Illinois

Illinois’s Marketplace is run by the federal government and residents should use HealthCare.gov to enroll in Marketplace plans. Open enrollment runs from November 1, 2023 until January 16, 2024.

• Under federal law, individuals may enroll in the marketplace outside of the open enrollment period if they experience certain qualifying events, such as the loss of employer-based insurance, marriage, or having a baby (see a more complete list here). 
• Illinois uses the federal Marketplace, which offers additional special enrollment periods (SEPs) if the following occurs:
  • Having a household income at or below 150 percent of the federal poverty level ($21,870 for an individual, $45,000 for a family of four) and being eligible for Marketplace subsidies.
  • Losing Medicaid between March 31, 2023 and July 31, 2024—HealthCare.gov offers an extended SEP for these individuals, allowing them to apply for Marketplace coverage at any point within this period and giving them 60 days once they submit an application to select a plan.
• SEPs are subject to change and restrictions may apply. Some SEPs may only be available to individuals who have current Marketplace coverage, and some SEPs may only be accessible through the Marketplace call center. The list of SEPs on our website is not an exhaustive one. If you recently experienced a change in circumstances that you think may qualify you for a SEP, check with the Marketplace to determine your enrollment options.

• Under federal law, short-term plans are not required to cover services for pre-existing conditions and therefore typically provide far fewer benefits and cost-sharing protections compared to health plans available through the Marketplace. Federal rules allow these plans to last up to 12 months and be marketed as a substitute for Affordable Care Act coverage. However, states may modify these federal standards to make them more strict and also require short-term plans to follow additional consumer protections.
• Illinois allows short-term plans that last up to 180 days. These products can be sold during the open enrollment period.

Illinois does not require individuals to pay a penalty or tax for failing to maintain minimum essential coverage.

Under the Affordable Care Act, individuals may qualify for premium tax credits and plans with reduced cost-sharing based on their income and other factors. Illinois does not provide state funds to supplement those federal premium tax credits or cost-sharing reductions.

Under the Affordable Care Act, individual and group health plans that offer dependent benefits must allow parents to keep their children up to age 26 on their plan. Illinois law goes further than this by allowing certain dependent adults from age 26 up to their 30th birthday to remain on their parent's insurance if it is a state-regulated plan that insures dependent children. These dependents must:

• Be an Illinois resident;
• Be unmarried; and
• Have served as a member of the active or reserve components of any branch of the U.S. Armed Forces and received a release or discharge other than a dishonorable discharge.

The Affordable Care Act gives states the option to expand Medicaid to adults with household income at or below 138 percent of the federal poverty level. Illinois has taken advantage of this option so adults with household incomes at or below 138 percent of the federal poverty level ($20,120 for an individual, $41,400 for a family of four annually) are eligible for Medicaid.

• In Illinois, children under age 19 are eligible for Medicaid and the Children’s Health Insurance Program (CHIP) with household incomes at or below 318 percent of the federal poverty level ($95,400 for a family of four annually).
• Pregnant people are eligible for Medicaid with household incomes at or below 213 percent of the federal poverty level ($63,900 for a family of four annually).
• In Illinois, if an individual’s circumstances indicate potential Medicaid eligibility, it may be faster to apply through the state Medicaid agency than through HealthCare.gov.

• Generally, lawfully residing immigrants are eligible for Medicaid after a 5-year waiting period with some exceptions.
• In Illinois, lawfully residing children are exempt from the 5-year waiting period.
• Pregnant people, who are otherwise qualified, are eligible for CHIP unborn child coverage regardless of immigration status.
• Additionally, income-eligible children and some income-eligible seniors over the age of 42 who are not eligible for Medicaid or CHIP due to immigration status may qualify for state-funded coverage.

Federal law gives states the opportunity to optionally extend Medicaid eligibility for postpartum individuals up to 12 months. Illinois has implemented this coverage expansion.