11/14/2025
Get Covered Illinois - Here's what we're discovering as Illinois residents are forced to switch from the federal health insurance marketplace (healthcare.gov) to the new Illinois marketplace (getcovered.illinois.gov):
1.) With the future of the "enhanced" premium tax credits uncertain as to its funding with the wrangling in Washington D.C. right now, if you estimate your family income at more than 400% of the federal poverty level (FPL), you will NOT receive any monthly advance premium tax credit (PTC). Here's a table of 400% federal poverty levels:
Family Size Amount
1 $62,600
2 $84,600
3 $106,600
4 $128,600
(Other amounts readily available with online search)
2.) What this means is that unless the "enhanced" PTC amounts are funded, the old "cliff" rules will apply for 2026, and if your final income amounts exceed the 400% limit, you will have to repay the entire year of advance PTC amounts. This is how the reconciliation worked prior to the 2021 ARPA enhancement which was extended by the 2022 Inflation Reduction Act. That's why when you apply for 2026 coverage and estimate your income over the 400% level for your family size, you will not be awarded any advance credits to pay for insurance.
3.) If the "enhanced" PTC are funded, then it will go back to the 2025 rules and the most you'll have to pay for your health insurance coverage will be 8.5% of your income, the "cliff effect" will go away (that's what lawmakers are calling the "enhanced" premium tax credits). I have no clue if they will reinstate the Advanced Enhanced PTC at such time or if taxpayers will have to wait until they file their 2026 income tax return to reconcile and "settle up" at that time.
4.) We are seeing higher deductibles, typically doubled from 2025 and rates typically 30%-50% higher than for the same plan as 2025.
5.) My guess is that the federal marketplace is likely following the same practice, but I cannot confirm that.
6.) I still recommend families with incomes higher than 400% FPL obtain their insurance through the marketplace just in case the enhanced PTC are reinstated. If you get your insurance outside the marketplace, there is no chance for any PTC.
Anyone, 6 months of age and older, is eligible to receive the COVID-19 vaccine. Find your nearest vaccination location at vaccines.gov.