How to Choose the Right Health Insurance Plan in Illinois (2025) — Avoid Costly Mistakes

Choosing a health insurance plan in Illinois in 2025 can feel overwhelming. With multiple plan types, metal tiers, carrier options, subsidy rules, and a brand new state marketplace to navigate, it is no wonder so many Illinois residents either pick the wrong plan or give up and go without coverage altogether.

This guide cuts through the confusion. Whether you are an individual, a family, a self-employed professional, or a small business owner in Illinois, we will walk you through exactly how to choose the right health insurance plan for your specific situation, step by step, in plain language.

At Chime Insurance Group, our licensed agents specialize in helping Illinois residents and families find health coverage that makes sense for their healthcare needs and their budget. We do the comparison work for you at no cost. Get a free consultation or visit our Health Insurance page to get started today.

WHAT HAS CHANGED IN ILLINOIS HEALTH INSURANCE FOR 2025 AND 2026

Before diving into how to choose a plan, it is important to understand the major changes that have reshaped the Illinois health insurance market in the past year,  because they directly affect your options and costs.

Get Covered Illinois launched as Illinois's own state marketplace on November 1, 2025, replacing the enrollment portal for Illinois residents. This is now the only place where Illinois residents can apply for income-based subsidies known as Advance Premium Tax Credits, to reduce their monthly premiums. If you have been using it in previous years, your account was transitioned to Get Covered Illinois.

Federal subsidy enhancements expired at the end of 2025. The enhanced subsidies that were in place since 2021 under the American Rescue Plan are no longer available for 2026 plans. This means middle-income earners who previously qualified for significant subsidy help may now pay substantially more. Individuals earning over $62,600 and families of four earning above $128,600 are most affected. Working with a licensed broker is now more important than ever to find the best value.

Fewer carriers are available in 2026. Illinois went from 11 marketplace carriers in 2025 to 7 in 2026 after Health Alliance, Aetna, CVS Health, and Quartz exited the market. Cigna also stopped offering plans to Cook County residents. This means your options may be more limited than in previous years, depending on your county.

Despite these changes, the average after-subsidy monthly premium for qualifying Illinois enrollees was $142 in 2026, and 8 out of 10 Illinois marketplace enrollees were eligible for some level of subsidy. The key is knowing whether you qualify and how to maximize your savings.

STEP 1: UNDERSTANDING YOUR HEALTH INSURANCE SITUATION

The first step in choosing health insurance in Illinois is understanding which type of coverage you are shopping for. Your situation determines which options are available to you.

You need individual or family coverage if you are self-employed, your employer does not offer health insurance, you are between jobs, or you do not qualify for Medicaid or Medicare. In this case, you will shop through Get Covered Illinois, the state marketplace, or purchase directly from a carrier through an off-marketplace plan.

You need employer-sponsored coverage if your employer offers health insurance and you want to enroll in or change your workplace plan. In this case, your options are limited to what your employer offers, but a broker can help you understand and optimize your selection during open enrollment.

You may qualify for Medicaid if your household income is below roughly 138% of the federal poverty level, approximately $20,000 per year for a single person in 2025. Illinois Medicaid, called Illinois Medicaid or All Kids for children, provides free or low-cost coverage with no premiums for qualifying residents. Enrollment is open year-round with no waiting period.

You are approaching Medicare eligibility if you are 64 and preparing for Medicare at 65, or if you have a qualifying disability. See our separate Medicare guide or visit our Health Insurance page for information on Medicare supplement plans.

STEP 2: KNOW THE PLAN TYPES AVAILABLE IN ILLINOIS

Understanding the different plan structures is essential before you compare costs. Here are the main types of health insurance plans available to Illinois residents:

• Health Maintenance Organization (HMO) plans require you to choose a primary care physician who coordinates all of your care. You need a referral from your PCP to see a specialist. HMOs have lower monthly premiums and out-of-pocket costs but less flexibility; you must use providers within the plan's network or pay the full cost yourself. Best for people who want lower costs and are comfortable with coordinated care through a single doctor.

• Preferred Provider Organization (PPO) plans give you more flexibility to see any doctor or specialist without a referral, including out-of-network providers — though out-of-network care costs more. PPOs have higher monthly premiums than HMOs but are popular with people who have existing relationships with specialists or want maximum choice. Blue Cross Blue Shield of Illinois offers PPO plans with wide networks, including Northwestern, Loyola, and Rush Hospital systems.

• Exclusive Provider Organization (EPO) plans combine some features of HMOs and PPOs. You do not need a referral to see a specialist, but you must stay within the plan's network for all non-emergency care. EPOs typically have lower premiums than PPOs while offering more specialist flexibility than HMOs.

• High Deductible Health Plan (HDHPs) have lower monthly premiums but higher deductibles, meaning you pay more out of pocket before insurance kicks in. HDHPs are almost always paired with a Health Savings Account, which allows you to save and spend money tax-free for qualified medical expenses. Best for healthy individuals or families who rarely use medical care and want lower monthly costs with tax-advantaged savings.

• Point of Service (POS) plans are a hybrid between HMO and PPO plans. You choose a primary care physician and need referrals for specialists, as in an HMO, but you can also see out-of-network providers at a higher cost, as in a PPO. Less common but available in some Illinois markets.

STEP 3: UNDERSTANDING THE METAL TIERS

All ACA marketplace plans in Illinois are organized into four metal tiers that describe how costs are shared between you and your insurer. The tiers are Bronze, Silver, Gold, and Platinum.

Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs when you use healthcare. Your insurer covers about 60% of costs, and you cover 40%. The out-of-pocket maximum for 2025 Bronze plans in Illinois is $9,200 for individuals and $18,400 for families. Best for young, healthy people who rarely use medical care and want the lowest possible monthly cost.

Silver plans are the middle ground; your insurer covers about 70% of costs. Silver plans are uniquely important because they are the only tier eligible for Cost-Sharing Reductions, which can dramatically lower your deductibles and copays if your household income is between 100% and 250% of the federal poverty level. Blue Cross Blue Shield of Illinois Silver plans start at approximately $368 per month. For lower-income Illinois residents, a Silver plan with CSRs can be the best value of any tier.

Gold plans have higher monthly premiums, but your insurer covers about 80% of costs, meaning lower deductibles and copays when you actually use care. Best for people who expect to use healthcare frequently or have ongoing conditions requiring regular treatment. Gold plans from BCBSIL start around $395 per month in Chicago.

Platinum plans have the highest monthly premiums, but your insurer covers 90% of costs — the lowest possible out-of-pocket expenses. Best for people with significant, predictable healthcare needs who want maximum financial protection.

The right tier for you depends on one key question: how much healthcare do you actually use? If you are generally healthy and rarely see a doctor, a Bronze or Silver HDHP may save you the most money overall. If you have regular prescriptions, ongoing conditions, or a family with children who need frequent care, a Gold or Platinum plan may cost less in total over the course of the year, even with higher premiums.

STEP 4: CHECK YOUR SUBSIDY ELIGIBILITY

Before comparing specific plans, check whether you qualify for financial assistance to reduce your costs. There are two types of financial help available through Get Covered Illinois:

Premium Tax Credits reduce your monthly premium. They are available to Illinois residents with household incomes between 100% and 400% of the federal poverty level, roughly $15,650 to $62,600 for a single person and up to $128,600 for a family of four in 2025. In 2026, 8 out of 10 Illinois marketplace enrollees qualified for premium tax credits, with an average savings of $688 per month. After credits, the average Illinois enrollee paid just $142 per month.

Cost-Sharing Reductions further reduce your deductibles, copays, and out-of-pocket maximums if your income is between 100% and 250% of the federal poverty level. CSRs are only available on Silver plans. For qualifying households, a Silver plan with CSRs can cover up to 94% of healthcare costs, far better than even a Gold plan at a much lower premium.

Important: You can only access these subsidies by enrolling through Get Covered Illinois. If you purchase a plan directly from an insurer off-marketplace, you forfeit any subsidy eligibility.

Chime Insurance Group helps you calculate your exact subsidy eligibility as part of our free consultation. Contact us before assuming you do or do not qualify, the savings can be substantial.

STEP 5: CHECK THE PROVIDER NETWORK

This is the step most people skip, and it can be a costly mistake. Before you enroll in any plan, confirm that your current doctors, specialists, and preferred hospitals are in-network.

Why this matters: Out-of-network care can cost significantly more, sometimes three to five times the in-network rate, and some plan types like HMOs will not cover out-of-network care at all except in emergencies.

How to check: Every plan has an online provider directory. Before enrolling, search for your primary care physician, any specialists you see regularly, and your preferred hospital. Also, check your prescriptions, confirm that your medications are on the plan's formulary, and check the copay tier for each drug.

Specific Illinois considerations: Major Chicago-area hospital systems like Northwestern Memorial, Rush, Loyola, and University of Illinois Health are in-network for some plans but not others. If access to a specific hospital is important to you, this must be confirmed before enrolling.

STEP 6: COMPARE YOUR TOTAL ANNUAL COST, NOT JUST THE PREMIUM

The biggest mistake Illinois health insurance shoppers make is choosing the plan with the lowest monthly premium without considering the total annual cost. Here is how to calculate which plan actually costs you less:

Total annual cost = Annual premiums plus expected out-of-pocket costs, including deductibles, copays, and coinsurance.

For example, A Bronze plan with a $350 monthly premium but a $7,000 deductible may cost you more in a year where you have a significant medical event than a Silver plan with a $450 monthly premium and a $1,500 deductible. The $100 monthly premium difference equals $1,200 per year — far less than the $5,500 difference in deductibles.

Think about your expected healthcare use for the coming year when making this calculation. If you are planning a surgery, having a baby, managing a chronic condition, or have a family member with regular medical needs, a higher-premium, lower-deductible plan almost always wins on total cost.

ILLINOIS HEALTH INSURANCE FOR FAMILIES — SPECIAL CONSIDERATIONS

Illinois families shopping for health insurance have several additional factors to consider:

• Pediatric coverage: All ACA marketplace plans in Illinois cover pediatric dental and vision as part of the essential health benefits. This means your children's basic dental and vision needs are included in your health plan, though standalone dental and vision plans may offer more comprehensive coverage.

• Dependent coverage: Children can remain on a parent's health insurance plan until age 26 in Illinois, regardless of whether they live at home, are students, or are married. This is an important planning consideration for families with young adults.

• Maternity care: All ACA-compliant plans cover maternity and newborn care as an essential health benefit. Pre-existing pregnancy conditions cannot be used to deny coverage or increase premiums.

• Mental health coverage: All plans must cover mental health and substance use disorder services at the same level as physical health benefits. If your family needs behavioral health services, confirm that your preferred mental health providers are in-network before enrolling. Our healthcare partner Hometown NP provides telehealth mental health consultations for individuals and families nationwide, which can be a useful complement to your health coverage.

For Illinois families navigating insurance while managing a chronic condition, our partner Sarah's Haven provides virtual support and care coordination resources for families dealing with Parkinson's disease and other neurological conditions — helping patients and caregivers navigate coverage options and connect with the right care.

HOW CHIME INSURANCE GROUP MAKES CHOOSING EASIER

At Chime Insurance Group, we believe that every Illinois resident deserves to understand their health insurance options and to make a choice they feel confident about, without feeling pressured or confused.

Here is what our free consultation looks like:

We assess your situation. We start by understanding your income, household size, health needs, preferred doctors, and budget. This takes about 15 minutes and gives us everything we need to make meaningful recommendations.

We calculate your subsidy eligibility. We determine exactly what premium tax credits and cost-sharing reductions you qualify for, so you know your real out-of-pocket costs, not just the sticker price.

We compare plans across all available Illinois carriers. Because we are an independent agency, we compare options from Blue Cross Blue Shield of Illinois, UnitedHealthcare, Ambetter, Molina Healthcare, Oscar Health, and other carriers available in your county, not just one company's offerings.

We explain your top options clearly. We present your best two or three options in plain language, premium, deductible, network, and total estimated annual cost, so you can make an informed decision without feeling overwhelmed.

We help you enroll. Once you choose a plan, we guide you through the enrollment process on Get Covered Illinois or directly with the carrier, making sure everything is completed correctly.

There is no cost to you for any of this. Our service is completely open to Illinois residents and families. Contact us to get started.

HEALTH INSURANCE IN FRANKFORT AND WILL COUNTY, ILLINOIS

Chime Insurance Group is based in Frankfort, Illinois, and serves clients throughout Will County, Cook County, and the greater Chicago metropolitan area. We have a deep understanding of the health insurance options available in our local market and the carriers and networks that serve our communities best.

If you live in Frankfort, Mokena, New Lenox, Tinley Park, Orland Park, Joliet, Bolingbrook, Romeoville, or anywhere in the south and southwest Chicago suburbs, our team is ready to help you find the right coverage for 2025 and beyond.

Will County residents benefit from some of the most competitive health insurance rates in Illinois, with Bronze plan premiums among the lowest in the state at around $332 per month for a 30-year-old. Our local expertise means we know which plans offer the best network coverage and value for residents in our area.

Ready to find your plan?

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FREQUENTLY ASKED QUESTIONS: CHOOSING HEALTH INSURANCE IN ILLINOIS

People searching for how to choose health insurance in Illinois are also asking these questions. Here are clear, direct answers:

1. What is the best health insurance plan in Illinois for 2025? There is no single best plan; it depends on your health needs, income, preferred doctors, and budget. For budget-conscious healthy individuals, Bronze plans offer the lowest premiums. For people who qualify for Cost-Sharing Reductions, a Silver plan may offer the best overall value. For those with frequent healthcare needs, Gold plans typically cost less in total over the year. Chime Insurance Group compares all options to help you find the best plan for your specific situation.

2. What is Get Covered Illinois, and do I have to use it? Get Covered Illinois is Illinois's official state health insurance marketplace, launched on November 1, 2025. It is the only place where you can access income-based premium tax credits and cost-sharing reductions to lower your costs. If you qualify for subsidies, you must enroll through Get Covered Illinois to access them.

3. How much does health insurance cost in Illinois in 2025? Individual health insurance averages approximately $556 per month before subsidies. After premium tax credits, the average qualifying Illinois enrollee paid just $142 per month in 2026. Silver plans from Blue Cross Blue Shield of Illinois start at approximately $368 per month. Costs vary by age, location, household size, and income.

4. Do I qualify for a health insurance subsidy in Illinois? You may qualify for a premium tax credit if your household income is between 100% and 400% of the federal poverty level — approximately $15,650 to $62,600 for a single person. Additional Cost-Sharing Reductions are available for Silver plan enrollees with incomes between 100% and 250% of the federal poverty level. Chime Insurance Group can calculate your exact eligibility for free.

5. What is the difference between Bronze, Silver, Gold, and Platinum health plans in Illinois? The metal tiers describe how costs are shared between you and your insurer. Bronze covers 60% of costs and has the lowest premiums. Silver covers 70% and is the only tier eligible for Cost-Sharing Reductions. Gold covers 80% with lower out-of-pocket costs. Platinum covers 90% and has the highest premiums but the lowest out-of-pocket expenses.

6. Can I keep my doctor if I switch health insurance plans in Illinois? Only if your doctor is in-network with your new plan. Before enrolling in any plan, check the plan's online provider directory to confirm your preferred doctors, specialists, and hospitals are included. Chime Insurance Group checks network coverage as part of every free consultation.

7. What is the open enrollment period for health insurance in Illinois? Open enrollment for ACA marketplace plans in Illinois typically runs from November 1 to December 31 each year, with coverage starting January 1. Outside of open enrollment, you can only enroll if you experience a qualifying life event such as losing other coverage, getting married, having a baby, or moving to a new area. These are called Special Enrollment Periods.

8. Is it better to get health insurance through an employer or the marketplace in Illinois? It depends on how much your employer contributes to your premium. If your employer covers a significant portion of your premium, employer-sponsored insurance is often the most cost-effective option. If your employer's contribution is minimal or you are self-employed, a marketplace plan with subsidy assistance through Get Covered Illinois may offer better value. Chime Insurance Group can help you compare both options.

9. What health insurance is available in Frankfort and Will County, Illinois? Will County residents will have access to multiple ACA marketplace plans from carriers, including Blue Cross Blue Shield of Illinois, UnitedHealthcare, Ambetter, Molina, and Oscar Health. Will County has some of the most competitive premiums in Illinois. Chime Insurance Group, based in Frankfort, specializes in helping Will County and Chicago suburb residents find the best local coverage.

10. How do I get help choosing health insurance in Illinois for free? Contact Chime Insurance Group. Our licensed independent agents provide free plan comparisons, subsidy calculations, network checks, and enrollment assistance for Illinois residents and families. There is no cost to you, our service is completely free.

READY TO FIND THE RIGHT PLAN?

Choosing health insurance does not have to be confusing. With the right guidance, the right plan is closer than you think, and the savings from making the right choice can be substantial.

Chime Insurance Group is here to make it simple. Contact us today for your free consultation, and we will find the right health insurance plan for you and your family.

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Chime Insurance Group serves individuals and families across Illinois, including Frankfort, Mokena, New Lenox, Tinley Park, Orland Park, Joliet, Bolingbrook, Romeoville, Chicago, and throughout Will County, Cook County, and the greater Chicago metropolitan area.