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Private and individual health plans in Illinois
How individual major medical coverage works in Illinois for 2027, including metal levels, network types, and the issuers compiled from official sources. See also the <a href="carriers.html">carriers this agency is appointed with</a>.
Guaranteed-issue ACA coverage
For 2027 individual ACA plans in Illinois, coverage is guaranteed issue regardless of health history, and there is no pre-existing condition waiting period on those ACA plans. You generally must enroll during Open Enrollment or a Special Enrollment Period. You also have to live in the plan’s approved geographic area — many networks are county- or ZIP-specific.
Source: Illinois Department of Insurance, 2027 Analysis of Illinois On-Exchange Plans.
Metal levels, in plain language
Marketplace and other ACA individual plans are grouped by actuarial value — a standard-population estimate of the share of essential health benefit costs the plan is designed to pay, not a promise about your household:
- Bronze — about 60%
- Silver — about 70%. Cost-sharing reductions, if you qualify, are generally tied to selecting a Silver plan on the Marketplace.
- Gold — about 80%
- Platinum — about 90%
Catastrophic plans are a separate category with narrower eligibility (typically under age 30, or a hardship or affordability exception). Lower monthly premiums usually mean higher deductibles, and the reverse.
Sources: HealthCare.gov plan categories; ACA section 1302(d).
What ACA plans must cover
Non-grandfathered individual and small-group plans must cover essential health benefits in these ten categories: ambulatory (outpatient) services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. In-network preventive services required by the ACA are typically $0 when delivered as specified in the plan.
Sources: CMS, essential health benefits; HealthCare.gov glossary.
Network types you will see in Illinois
- HMO — Generally covers only in-network providers except in an emergency. You often select a primary care physician, and specialists may require a referral. You usually must live or work in the service area.
- EPO — Services are generally covered only in-network except in an emergency. Referral rules vary by plan.
- PPO — A contracted network with a lower cost for in-network care, and some coverage (usually at a higher cost) for out-of-network care. Balance billing may still apply out of network.
- POS — Typically an HMO-style plan with an out-of-network option at higher cost-sharing if you go outside the network.
Companies offering individual ACA plans in Illinois for 2027
Issuers that offered individual Marketplace (on-Exchange) medical plans in Illinois for plan year 2027, compiled from official sources cited on the Carriers page. A company may also sell off the Exchange. You must live in the plan’s approved service area. This agency is appointed with these issuers and with the other Illinois Marketplace/ACA issuers from plan years 2020–2027 listed on the Carriers page. An appointment does not mean every plan is available in every Illinois county or ZIP code.
- Ambetter of Illinois
- Health Care Service Corporation (Blue Cross and Blue Shield of Illinois)
- MercyCare HMO, Inc.
- Oscar Health Plan, Inc.
- UnitedHealthcare
confirm Marketplace plans at your ZIP code on Get Covered Illinois.
We are appointed with these 2027 issuers and with the other Illinois Marketplace and ACA individual issuers from plan years 2020–2027 listed on Carriers we’re appointed with, along with the private PPO and other appointments named there. Availability still depends on your county and ZIP code.
What a quote actually depends on
Individual ACA premiums in Illinois may vary by age, tobacco use, plan, and rating area (tied to where you live). They cannot be based on your health status, medical history, or sex. This is a published average change for a benchmark Silver-plan metric. It does not include premium tax credits, and it is not a quote for any household.
Sources: HealthCare.gov, How insurance companies set health premiums; Illinois Department of Insurance, 2027 Analysis of Illinois On-Exchange Plans.