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Chicago Individual & Family Health (ACA)

Chicago family reviewing health insurance options
2026 Open Enrollment

Chicago Individual & Family Health (ACA)

The 2026 Strategy: How to navigate the "Subsidy Cliff" and why Gold plans are now cheaper than Silver for most families.

The Silver Pricing Anomaly

Why Gold Is Cheaper Than Silver

Critical Insight: Because insurers "loaded" the cost of extra benefits into Silver plans, Gold Plans are now often cheaper than Silver in Illinois.

If you don't get a subsidy, do not buy Silver. Buy Gold. MC Chicago Insurance runs the math to show you exactly how much you'll save by upgrading.

2026 Enrollment Essentials

  • Blue Choice Preferred PPO (The only PPO left)
  • Blue Precision HMO (Northwestern/Rush In-Network)
  • Blue FocusCare (Warning: Micro-Network, No Northwestern)
  • Ambetter & Molina (Budget HMO Options)
  • Child-Only Policies (For uninsurable parents)
  • Subsidy Recalculation (Vital for 2026)
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Which Strategy Fits You?

The Unsubsidized (Income >400% FPL)

Strategy: Avoid Silver Plans. They are artificially inflated. You will likely save $100-$300/month by upgrading to a Gold Plan or dropping to a High-Deductible Bronze plan with an HSA.

The Subsidized (Income <400% FPL)

Strategy: Leverage the Load. Because subsidies are based on the high price of Silver plans, your subsidy is huge. You can often use it to buy a Gold Plan for near $0, or stay in Silver to get the "Cost Sharing Reductions" (lower deductibles).

The Network Trap

Critical Warning: "Blue Cross has 3 networks."
• Blue Choice PPO: Covers everyone (Northwestern, Rush, UChicago).
• Blue Precision HMO: Covers most (Northwestern/Rush).
• Blue FocusCare: Excludes many top hospitals. We check before you enroll.

Child-Only Plans

Family with children

The Family Loophole

Parents rarely know this: You can buy a policy just for your child. If adding your kids to your work plan costs $800/mo, we can often write a standalone PPO for them for $250/mo. It's a huge loophole for families priced out of employer coverage.

Massive Savings
Save 50-70% vs. adding kids to employer plans.
Full PPO Access
Child-only plans include full PPO networks.
Pediatric Benefits
Includes dental & vision for children under 19.
No Parental Link
Parent's health status doesn't affect child's coverage.

Get Covered Illinois

Illinois Has Its Own Exchange Now

Illinois has moved off HealthCare.gov. For 2026, we now use Get Covered Illinois. We handle the migration for you—moving your data from the federal system to the state system so you don't lose your history or subsidy eligibility.

What This Means For You

  • New Login Required: Your HealthCare.gov account won't work. We set up your new account.
  • Data Migration: Your previous enrollment history transfers automatically.
  • Same Plans: The carriers and plans remain the same—just a new portal.
  • Local Support: Illinois-based customer service for enrollment issues.

HealthCare.gov vs. Get Covered Illinois

Before (HealthCare.gov): Federal marketplace used by 30+ states. Generic customer service. Limited Illinois-specific features.

Now (Get Covered Illinois): State-run exchange with Illinois-specific plans, local customer service, and integration with state Medicaid programs. Same subsidies, better local support.

Carrier Exits for 2026

What Happens If You Don't Act

  • Auto-Mapped to Random Carrier
  • Network Disruption (New Doctors)
  • Drug Formulary Changes
  • Higher Deductibles/Copays

How We Help

Plan Mapping: We identify where your current carrier is sending you—and whether it's a good fit.

Active Selection: We help you choose proactively, verifying your doctors and drugs are covered before you enroll in a replacement plan.

The HSA Strategy

Your Defense Against the Subsidy Cliff

For high earners hit by the Subsidy Cliff, the HSA (Health Savings Account) is your best defense. It gives you a tax deduction to lower your income (potentially restoring your subsidy) and pays medical bills tax-free. Triple tax advantage: deductible contributions, tax-free growth, tax-free withdrawals for medical expenses.

2026 Individual: $4,300 max 2026 Family: $8,550 max 55+ Catch-Up: +$1,000

HSA Requirements

  • Enrolled in HDHP (High-Deductible Health Plan)
  • No other non-HDHP coverage
  • Not enrolled in Medicare
  • Can't be claimed as dependent

2026 Enrollment Timeline

Open Enrollment

Nov 1, 2025 – Jan 15, 2026. The main window to enroll or change plans for 2026 coverage.

Jan 1 Coverage

Enroll by Dec 15 for coverage starting January 1, 2026. Don't miss this deadline.

Special Enrollment

Lost coverage? Got married? Had a baby? You may qualify to enroll outside the window.

Common Questions

This is called "Silver Loading." Insurers increased Silver plan rates to boost federal subsidies (which are calculated based on Silver prices). The unintended consequence: if you don't qualify for a subsidy, Silver plans are artificially expensive. Unsubsidized buyers should skip Silver and buy Gold—often $100-$300/month cheaper for better coverage.

It depends on which Blue Cross plan you buy. YES for "Blue Choice Preferred PPO" and "Blue Precision HMO"—these include Northwestern, Rush, and UChicago. NO for "Blue FocusCare" and "BlueCare Direct"—these exclude many top Chicago hospitals. We verify your network before you enroll.

The 400% FPL (Federal Poverty Level) cap is back for 2026. This means approximately $62,000 for a single person and $128,000 for a family of 4. If your income exceeds these thresholds, you pay full price with no tax credit assistance. Contact us for a precise calculation based on your household size and projected income.

Yes! Child-only plans are full PPO/HMO policies and are often dramatically cheaper than adding children to an employer group plan. If your employer charges $800/month to add your kids, we can frequently write a standalone ACA plan for $250/month with full PPO access including pediatric dental and vision.

Aetna CVS and Cigna (in Cook County) have exited the Individual ACA market for 2026. If you had coverage with them, you must actively select a new plan by January 15, 2026. If you don't, you'll be "auto-mapped" to a random carrier—potentially with different doctors, drug formularies, and costs.

Get Covered Illinois is Illinois' new state-based health insurance marketplace, replacing HealthCare.gov for Illinois residents starting in 2026. The same carriers and plans are available, but through a state-run portal with Illinois-based customer service. Your HealthCare.gov login won't work—we help you set up your new account and migrate your data.

Potentially yes. An HSA (Health Savings Account) paired with a High-Deductible Health Plan can lower your taxable income through deductible contributions. For some people near the 400% FPL threshold, an HSA contribution could reduce MAGI enough to restore subsidy eligibility—while also providing tax-free money for medical expenses.

CSRs are extra savings available ONLY on Silver plans for people with incomes below 250% FPL. They lower your deductibles, copays, and out-of-pocket maximums. If you qualify for CSRs, staying on Silver makes sense. If you don't qualify, Gold is usually the better value due to Silver Loading.

Only with a Qualifying Life Event (QLE)—such as losing other coverage, getting married, having a baby, or moving to a new area. Outside of Open Enrollment, you need a QLE to enroll or change ACA plans. We help you determine if you qualify for a Special Enrollment Period.

Ambetter and Molina are budget-friendly HMO options that work well for healthy individuals seeking lower premiums. Their networks are more limited than Blue Cross PPO plans, but they include many community health centers and hospitals. We check if your doctors are in-network before recommending them.

Navigate 2026 With Confidence

Silver Loading, carrier exits, and the Subsidy Cliff don't have to derail your family's coverage. We compare every option on Get Covered Illinois to find your best fit.

(224) 616-9430 Get Your Free Quote

Serving Chicago from 3945 W Devon Avenue