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

Sam Jaber, Licensed Health Insurance Advisor · Updated September 2026

If you are self-employed in Illinois, 2026 is the first year you shop on Get Covered Illinois, the state's own marketplace, instead of HealthCare.gov. Your paths to coverage are a marketplace plan with federal premium help, Medicaid if your income is low, a marketplace plan at full price, or holding on to a former employer's plan for a while. One path that exists in many states, short-term medical, is closed here.

Illinois changed several things at once for 2026. The sections below cover what moved, what it means for someone who pays their own premium, and how to sort through it.

The self-employed starting line in Illinois

Working for yourself means two jobs on the insurance side: paying the full premium, and predicting an income that may not be predictable. The prediction matters because it decides which help you can get. In Illinois, that prediction now feeds into a new system.

Seven insurance companies sold plans on the Illinois marketplace for 2026. Two of them have said they will leave at the end of 2026, so the field is set to shrink for 2027. If one of the departing companies covers you now, plan on choosing a new plan in the fall rather than letting yours renew.

Statewide counts also hide a lot of local variation. The plans you can actually buy depend on where you live, so compare only the list Get Covered Illinois shows for your own address.

Path one: Get Covered Illinois with federal premium help

Illinois became a full state-based marketplace for 2026, and enrollment for 2026 coverage ran from November 1, 2025 to January 15, 2026. The move did not change the federal money. Premium tax credits still come from the federal government and still depend on household size, projected income and local plan prices. What changed is where you apply: getcoveredillinois.gov, not HealthCare.gov.

A new platform is a good reason to start early and to keep copies of everything you submit.

The self-employed risk here is the same one found everywhere. Advance credits are reconciled on your tax return against the income you actually earned, and a better year than you forecast can mean paying some of the credit back. The enhanced credits that smoothed this ended after 2025, so the point where help stops is abrupt again. If your earnings swing, work through the subsidy cliff for self-employed households before you pick a number.

The silver-plan pricing change

Illinois also changed how silver plans are priced for 2026. A state-regulated "load factor" is now added to silver-tier premiums. The practical effect, according to published coverage of the change, is that gold plans can come in relatively cheaper than silver for people who do not qualify for cost-sharing reductions, the extra help that lowers deductibles on silver plans at lower incomes.

For you, that means the habit of defaulting to silver deserves a second look. If your income is too high for cost-sharing help, put the gold plans in your area next to the silver ones and compare premium, deductible and out-of-pocket maximum side by side. The better value may not be where you expect.

Path two: Medicaid in a low-income year

Illinois expanded Medicaid, so adults can qualify with income up to 138% of the federal poverty level. A slow year, a startup year or a year spent between contracts can all put a self-employed household in that range. If yours is close, check Medicaid before buying a plan, and ask how your business income will be counted.

For Illinois Medicaid's expansion group, a federal work rule takes effect January 1, 2027: adults 19 to 64 must show 80 hours a month of work, school, training or volunteering, or earn $580 or more a month, unless exempt. Because self-employment income is harder to document than a paycheck, ask Illinois Medicaid what proof it will want from your business.

One state program has changed for immigrant residents. Illinois' state-funded Health Benefits for Immigrant Adults program, which covered noncitizens ages 42 to 64 regardless of immigration status, closed effective July 1, 2025 because of budget constraints. The companion program for people 65 and older stays open only to those already enrolled. If you are self-employed and relied on either, you will need to look at what other routes your status allows.

Path three: paying full price

Above the federal subsidy range, you can still buy any plan on Get Covered Illinois. You pay all of it, and you keep every marketplace protection. No plan can ask about your health, turn you away, or charge you more for a condition, and each one covers a standard benefit package.

This is where the 2026 rate increase lands hardest, because there is no credit to absorb it. It is also where the silver-and-gold comparison above matters most, since full-price buyers are exactly the group that does not qualify for cost-sharing reductions. Our breakdown of what coverage really costs when you are self-employed puts full-price premiums in context.

Path four: continuing a former employer's plan

Many people become self-employed right after leaving a job, and Illinois gives them an unusually broad option. Federal COBRA covers employers with 20 or more workers. Illinois adds its own continuation law for fully insured group plans, and unlike a law that only reaches small employers, it is not limited by employer size. It applies to plans sold by insurers and to HMO plans, and you generally need three months of continuous coverage before you leave to qualify.

We are not printing a length of time here on purpose. How long you can stay on, and how fast you must elect, depend on the plan and your circumstances, and an election deadline missed is usually gone for good. Ask the employer or the insurer exactly what applies before your coverage ends. You will also pay the full group premium yourself, so price it against the other paths using a side-by-side look at COBRA and its alternatives.

Why short-term plans are not on this list

In many states, short-term medical is a common stopgap between jobs. Illinois passed legislation in 2024 that ended the sale of short-term health insurance in the state, so it is not an option here. If you see one advertised to Illinois residents, treat that as a reason for caution. Coverage sold outside the marketplace that asks health questions follows different rules again, and our explainer on medical underwriting covers how it works.

Illinois prices for 2026

The benchmark plan, meaning the second-lowest-cost silver plan in an area, is the yardstick federal help is measured against. For a 40-year-old in Illinois, the average benchmark premium in 2026 was $646 a month.

Approved rates for 2026 rose by a weighted average of about 28.8% before subsidies. For subsidized buyers, a higher benchmark generally means a larger credit, which absorbs part of the increase. For full-price buyers, nothing absorbs it.

Averages describe the state, not your household. Age, location, household size and income all move the number you would actually see, and 2027 rates are approved separately. With two companies leaving, the 2027 lineup may look different as well.

A clear way to decide in Illinois

Sort yourself by income first, then check the Illinois rule that applies to that group.

• Bookmark the new site. Illinois residents now apply through Get Covered Illinois, not HealthCare.gov.
• Check whether your insurer is staying. Two companies plan to leave after 2026.
• Compare gold against silver if you do not qualify for cost-sharing help.
• Confirm your doctors and prescriptions in each plan before you look at price.
• Talk to your tax preparer about the federal self-employed health insurance deduction and how it shows up on your returns.

A licensed advisor can run these comparisons with your real numbers, without asking health questions first.

Common questions