As the "Get Covered Illinois" program launches, consumers need to prepare

This reporter has conducted additional research on the "Get Covered Illinois" (GCI) program, slated this November to replace "Healthcare. gov," also referred to as the "Health insurance Marketplace," which approximately 466,000 Illinoisans used for their health insurance needs in 2025. Those who purchase their insurance through "Healthcare.gov" do not have the option to continue with that program. "Get Covered Illinois" is the State of Illinois replacement.

Like many policies, "Get Covered Illinois" premiums can be impacted by factors such as age, tobacco use, and location. How these factors will be determined and to what degree they will impact premiums is currently unknown and may vary by carrier.

Recent changes in federal policy may result in double-digit premium increases for many Illinoisans, due to the expiration of Enhanced Premium Tax Credits. While some tax credits will still be available for those who qualify, the amount will be smaller, driving up insurance costs for enrollees.

"Get Covered Illinois" will be the state's official health insurance marketplace, offering financial assistance in the form of Advance Premium Tax Credits (APTC) to help lower your monthly premiums.

In 2025, approximately 9 out of 10 Illinois exchange enrollees qualified for subsidized plans, saving just over $500 per month. Eligibility for these subsidies is primarily based on income, with the amount you receive decreasing as your income increases.

Different plan categories (Bronze, Silver, Gold, Platinum, and Catastrophic) have different premium outof-pocket expenses for care.

Bronze plans tend to have lower monthly premiums and higher out-of-pocket costs, while Platinum plans tend to have the highest monthly premiums and lower out-ofpocket costs.

It is important to know all options available to you, such as employer-sponsored coverage or Medicaid. If you have access to affordable, comprehensive health coverage through your employer, this may be more cost-effective than a "Get Covered Illinois" plan, especially if you wouldn't qualify for any subsidies. If your income is at or below 138% of the Federal Poverty Guidelines, you may qualify for Medicaid, which provides free or lowcost health coverage. Medicaid (typically) does not have a monthly premium and lower copayments than individually purchased plans, and may, in some cases, cover services not covered by individual plans. Medicaid coverage for adults, though, tends to be limited when it comes to dental and vision services.

"Get Covered Illinois" plans to have a network of brokers to help applicants navigate the plans available to them and make selections based on their needs and what they can afford. Recent legislation like the Consolidated Appropriations Act of 2021 (CAA) requires brokers to proactively disclose their compensation, including commissions and fees, to their clients before a contract is signed. This ensures transparency when clients have to make decisions on the plan they are going to purchase. The bottom line: make sure you know who is footing the bill for the assistance you will get through the GCI broker network. While brokers represent clients, they still typically receive commissions from insurance companies, and those commissions (and at times, fees) vary.

Before the enrollment period begins, determine the coverage you need and know how much you can afford, and be prepared to make compromises between the two.

Insurance is necessary in today's world, and the world of insurance can be intimidating to understand and navigate, but understanding the basics is critical to making the right choice based on your needs.

Ask questions and stick with it until you understand what you are getting, how much you will be paying, what the exclusions are (especially exclusions), and who is being paid with your premiums.

Having a trusted broker who will provide this information with transparency will help you get the coverage you need at a price you can afford, but always do your homework.

"Trust but verify." Two final matters to remember: this is a new system, with other systems built within it, so patience will be key to navigating GCI. As many know already, once technology is involved (logins, emails, phone trees, passwords, eDocs, etc) patience will serve you well.

Always document who you spoke with, when you spoke with them, summarize what was said, and get names, badge numbers, and confirmations as applicable.