CHICAGO — Illinois residents who buy health insurance through the Affordable Care Act (ACA) exchange could face an average 78% increase in premiums if Congress fails to extend enhanced premium tax credits, state regulators warned Monday.
According to the Illinois Department of Insurance, letters will be sent this week to affected policyholders explaining how their 2025 costs could change.
Currently, about 91% of Illinois ACA enrollees receive enhanced premium tax credits that help lower their monthly premiums, said Ann Gillespie, the department’s director.
“Some of them are going to lose their coverage entirely,” Gillespie said. “But everybody is going to be hit by this.”
At present, Illinois households pay an average of $260 per month for exchange coverage. Without the enhanced credits, that figure could rise to $464 per month.
The projected increases vary by county:
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Cook County: 95% increase
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Lake County: 47% increase
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DuPage County: 71% increase
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Will County: 83% increase
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Kane County: 66% increase
The ACA exchange serves residents who lack employer-sponsored insurance, don’t qualify for Medicaid, or are too young for Medicare. A record 550,000 Illinois residents enrolled in marketplace plans this year.
The enhanced subsidies, first expanded in 2021, are now central to the ongoing government shutdown debate. Democrats insist that funding cannot resume until Republicans agree to extend the subsidies beyond 2025, arguing that without them, millions could lose affordable coverage.
Republicans, including House Speaker Mike Johnson, have called the credits a “boondoggle,” saying they should be reformed before being extended.
If the enhanced subsidies expire, people earning more than 400% of the federal poverty level—$60,240 for an individual or $128,600 for a family of four—would lose eligibility. Lower-income households would continue receiving aid, but smaller subsidies than before.
State Transition to Its Own Exchange
Starting Nov. 1, Illinois will launch its own ACA marketplace at GetCoveredIllinois.gov, marking its shift from the federal HealthCare.gov platform. The new system aims to simplify transitions between Medicaid and marketplace plans and allow more special enrollment periods.
Pregnant women will be able to enroll at any time, and uninsured residents can sign up while filing their state taxes, said Morgan Winters, director of Get Covered Illinois.
“We encourage people not to wait to sign up,” Winters said. “The minute Congress acts, we’ll be ready to implement those subsidies.”
If Congress restores the subsidies after enrollment ends, the state plans to work with insurers to ensure residents receive the adjusted savings retroactively.
Rising Costs and Market Shifts
Insurers have already filed for steep rate increases, anticipating the subsidy expiration. They also cite rising health care costs, greater use of medical services, pharmaceutical tariffs, and inflation as major contributors.
Additionally, several insurers are exiting Illinois’ exchange for 2026:
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Aetna CVS Health
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Health Alliance
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Quartz
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Cigna Healthcare of Illinois (plans will remain available outside Cook County)
Gillespie warned that without the enhanced subsidies, younger, healthier individuals may drop coverage due to cost, driving up prices for everyone else.
“It’s a ripple effect,” she said. “When healthy people leave the market, everyone’s premiums go up. These subsidies help keep coverage affordable for working families.”
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