Private Health Insurance in Illinois
Private health insurance in Illinois is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Illinois Marketplace premiums rising 14% to 14.1% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Illinois and when the Marketplace is the better call.
Who buys their own coverage in Illinois
Get Covered Illinois ran its first open enrollment on its own platform for 2026 and logged 448,568 plan selections, CMS's state-level file shows, about 3.7 percent below the 465,985 Illinoisans who signed up a year earlier. New customers fell harder, from about 111,000 to about 75,000. Roughly 85 percent of 2026 buyers received an advance premium tax credit, so about 15 percent paid full price, up from about 10 percent before the enhanced credits expired. Census data for 2024 put about 42 percent of Illinois households at $100,000 or more in income.
How Illinois regulates private plans
Illinois treats fixed indemnity and other limited-benefit policies as regulated insurance. Under 215 ILCS 5/355a they must meet state minimum benefit standards, and 50 Ill. Adm. Code 2007.80 requires their applications and plan materials to say, in at least 14-point type, that the policy supplements but does not replace major medical coverage. No Illinois statute exempts health care sharing ministries; HB 4162, a bill that would have required them to file with the state, died in 2023. Illinois has no law allowing agricultural organization plans. Company Bulletin 2020-20 says association plans qualify as group coverage only under pre-2018 federal standards.
Protecting yourself when you buy in Illinois
Section 355a of the Insurance Code requires every individual accident and health policy, except single-premium nonrenewable ones, to state on its first page that you may return it within 10 days of delivery for a full premium refund. You must also receive an outline of coverage. To check an agent, the Department of Insurance sends consumers to the NAIC's State Based Systems lookup, where the license should show as active. Complaints go online or to the hotline at 866-445-5364. Get Covered Illinois warns that scammers push fake limited-benefit plans through unexpected calls and urges reports to 866-311-1119.
The Illinois Marketplace you would be comparing against
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.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
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 is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, www.ilga.gov, insuranceqa.illinois.gov, insuranceqa.illinois.gov, getcovered.illinois.gov. Facts checked October 2026. See all Illinois health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Illinois and 30 other states, NPN 21032307.