018,²² 2019,²³ 2020,²⁴ 2021,²⁵ 2022,²⁶ 2023,²⁷ 2024²⁸

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.