Early Retiree Health Insurance in Illinois
Retiring in Illinois before 65 means buying your own coverage until Medicare starts, and premiums are highest in exactly those years: insurers can charge a 64-year-old up to three times what they charge a 21-year-old. Illinois individual premiums are also set to rise 14% to 14.1% on average for 2027. How you draw retirement income can matter as much as which plan you pick.
Private health insurance in Illinois
Most people I help in Illinois end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.
Why people leave the Marketplace
- Premiums keep climbing. Illinois Marketplace premiums are rising 14% to 14.1% on average for 2027.
- The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
- Surprise tax bills. Underestimate your income and you repay the tax credit in April.
- Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
- High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
- One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.
What a private plan does differently
- Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
- Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside Illinois too. Networks vary by plan.
- Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
- Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
- Approval is based on health. You answer health questions, and acceptance is not guaranteed.
With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.
Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.
Get a private plan quoteLearn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace
Retiring early in Illinois
Census Bureau estimates for July 2025 count about 1.55 million Illinoisans aged 55 to 64, about 12 percent of the state, in line with the national share. Cook County alone has about 603,000 people in that age group. The share runs higher at the edges of the metro and downstate: McHenry County is close to 14 percent, and LaSalle, Ogle and Boone counties are about 13.5 percent. Small river counties such as Pope and Calhoun lean older still, with 28 percent or more of residents already 65 and up.
Illinois rules for the bridge to Medicare
Illinois offers a real bridge to spouses of retirees. Under Section 367.2, when an employee retires, a spouse aged 55 or older can keep the insured group plan until Medicare, paying the employee and employer share for two years and then up to 20 percent more, with written notice due within 30 days. After 65, Medigap holders aged 65 to 75 get a 45-day window each birthday to switch to equal or lesser coverage with the same insurer. People under 65 on Medicare due to disability are guaranteed Medigap if they apply within six months of starting Part B.
The Illinois market for 55-to-64-year-olds in 2027
Illinois buyers use Get Covered Illinois, the state's own exchange since the 2026 plan year. Final 2027 individual rates rise about 14 percent on average across five insurers, and two insurers are leaving the exchange, so some enrollees must pick new plans. Illinois now requires prior approval of individual and small-group rates. The state banned short-term plans in 2025, so the alternatives to Marketplace coverage are private, medically underwritten plans and employer or union coverage. Continuation rights are relatively strong: 12 months for employees, and up to two years, or until Medicare for those 55 and older, for divorced or widowed spouses.
Other Illinois rules to know
- Leaving a small employer: Illinois requires insured group plans to offer up to 12 months of continuation after three months of coverage, and gives divorced or widowed spouses up to two years, or until Medicare if they are 55 or older.
- Short-term plans: Illinois banned new short-term health plans starting January 1, 2025.
- Where to enroll: Illinois uses its own exchange, Get Covered Illinois, which replaced HealthCare.gov for 2026. Get Covered Illinois sets its own open enrollment dates; check its site for 2027 deadlines. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 14% to 14.1% on average, small-group plans about 17.6%. See the Illinois 2027 rate page.
Your income is partly your choice
The Marketplace credit is based on modified adjusted gross income. Early retirees often control it: Roth withdrawals and cash savings generally do not count, while traditional IRA withdrawals, Roth conversions and capital gains do. For 2027 the credit stops at 400 percent of the poverty level, $63,840 for one person and $86,560 for a couple. Plan withdrawals with that line in mind. General information, not tax advice — confirm with your CPA based on your specific entity structure.
Private plans for healthy retirees
A retiree above the line pays full price on the Marketplace. A healthy 55-to-64-year-old can may pay less with a private, medically underwritten plan, which is priced on health and can start the first of any month if approved. With a health condition, the Marketplace remains the guaranteed choice.
Planning the switch at 65
Your Medicare initial enrollment period runs seven months around your 65th birthday. Line up the end of your individual plan with the start of Medicare so you never pay for both or go without.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
Compare Illinois plans
Licensed in Illinois. Private plans priced first, Marketplace alongside when it fits. No fee.
Illinois questions
Where do Illinois residents enroll in 2027 coverage?
Illinois uses its own exchange, Get Covered Illinois, which replaced HealthCare.gov for 2026. Get Covered Illinois sets its own open enrollment dates; check its site for 2027 deadlines.
What continuation rights does Illinois give after leaving a small employer?
Illinois requires insured group plans to offer up to 12 months of continuation after three months of coverage, and gives divorced or widowed spouses up to two years, or until Medicare if they are 55 or older.
How much are Illinois premiums rising for 2027?
Individual-market premiums are set to rise 14% to 14.1% on average, and small-group plans about 17.6%.
What health insurance do people use if they retire before 65?
COBRA or state continuation for a while, a Marketplace plan, a private underwritten plan, or a spouse's employer plan. Many use COBRA briefly and then switch.
Do Roth IRA withdrawals count toward Marketplace income?
Qualified Roth withdrawals generally do not count toward the modified adjusted gross income used for the credit, while traditional IRA withdrawals do. General information, not tax advice — confirm with your CPA based on your specific entity structure.
Sources: www2.census.gov, www2.census.gov, ilga.gov, ilga.gov. Facts checked October 2026. See all Illinois health insurance rules.
Early retirees in other states
Written by Frank Caballero, licensed health insurance agent in Illinois and 30 other states, NPN 21032307.