Self-employed health insurance in Illinois: a new marketplace and new rules (2026)

Sam Jaber, Licensed Health Insurance Advisor · Updated September 2026 · Last reviewed September 18, 2026

If you work for yourself in Illinois, you'll notice a major change for 2026: enrollment now happens through Get Covered Illinois, the state's marketplace, rather than HealthCare.gov. You can choose federally subsidized marketplace coverage, qualify for Medicaid at lower incomes, purchase marketplace insurance without assistance, or temporarily continue coverage from a previous employer. Unlike many other states, Illinois does not permit short-term medical plans.

Illinois introduced several insurance changes together in 2026. I'll explain what's different, how those changes affect people paying their own premiums, and what to consider when choosing coverage.

The self-employed starting line in Illinois

When you're working for yourself, you handle the entire insurance premium while also estimating earnings that might fluctuate. That estimate determines what financial assistance is available to you. In Illinois, your projected income now goes through a newly established enrollment system.

Illinois offered marketplace coverage from seven insurers during 2026. However, two have announced plans to exit after 2026, leaving fewer participating companies in 2027. If your current coverage comes from either departing insurer, prepare to select another plan this fall instead of expecting an automatic renewal.

The statewide insurer total doesn't necessarily reflect what's available in your neighborhood. Your location determines which plans you can purchase, so use the options displayed for your address on Get Covered Illinois when making comparisons.

Path one: Get Covered Illinois with federal premium help

Illinois launched its fully state-operated marketplace for 2026, with enrollment running November 1, 2025 through January 15, 2026. Federal financial assistance stayed the same despite the platform change. Premium tax credits still depend on your household size, anticipated income and nearby plan costs, and the federal government still provides them. The difference is that applications now go through getcoveredillinois.gov instead of HealthCare.gov.

Whenever an enrollment platform is new, I'd recommend applying ahead of time and saving copies of all your submitted documents.

Illinois self-employed households face the same income-estimation issue as everyone else. The advance credits you receive are compared with actual earnings when you file taxes. If you make more than expected, repayment may be required. Enhanced federal credits expired after 2025, meaning assistance once again ends at a sharp income threshold. When your earnings fluctuate, review the subsidy cliff for self-employed households before deciding what income to report.

The silver-plan pricing change

Another Illinois change for 2026 affects silver-tier pricing. The state now requires a regulated "load factor" to be included in silver premiums. Published reporting indicates this can make gold coverage comparatively less expensive than silver for people who aren't eligible for cost-sharing reductions. Those reductions provide additional assistance with silver-plan deductibles for qualifying lower-income households.

That means choosing silver automatically may no longer make sense. If your earnings put cost-sharing reductions out of reach, compare available gold and silver plans directly. Look at the monthly premium, deductible and maximum out-of-pocket cost for each. You might discover that the stronger value comes from a different tier than expected.

Path two: Medicaid in a low-income year

Because Illinois expanded Medicaid, qualifying adults can earn up to 138% of the federal poverty level. If you're launching a business, experiencing slower sales or between contracts, your household income might fall within that limit. Before purchasing insurance, check Medicaid eligibility if you're close to the threshold and clarify how your self-employment earnings are calculated.

Beginning January 1, 2027, federal work requirements apply to Illinois Medicaid expansion enrollees. Unless exempt, adults ages 19 to 64 must complete 80 monthly hours of employment, education, training or volunteering, or earn at least $580 monthly. Since documenting business activity isn't always as straightforward as showing pay stubs, ask Illinois Medicaid which self-employment records they'll accept.

Illinois has also revised coverage for immigrant residents. Budget limitations led to the July 1, 2025 closure of the state-funded Health Benefits for Immigrant Adults program, which previously served noncitizens ages 42 to 64 regardless of immigration status. Its related program for adults 65 and older now serves existing enrollees only. If you work for yourself and previously depended on either program, review which alternative coverage options your immigration status permits.

Path three: paying full price

Even when your earnings exceed the federal subsidy limit, every Get Covered Illinois marketplace plan remains available at its full premium. You retain the standard marketplace safeguards: insurers cannot question your health, deny coverage or increase rates because of medical conditions. Each plan must also include the required essential benefits.

The 2026 premium increase hits hardest when you're paying without a tax credit to soften the cost. That's also why comparing silver and gold matters so much for full-price customers, who don't receive cost-sharing reductions. To put those monthly premiums into perspective, see our explanation of what coverage really costs when you are self-employed.

Path four: continuing a former employer's plan

Starting a business often follows leaving an employer, and Illinois provides a particularly broad continuation option. Federal COBRA generally covers businesses employing at least 20 people. Illinois also has continuation protections for fully insured employer group coverage, without restricting eligibility based on employer size. The state provisions include insurer-issued plans and HMO coverage. Generally, you must have maintained coverage continuously for three months before leaving your job.

I'm deliberately not giving one fixed continuation period here. Your circumstances and specific plan determine both how long coverage can continue and when you must elect it. Missing that election deadline can permanently eliminate the opportunity. Get precise answers from your employer or insurer before your existing plan terminates. Because you'll pay the entire group premium yourself, use a side-by-side look at COBRA and its alternatives to weigh the costs against other coverage.

Why short-term plans are not on this list

Short-term medical policies frequently serve as temporary coverage between jobs elsewhere, but Illinois ended their sale through legislation enacted in 2024. They're therefore unavailable as an Illinois option, and advertisements targeting state residents deserve scrutiny. Other nonmarketplace policies that evaluate your medical history operate under separate rules. You can learn more through our explainer on medical underwriting.

Illinois prices for 2026

The second least expensive silver plan available locally is called the benchmark, and federal premium assistance is calculated using its price. In Illinois, the 2026 average benchmark cost for a 40-year-old was $646 monthly.

Illinois approved a weighted average premium increase of approximately 28.8% for 2026 before financial assistance. A rising benchmark typically increases available tax credits for eligible households, offsetting some of that increase. People paying full premiums, however, receive no such offset.

These statewide figures won't necessarily match your quote. Premiums depend on your age, address, family size and earnings, while 2027 rates undergo their own approval process. The departure of two insurers could also change which plans are offered next year.

Illinois’s 2026 marketplace sells a PPO medical plan in every county (102 of 102). You can still get a nationwide PPO plan in Illinois through Sam Jaber. See Illinois in the state-by-state PPO table.

A clear way to decide in Illinois

Begin with your expected income, then identify the Illinois coverage rules that apply to your situation.

• Save the updated enrollment website. Applications in Illinois now go through Get Covered Illinois instead of HealthCare.gov.
• Find out whether your carrier will remain. Two insurers intend to exit following 2026.
• Put gold and silver side by side when cost-sharing reductions aren't available to you.
• Verify your physicians and medications are covered under each plan before comparing premiums.
• Ask your tax professional how the federal self-employed health insurance deduction affects what you report on your tax returns.

A licensed advisor can help evaluate these plans against your household's actual financial picture, with no initial medical screening questions.

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