Last updated: February 2026
Disclaimer: This guide provides general information about ACA health coverage in Illinois and is not legal or financial advice. Eligibility rules can change, and individual circumstances vary. Always verify current requirements with Get Covered Illinois or a licensed insurance navigator before enrolling.
Health insurance in Illinois changed significantly in 2026. The state launched its own marketplace, Get Covered Illinois, on November 1, 2025, replacing Healthcare.gov as the enrollment portal. If you are shopping for individual or family coverage, understanding what ACA plans include and how subsidies work can save you hundreds of dollars each month.
Here is the key takeaway: every ACA Marketplace plan sold in Illinois must cover 10 categories of essential health benefits, from doctor visits to prescription drugs to mental health care. If your household income falls between 100% and 400% of the federal poverty level (roughly $15,650 to $62,600 for an individual), you likely qualify for premium tax credits. Seven carriers offer plans on the Illinois marketplace for 2026, and the average monthly premium after subsidies is about $190.
This guide covers what Illinois ACA plans include, who qualifies for financial help, how much you could save, and how to enroll.
What ACA Plans Cover in Illinois
Every health plan sold on the Illinois ACA marketplace must include essential health benefits. These are required by federal law regardless of which metal tier you choose.
The 10 categories of essential health benefits are:
- Ambulatory patient services (outpatient care and doctor visits)
- Emergency services (ER visits, including out of network)
- Hospitalization (inpatient care, surgeries, overnight stays)
- Maternity and newborn care (prenatal visits, labor, delivery)
- Mental health and substance use disorder services (therapy, counseling, treatment)
- Prescription drugs (at least one drug in every therapeutic category)
- Rehabilitative and habilitative services (physical therapy, occupational therapy)
- Laboratory services (blood tests, imaging, diagnostics)
- Preventive and wellness services (annual checkups, vaccines, screenings)
- Pediatric services (dental and vision care for children under 19)
These benefits apply to every Bronze, Silver, Gold, and Platinum plan. The metal tier affects how costs are split between you and your insurer, not what is covered.
All ACA plans must also cover recommended preventive services with no copay or deductible, including annual wellness exams, immunizations, cancer screenings, blood pressure checks, and well child visits.
Choosing the right plan level depends on how often you use health care and what you can afford each month.
Understanding Illinois Marketplace Plan Levels
The Illinois ACA marketplace offers four metal tiers. Each covers the same essential health benefits, but the balance between your monthly premium and out of pocket costs shifts at each level.
Bronze plans have the lowest monthly premiums and cover about 60% of average health care costs. You pay more when you use services. These plans work well if you are generally healthy and want protection against major medical events.
Silver plans cover about 70% of costs and are the most popular choice. They serve as the benchmark for calculating premium tax credits. Silver plans also unlock cost sharing reductions (CSRs) if your income is between 100% and 250% of the federal poverty level, lowering your deductibles, copays, and out of pocket maximum.
Gold plans cover about 80% of costs with higher premiums but lower out of pocket expenses each time you visit a doctor or fill a prescription.
Platinum plans cover about 90% of costs and have the highest monthly premiums. They offer the lowest out of pocket costs for people with ongoing health conditions that require frequent care.
A family of four in Illinois with income around $60,000 per year would likely qualify for both premium tax credits and cost sharing reductions on a Silver plan, significantly reducing both the monthly premium and the costs paid at the point of care.
Understanding your income relative to the federal poverty level is the next step in determining what financial help you qualify for.
Who Qualifies for ACA Subsidies in Illinois
Premium tax credits are available to Illinois residents with household income between 100% and 400% of the federal poverty level. Enhanced subsidies cap contributions at 8.5% of income toward a benchmark Silver plan premium.
Here are the federal poverty level thresholds used for 2026 coverage:
| Household Size | 100% FPL | 150% FPL | 250% FPL | 400% FPL |
|---|---|---|---|---|
| 1 | $15,650 | $23,475 | $39,125 | $62,600 |
| 2 | $21,150 | $31,725 | $52,875 | $84,600 |
| 3 | $26,650 | $39,975 | $66,625 | $106,600 |
| 4 | $32,150 | $48,225 | $80,375 | $128,600 |
If your income falls below 100% FPL, you likely qualify for Illinois Medicaid instead of marketplace coverage. Illinois expanded Medicaid in 2014, so adults earning up to 138% of FPL ($21,597 for an individual) can get free health coverage through the state Medicaid program.
Cost sharing reductions are additional help only available with Silver plans. If your income is between 100% and 250% of FPL, a Silver plan automatically comes with lower deductibles, smaller copays, and a reduced out of pocket maximum. You do not need to apply separately. CSRs are built into Silver plan pricing when you enroll through Get Covered Illinois.
A single person earning $30,000 per year falls within the subsidy range and could see their monthly premium drop to well under $100 after tax credits.
Illinois also connects residents to Medicaid and other programs during the marketplace application process, which is worth exploring.
Get Covered Illinois: The New State Marketplace
Illinois launched Get Covered Illinois as a full state based marketplace on November 1, 2025, replacing Healthcare.gov. The switch gives Illinois more control over outreach, enrollment assistance, and plan offerings.
Seven insurance carriers offer marketplace plans in Illinois for 2026, down from 11 in 2025. Health Alliance, Aetna CVS Health, and Quartz exited the market, and Cigna stopped offering plans to Cook County residents while continuing elsewhere in the state. Despite fewer carriers, most areas still have multiple plan options to compare.
Existing Healthcare.gov enrollees had their accounts transitioned to Get Covered Illinois. If you had a 2025 plan and did not claim your new account by February 1, 2026, your coverage was automatically renewed. You have until March 31, 2026 to log in and select a different plan.
Free enrollment help is available through certified navigators and brokers across the state. You can find local assistance through the Get Covered Illinois website.
Knowing what financial help exists is only part of the picture. Estimating your actual savings is the next step.
How Much Can You Save on Illinois ACA Coverage
Your savings depend on household income, age, location, and plan choice. Premium tax credits are calculated based on the cost of the second lowest Silver plan in your area compared to your expected contribution.
Single person, age 30, earning $25,000/year: At about 160% of FPL, a Silver plan could cost roughly $50 to $100 per month after premium tax credits. Cost sharing reductions would also apply, reducing deductibles and copays.
Family of four, earning $60,000/year: At about 187% of FPL, this family would qualify for substantial premium credits and cost sharing reductions. Monthly premiums for a Silver plan could drop to $200 or less after subsidies.
The average monthly premium after subsidies for Illinois marketplace enrollees is approximately $190. Many residents are paying less for comprehensive coverage than they expect. Enhanced subsidy rules cap contributions at 8.5% of household income, so even households above 400% FPL see some relief.
Beyond ACA coverage, Illinois residents may qualify for additional benefit programs that work alongside health insurance.
Other Benefits Illinois Residents Should Know About
ACA coverage is one piece of the benefits landscape in Illinois. Several other programs can work alongside your marketplace plan or serve as alternatives.
Medicaid: If your income is at or below 138% of FPL, you likely qualify for free coverage through Illinois Medicaid. For a family of four, that is about $44,367 per year. Medicaid covers doctor visits, hospital stays, prescriptions, dental, vision, and mental health services.
All Kids (CHIP): Children can qualify with family income up to 318% of FPL (about $102,237 for a family of four). Premiums and copays were eliminated for most children as of July 2022.
SNAP: Helps families buy groceries. A family of four can qualify with gross monthly income up to $4,290. Benefits are delivered through the Illinois Link EBT card.
LIHEAP: Helps pay heating and cooling bills for households earning up to 60% of state median income. Apply at helpillinoisfamilies.com.
You can check eligibility for multiple programs at once with a free benefits screener that takes about five minutes. You can also explore other states' ACA coverage, like our Florida ACA benefits guide or California ACA marketplace guide.
Understanding how to enroll is the final step.
How to Enroll in an Illinois ACA Plan
Enrolling through Get Covered Illinois takes a few steps.
Step 1: Gather your information. You will need Social Security numbers for household members, income documentation (pay stubs, tax returns, or W2s), and details about any employer coverage available to you.
Step 2: Create an account. Visit Get Covered Illinois and create a new account or log into your migrated Healthcare.gov account.
Step 3: Complete your application. Answer questions about household size, income, and insurance situation. The marketplace will determine your eligibility for premium tax credits, cost sharing reductions, and Medicaid.
Step 4: Compare plans. Browse available plans filtered by premium, deductible, provider network, or prescription coverage. Check whether your preferred doctors and medications are included.
Step 5: Enroll and pay your first premium. Select a plan and make your first monthly payment to activate coverage.
Open enrollment for 2026 ended January 31, 2026. You can still enroll with a qualifying life event such as losing coverage, getting married, having a baby, or moving. Automatic renewal enrollees have a special window through March 31, 2026. Free help from certified navigators and brokers is available through the Get Covered Illinois website.
Frequently Asked Questions
What are the 10 essential health benefits required in Illinois ACA plans? All marketplace plans must cover ambulatory care, emergency services, hospitalization, maternity care, mental health services, prescription drugs, rehabilitative services, lab services, preventive care, and pediatric dental and vision. These apply to every metal tier.
How do I know if I qualify for ACA subsidies in Illinois? If your household income is between 100% and 400% of the federal poverty level and you lack affordable employer coverage, you likely qualify. For a single person, that range is roughly $15,650 to $62,600. Apply through Get Covered Illinois to see your exact amount.
What is Get Covered Illinois? Get Covered Illinois is the state's own ACA marketplace, launched November 1, 2025. It replaced Healthcare.gov for Illinois residents. You use it to compare plans, apply for financial help, and enroll in coverage.
Can I still enroll if open enrollment has ended? You can enroll outside of open enrollment with a qualifying life event such as losing coverage, getting married, having a baby, or moving. Illinois also extended a special enrollment period through March 31, 2026 for auto renewed enrollees.
What is the difference between premium tax credits and cost sharing reductions? Premium tax credits lower your monthly premium. Cost sharing reductions lower your deductible, copays, and out of pocket maximum. Tax credits work with any metal tier, while cost sharing reductions only apply to Silver plans. Both are income based.
What if my income is too low for ACA subsidies? If your income falls below 100% of FPL ($15,650 for an individual), you likely qualify for Illinois Medicaid, which provides comprehensive coverage at no cost. Illinois expanded Medicaid in 2014, so most low income adults are eligible.
Next Steps
If you need health insurance in Illinois, check whether your income qualifies you for premium tax credits. Most residents earning between $15,650 and $62,600 (individual) can get significant financial help.
Visit Get Covered Illinois to compare plans and apply. If your income is below the Medicaid threshold, apply for free coverage through the ABE portal.
