Illinois takes over health insurance marketplace in 2026 amid skepticism

By Catrina Barker | The Center Square contributor
The Center Square

(The Center Square) – Illinois will fully take over operation of its health insurance marketplace in 2026, moving away from the federal Healthcare.gov platform and rebranding as the state-run Get Covered Illinois exchange.

Gov. J.B. Pritzker said the shift will give the state more flexibility to tailor coverage options to residents’ needs.

“Today marks a pivotal step towards bringing quality, affordable healthcare to all Illinoisans,” Pritzker said.

In announcing the Centers for Medicare and Medicaid Services approving Illinois’ transition to a state-based health insurance marketplace, the governor’s office said beginning Nov. 1, Illinoisans who were previously enrolled through Healthcare.gov will transition to Get Covered Illinois for their 2026 coverage.

State Rep. Bill Hauter, R-Morton, a physician, said he gave the legislation creating the marketplace “a lot of thought” before ultimately voting for it a few years ago, but he remains skeptical.

“We were told that Illinois could do it better. But what has Illinois done that’s gotten better or done better?” Hauter said. “In the end, I think there is a chance that it could make it more streamlined and maybe save some money. We’ll see.”

One concern Hauter raised is that Illinois’ political clashes with Washington could affect federal funding and benefits.

“It’s a huge concern. Is the state going to use the marketplace to get health insurance for illegal immigrants? The federal government could respond by cutting other benefits to Illinois, maybe even Medicaid,” Hauter said. “We have to ask ourselves: does Illinois really want to keep fighting with the federal government on everything, whether it’s [diversity, equity and inclusion], sanctuary status or illegal immigrant health care?”

Hauter said the state is picking a fight with “an 800-pound gorilla, and the people who get hurt are Illinois residents.”

“For the Trump administration, it’s no skin off their back, but Governor Pritzker seems to think these fights help him stand out for a presidential run,” he said.

In a news release, Get Covered Illinois Director Morgan Winters noted that recent federal policy changes, along with the expiration of Enhanced Premium Tax Credits, could lead to “double-digit premium increases for many” Illinoisans.

“Since 2021, the federal government has offered enhanced tax credits, making health insurance cheaper for those enrolled in marketplace coverage. While some tax credits will still be available for those who qualify, the amount will be smaller, driving up insurance costs for enrollees,” states a news release from Get Covered Illinois.

Illinois uses Healthcare.gov, the federal website, for people who buy their own health insurance instead of getting it through a job, Medicare or Medicaid. In 2026, those people will use Illinois’ state-based website instead. The federal government will still decide which insurance companies are approved to sell plans, but Illinois will run the sign-up system and decide what benefits the plans must cover.

When asked what was wrong with Healthcare.gov, Hauter, a physician, said many doctors and hospitals stopped accepting plans from the federal exchange because the reimbursement rates were too low.

“Insurance products were terrible for providers, so much so that it was almost like Medicaid reimbursement,” Hauter said. “When you get reimbursed less than what it costs you to have the labor and the overhead, you just cannot continue to stay in business. Even if more people get covered, they might have struggled to find a doctor who would take their insurance.”

Hauter said the state-controlled website likely isn’t going to be much better for providers.

“I’m not here to look out for doctors or hospitals, but this new state-run website isn’t being promoted as better for providers. It’s advertised as easier for people who need insurance outside of their job, Medicaid or Medicare,” said Hauter. “I ended up voting for it because I want people to be able to go to a centralized marketplace with experienced, knowledgeable people who can help them choose insurance to protect themselves and their families. I want that to happen, but that’s a good theory. I don’t know if it will work in practice.”

State officials say the new system will have a simpler website, a call center and more local “navigators” to help people sign up for coverage.

Last year, as part of the transition to a state-based marketplace, Get Covered Illinois launched a $6.5 million grant to establish a statewide navigator network. These navigators are placed in communities across Illinois and are trained to assist residents who may need help applying for and enrolling in health insurance.

Open enrollment for 2026 coverage starts Nov. 1, 2025. Details are available at GetCoveredIllinois.gov.