Affordable Care Act open enrollment begins in Illinois amid election that could mean future changes

Lisa Schencker, Chicago TribuneChicago Tribune

Chicago-area residents might notice fewer health insurance plans available and a mixed bag when it comes to costs, as they select Affordable Care Act plans this open enrollment season, which kicked off Friday amid an election that could have consequences for future coverage.

Most people in Illinois get health insurance through employers, Medicaid or Medicare, but each year, hundreds of thousands of Illinois residents in need of coverage select plans on HealthCare.gov. Last year during open enrollment, 398,814 Illinois residents enrolled in HealthCare.gov plans, according to the Centers for Medicare and Medicaid Services.

This year’s open enrollment season began Nov. 1, and people must enroll in plans by Dec. 15 if they want coverage to start Jan. 1. They have until Jan. 15 to choose coverage that would start Feb. 1.

This year, residents of Cook, Kane and Kankakee counties will have 16 to 20 fewer plans from which to choose, Lake County residents will have 31 to 35 fewer plans and DuPage County residents will have 21 to 25 fewer plans, according to an Illinois Department of Insurance analysis. Kendall and Grundy counties will also see decreases in the number of plans, while residents of Will and McHenry counties will see slight increases in the numbers of plans available.

Insurance company Cigna is no longer offering plans in Lake or McHenry counties this year, and Health Alliance Medical Plans left Kankakee County.

Chicago-area residents will also see a variety of rates, or monthly premiums, for those plans, before tax credits.

There will be three levels of plans in Illinois next year, bronze, silver and gold. Higher metal levels have higher premiums but lower out-of-pocket costs, while lower level metal plans have lower premiums but higher out-of-pocket costs.

Rates for the lowest cost silver plans are rising an average of 2% next year across the state. Rates for the second lowest cost silver plans are not changing, on average. The lowest cost gold plans will be 4% more expensive this year, on average, and the lowest-cost bronze plans will be 5% more expensive, on average.

Behind those averages are double digit rate increases for some plans and double digit decreases for others.

Many Illinois residents, however, will likely be insulated from big increases thanks to enhanced tax credits that offset costs, said Stephanie Altman, director of healthcare justice at the Shriver Center on Poverty Law in Chicago.

Last year, nearly 90% of Illinois residents with Affordable Care Act plans received the credits, according to the Illinois Department of Insurance. Nationally, about 80% of HealthCare.gov customers should be able to find plans for next year for $10 a month or less, with help from the tax credits, according to the Centers for Medicare and Medicaid Services.

“The rates were pretty stable, and the increases we’re seeing were less than in other states,” Altman said. “That’s welcome news, and also most people won’t even feel these increases because of the premium tax credit offset.”

The election Tuesday could have implications, however, for the future of those tax credits.

Consumers began receiving enhanced tax credits after the passage of the American Plan Rescue Act in 2021, and the Inflation Reduction Act then extended those expanded subsidies through 2025.

If Democrats gain power during this election, they will likely try to extend those enhanced tax credits beyond 2025, Altman said. It’s unclear whether Republicans would do the same. During President Donald Trump’s time in office, his administration tried unsuccessfully to repeal the Affordable Care Act.

If the federal enhanced tax credits expire after 2025, it’s possible that states could step in to try to provide some relief for consumers who buy exchange plans, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University McCourt School of Public Policy. But it’s unlikely any state would be able to provide enough funding, on its own, to fully replace the enhanced credits if they expire, she said.

Illinois is taking steps to try to better insulate its health insurance marketplace from changes in Washington, D.C.

Last year, Gov. JB Pritzker signed a bill into law giving Illinois the power to run its own marketplace. Starting next year, for plans sold for 2026, Illinois consumers will select plans from an independent, state-based marketplace, rather than on the federal HealthCare.gov.

The new state-based exchange could allow Illinois to give consumers more chances to buy health insurance, and better understand the challenges Illinois residents may face when it comes to health insurance, advocates of the state-based exchange say.

“Operating our own health care marketplace gives us the dexterity to offer more enrollment windows, coordinate with nonprofit partners who help families navigate insurance choices, and protect Illinoisans from any future changes in federal policy that seek to undermine access to affordable healthcare — including access to reproductive health care,” Pritzker said in a news release at the time of the bill signing last year.