How Much Is Health Insurance in Illinois?

Health insurance costs in Illinois are a significant consideration for many residents. Understanding the factors that influence these costs can help individuals and families make informed decisions about their coverage. Premiums vary considerably based on individual circumstances and the type of plan chosen.

Factors Influencing Health Insurance Costs

Several factors determine the cost of health insurance premiums. Age is a primary determinant, with premiums generally increasing as individuals get older due to higher anticipated healthcare needs. For instance, costs can increase by approximately $5 per year in early adulthood and significantly more, around $33 per year, after age 50. Geographic location is another key factor, as costs can vary by county or region within the state, often reflecting differences in local healthcare costs and provider availability. For example, average Bronze premiums for a 30-year-old might be lower in suburban Chicago metropolitan areas compared to southern regions of the state.

Tobacco use can also lead to higher premiums, with a surcharge that can increase costs by up to 1.5 times compared to non-tobacco users. The number of individuals covered by a plan directly impacts the overall cost, as adding dependents increases the total premium. Furthermore, the choice of plan category or tier, such as Bronze or Silver, significantly influences the premium, with higher tiers generally corresponding to higher monthly payments. Deductibles and out-of-pocket maximums also play a role, as plans with lower deductibles and out-of-pocket limits typically have higher premiums.

Average Health Insurance Premiums in Illinois

The average cost of health insurance in Illinois varies based on plan type, age, and financial assistance. For a 40-year-old with an individual Silver plan, the average monthly cost is around $684. Subsidies can significantly reduce this, with the average cost with income-based discounts dropping to about $141 per month.

Premiums generally increase with age. An 18-year-old might pay an average of $396 per month, while a 50-year-old could pay around $781, and a 60-year-old approximately $1,187 for a Silver plan. Plan tiers also show a range of costs; for instance, the average Bronze premium is approximately $401 per month. Silver and Gold plans typically cost about 23% and 39% more than Bronze plans, respectively, at each age level.

Understanding Plan Tiers and What They Cover

Health insurance plans available through the marketplace are categorized into metal tiers: Bronze, Silver, Gold, and Platinum. These tiers indicate the average percentage of healthcare costs a plan covers versus what an enrollee pays out-of-pocket.

Bronze plans typically have the lowest monthly premiums but the highest deductibles and out-of-pocket costs, covering approximately 60% of medical expenses on average. Silver plans offer a moderate balance, with moderate premiums and deductibles, covering about 70% of costs on average. These plans are the only tier eligible for cost-sharing reductions.

Gold plans come with higher monthly premiums but lower deductibles, covering around 80% of healthcare costs. Platinum plans have the highest premiums but the lowest deductibles and out-of-pocket expenses, covering approximately 90% of costs.

In addition to metal tiers, different plan types exist, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Point of Service (POS) plans. These types primarily differ in their network restrictions and whether referrals are required to see specialists. PPOs generally offer more flexibility in choosing providers, including some out-of-network options, while HMOs typically require members to stay within a specific network and obtain referrals for specialists.

Financial Assistance and Affordability Options

Various forms of financial assistance are available to help make health insurance more affordable. Premium tax credits, also known as subsidies, reduce the amount paid monthly for health insurance premiums. Eligibility depends on household income relative to the federal poverty level (FPL) and household size, with assistance generally available for those earning between 100% and 400% of the FPL. These tax credits can be received in advance, directly lowering monthly payments, or claimed when filing federal income taxes.

Cost-sharing reductions (CSRs) provide additional financial help by lowering out-of-pocket expenses such as deductibles, copayments, and coinsurance. CSRs are exclusively available to individuals who enroll in Silver-tier plans and meet specific income criteria, typically up to 250% of the FPL. Beyond marketplace subsidies, Medicaid and the Children’s Health Insurance Program (CHIP) offer comprehensive, low-cost or free coverage for individuals and families with very low incomes. Medicaid eligibility is based on income, which for adults can be up to 138% of the FPL, while CHIP (known as All Kids) covers children in families with incomes up to 318% of the FPL.

How to Shop for Health Insurance in Illinois

Individuals seeking health insurance can primarily shop through the official Health Insurance Marketplace, HealthCare.gov. This platform is important for those who may qualify for premium tax credits or cost-sharing reductions. Starting in the fall of 2025, for coverage effective in 2026, the state will transition to its own enrollment platform, Get Covered Illinois.

When applying, have specific information ready, including details about household size, home and mailing addresses, Social Security numbers, and employer and income information for all household members. The marketplace allows for a comparison of plans based on premiums, deductibles, out-of-pocket maximums, and provider networks. Enrollment typically occurs during the annual Open Enrollment Period, which runs from November 1 through January 15. Outside of this period, a Special Enrollment Period may be available due to qualifying life events, such as losing health coverage, getting married, or having a baby.