The Affordable Care Act in Illinois now runs through a state-operated marketplace called Get Covered Illinois, which took over from HealthCare.gov for the 2026 plan year. Medicaid still covers adults with household incomes up to 138% of the federal poverty level, and children qualify at much higher thresholds through the All Kids program. The biggest shift for 2026 is financial: the enhanced federal premium tax credits that made marketplace plans affordable from 2021 through 2025 expired at the end of 2025, premiums jumped sharply, and four insurers left the exchange. More changes are coming to Medicaid in 2027, including work requirements and twice-yearly eligibility checks.
Who Qualifies for Medicaid in Illinois
Illinois expanded Medicaid under the ACA to cover non-disabled adults under age 65 with household incomes up to 138% of the federal poverty level. For one person, that works out to about $1,799 per month; for a family of four, roughly $3,697 per month.1Illinois Department of Human Services. Family Health Plans Income Standards By fiscal year 2025, about 734,000 Illinoisans were enrolled through the ACA expansion, part of a total Medicaid population of roughly 3.26 million.2Illinois Department of Healthcare and Family Services. Statewide Program Enrollment
Pregnant women qualify at higher incomes, up to 213% of the federal poverty level. Children qualify at substantially higher thresholds — up to 318% of FPL through the All Kids program.3Illinois Department of Healthcare and Family Services. Medical Programs For children, there is no asset test; eligibility depends on household income and size.4Illinois Legal Aid Online. Medicaid Common Questions
All Kids covers doctor visits, hospital stays, prescriptions, dental, vision, and immunizations for children through age 18, with no cost-sharing for well-child visits and check-ups.5Illinois Department of Healthcare and Family Services. About All Kids The program is tiered: families up to 147% of FPL pay no premiums under All Kids Assist, while higher-income tiers (Share, Premium Level 1, and Premium Level 2) require graduated premiums and co-payments up to 318% of FPL.3Illinois Department of Healthcare and Family Services. Medical Programs All Kids does not check or report immigration status to the federal government, and participation does not affect a child’s public-charge determination.
Buying Coverage Through Get Covered Illinois
For most of the ACA’s history, Illinois residents shopping for individual plans used the federal HealthCare.gov platform. That changed for the 2026 plan year. The Centers for Medicare and Medicaid Services approved Illinois’s full transition to a state-based exchange on August 11, 2025. A redesigned Get Covered Illinois website and a live Customer Assistance Center went online October 1, 2025, and open enrollment for 2026 coverage ran from November 1, 2025 through January 15, 2026.6State of Illinois. Get Covered Illinois State-Based Marketplace Approval Illinois was the only state transitioning to its own exchange for 2026.7Becker’s Payer Issues. Illinois Gears Up for Transition to State-Based Insurance Marketplace
Outside open enrollment, you generally need a qualifying life event to enroll — a move, a marriage, the birth of a child, loss of other coverage, and similar changes. Illinois also offers a Tax Time Easy Enrollment option: uninsured residents can check a box on their state income tax return to receive an eligibility estimate, which opens a 60-day window to enroll in a plan.8Get Covered Illinois. Qualifying Life Events
What Marketplace Plans Cost in 2026
Enhanced premium tax credits, first created by the American Rescue Plan Act and extended by the Inflation Reduction Act, held marketplace premiums down from 2021 through 2025 for roughly 90% of the approximately 466,000 Illinoisans enrolled in ACA plans as of January 2025.9Capitol News Illinois. State-Based Health Insurance Marketplace Opens Those enhanced credits expired at the end of 2025. In December 2025, the Senate rejected both a Democratic proposal for a three-year extension and a Republican alternative focused on health savings accounts.10WTTW News. Federal Health Subsidies Expire, Launching Illinois Residents Into Uncertainty The baseline ACA premium tax credit structure remains, but it is less generous. Get Covered Illinois warns that “financial help available through Get Covered Illinois will be lower in 2026” unless Congress acts.11Get Covered Illinois. Financial Help
The dollar impact is significant. The Center on Budget and Policy Priorities estimated that a 45-year-old Illinois resident earning $64,000 would see annual premiums rise by about $2,777, and that a 60-year-old couple earning $85,000 could face an increase of about $23,661 per year.12Center on Budget and Policy Priorities. Health Insurance Premium Spikes Imminent as Tax Credit Enhancements Set to Expire Illinois Insurance Director Ann Gillespie said as many as 30% of marketplace enrollees could be forced to drop coverage.9Capitol News Illinois. State-Based Health Insurance Marketplace Opens
Underlying premiums also rose. The lowest-cost and second-lowest-cost Silver plans — the tier most commonly purchased and the one subsidies are calculated against — increased by an average of 34% statewide. Bronze plans rose by an average of 15%, while Gold plans held roughly flat on average. Those averages hide regional variation. The western part of the state, outside the St. Louis metro area, saw Bronze plan increases between 30% and 50% in several counties.13Illinois Department of Insurance. 2026 Analysis of Illinois On-Exchange
The number of insurers on the individual exchange also dropped from eleven to seven. Aetna, Aetna Life, Health Alliance (HAMP), and Quartz exited. The remaining issuers for 2026 are Celtic Insurance Company, Cigna, Health Care Service Corporation (Blue Cross Blue Shield of Illinois), MercyCare, Molina, Oscar, and UnitedHealthcare. HCSC is the sole insurer in 63 of the state’s counties. No Platinum tier plans are offered on the exchange, and no insurers participate in the Small Group (SHOP) market on the exchange.13Illinois Department of Insurance. 2026 Analysis of Illinois On-Exchange
Enrollment reflects the strain. After reaching a record 437,892 enrollees in February 2025, marketplace enrollment fell to 373,065 as of June 2026, a decline of nearly 15%. Of the more than 92,000 people who dropped off, 64% lost coverage for nonpayment of monthly premiums.14WBEZ Chicago. Affordable Care Act Enrollment in Illinois Continues to Drop, New State Data Shows
Cost-Sharing Reductions on Silver Plans
If your household income falls between 100% and 250% of the federal poverty level and you buy a Silver plan through Get Covered Illinois, you qualify for cost-sharing reductions that lower deductibles, co-payments, and the annual out-of-pocket maximum.15Get Covered Illinois. Cost-Sharing Reduction (CSR) In 2026, the standard Silver out-of-pocket maximum is $10,600. Cost-sharing reductions bring that cap down to no more than $3,500 for enrollees up to 200% of FPL, and no more than $8,450 for those between 201% and 250% of FPL.16KFF. How Much Are the Cost-Sharing Subsidies These reductions apply only to Silver-tier plans; buying a Bronze or Gold plan forfeits them.
Free Help Enrolling
Illinois residents can get free help picking a plan and applying for financial aid through Get Covered Illinois’s statewide network of trained navigators and certified brokers. Navigators help you understand your options and complete an application; brokers can also recommend specific plans. Both are listed on the Get Covered Illinois website. The Customer Assistance Center is reachable by phone at 1-866-311-1119.17Get Covered Illinois. Free Local Help Community organizations such as the Community Health Partnership of Illinois place certified application counselors at clinics around the state.18Community Health Partnership of Illinois. Enrolling in Health Insurance
What’s Changing in 2027 and Beyond
The One Big Beautiful Bill Act (H.R. 1, 119th Congress), signed into law in 2025, imposes several Medicaid changes that take effect over the next few years. The Congressional Budget Office estimated the law would cut more than $1 trillion in national health care spending and add 10 million to the uninsured count by 2034.19WTTW News. Illinois Faces Looming Health Crisis as Medicaid Cuts Threaten Coverage, Hospitals and Rural
Starting January 1, 2027, ACA expansion adults ages 19 to 64 who do not have dependents under age 14 will have to verify at least 80 hours per month of work, volunteering, or part-time school to keep Medicaid. Exemptions exist for people with disabilities, mental health diagnoses, and substance use disorders, though the federal government has not yet released the specific definitions.20Illinois Department of Healthcare and Family Services. FAQ: How Will Federal Changes Impact Medicaid The Illinois Department of Healthcare and Family Services estimates 270,000 to 500,000 recipients could lose coverage, largely because of administrative barriers rather than actual ineligibility. The state is weighing whether to apply for a “good faith effort determination” that could delay the requirement to January 1, 2029.21The Arc of Illinois. HFS OBBBA Briefing
On the same date, eligibility redeterminations for ACA expansion adults shift from annual to every six months.22Illinois Department of Healthcare and Family Services. Medicaid Federal Policy Changes Starting October 1, 2028, ACA expansion adults with incomes above 100% of FPL will face new cost-sharing, capped at 5% of annual income.20Illinois Department of Healthcare and Family Services. FAQ: How Will Federal Changes Impact Medicaid
A separate risk sits in state law. Illinois’s Medicaid statute contains a trigger provision that automatically ends ACA expansion if the federal matching rate drops below the current 90%. The statute provides that “eligibility under this paragraph 18 shall cease no later than the end of the third month following the month in which the reduction in FMAP takes effect.”23Georgetown University Center for Children and Families. How Would Changes to Federal Medicaid Expansion Funding Impact People in Trigger States If that trigger ever fires, more than 770,000 adults enrolled through the expansion would lose coverage.24Illinois Department of Healthcare and Family Services. Impact on Illinois Medicaid
The federal law also reshapes hospital funding. Provider taxes will be capped and gradually reduced from 6% to 3.5% between 2028 and 2032, and state-directed payments to hospitals will be capped at Medicare rates. The Illinois Health and Hospital Association projects rural hospitals will absorb the heaviest cuts. Federal Medicaid spending in Illinois is projected to drop by roughly $48 billion over ten years, with rural areas accounting for an estimated $6.73 billion of that. Association CEO A.J. Wilhelmi said that “we know that there are several hospitals that close because of these changes.”25Capitol News Illinois. Illinois Hospitals Fear Massive Cuts Under Trump Domestic Policy Law
How Illinois Compares
Illinois’s uninsured rate was 6.8% in 2024, below the national average of 8.2%, according to the most recent American Community Survey data.26KFF. Health Insurance Coverage of the Total Population27America’s Health Rankings. Health Insurance in Illinois Employer-sponsored insurance covers about 54% of the state’s population, followed by Medicaid at roughly 19% and Medicare at about 15%.