Obamacare premiums in Illinois rose sharply but not as much as expected

Monthly payments for health insurance through the Affordable Care Act, commonly known as Obamacare, did not increase by as much this year as Illinois officials had initially expected after the expiration of federal tax credits that made coverage significantly more affordable.

In Illinois, officials had estimated that enrollees would see an average increase of 78% in their monthly premiums this year. But nearly three months after open enrollment ended, Illinois officials now say premiums only rose by about 25%.

The drop-off in enrollees also has not been as steep as expected, at about 4%. In 2025, a record 465,985 individuals across the state signed up for the ACA. That number decreased this year to 448,568 enrollees, according to state data.

Still, medical providers in the Chicago area say it’s too soon to see the full impact of the expired subsidies, particularly because large numbers of people were auto-enrolled in coverage who could still drop off. They also worry that increases in health care costs in general are adding to the increasing number of uninsured patients they are seeing.

Nearly 43% of people in Illinois on the ACA were automatically re-enrolled. Enrollees typically have a grace period for keeping insurance even if they do not make the monthly payment, but those unpaid plans are typically canceled 90 days after enrollment.

Matthew McGough, an ACA policy analyst for KFF, which conducts health policy research and polling, said data on the number of people dropped from the program for lack of payment will come out later this year.

“That’ll be our best indication of people who are outside of the grace period and didn’t have their coverage effectuated," McGough said. “We’re waiting for that data to be able to, I think, start to really see how this picture is shaping up.”

Get Covered Illinois, the state-run ACA marketplace, said one reason monthly premiums didn’t rise dramatically is because the state was able to implement a strategy called “premium alignment.” That’s a tool that stabilizes the sticker price insurers charge for a premium, McGough said.

The household ACA monthly average premium is $328, up from $260 a year, according to state data. But if people buying coverage on the ACA exchange hadn’t adjusted their plans at all this year, the state expected the monthly average to rise to $464.

State officials say people switched to plans with lower and more affordable premiums. For example, more than 37,000 people moved to “bronze level” plans, which tend to have higher deductibles but lower monthly payments. An even larger share in Illinois than in the past moved into gold plans with lower deductibles, which follows a trend happening for the last few years across the country. The state says gold plans were more affordable for Illinois residents this year because of premium alignment.

The switch to bronze plans mirrors a larger national trend.

“They’re sort of hedging their bets that they’re hopefully not going to have a medical emergency in a given year,” McGough said. “They’re just trying to maintain some form of health coverage even if it means that they could potentially be on the hook for more financially if they have to seek out medical services.”

Digging deeper to find the real health care costs

But to truly measure affordability, consumers need to think beyond the deductible and monthly premium, said Carrie Espinosa, owner of Horizon Benefit Services in north suburban Gurnee.

For example, she saw one plan this year that introduced a deductible for prescriptions, which could end up shifting — or increasing — how much a person ends up paying for health care over the year.

When Espinosa is advising people on plans, she tells them to evaluate if their doctors are in network, the cost of medications, office visits and what procedures or tests they may need each year.

“You want to consider all of those factors as you’re making your decision, but the driver in all of that, in my humble opinion, is affordability,” she said. “If I can’t afford the health plan, I’m not going to be able to afford to use it.”

Espinosa had a handful of clients who opted this year to become uninsured, but others found ways to adjust their income to remain eligible for some form of assistance through the ACA.

Experts and officials, in particular Democrats, had warned that the expired enhanced premium tax credits could push people to become uninsured. The fight over the enhanced tax credits is what led to last fall’s government shutdown.

Medical providers around Chicago say it’s too soon to determine if the expired tax credits are causing people to become uninsured, but some report seeing more uninsured patients and are generally hearing concerns about rising health care costs. Paul Dark, from Benefit Management Associates, said costs increased this year not just for those who get insurance through the ACA but also for those who get health insurance through an employer, with some plans rising by as much as 40%.

Cook County Health is among the institutions that have seen an increase in uninsured patients, from 21% last year to about 25% this year so far, said Dr. Erik Mikaitis, the chief executive officer. That’s grown since the enhanced tax credits for the ACA expired, but other factors, including a drop in patients with Medicaid public health insurance, could also be driving that change.

Mikaitis is also bracing for further changes to Medicaid that push more people off the program. The county recently launched a new website, getmedicaidfacts.com, to help sort through those changes.

Dr. Mustafa Alavi, the medical director at the Erie Evanston/Skokie Health Center, sees patients falling through the cracks of both health care programs.

One patient lost Medicaid coverage because their income is too high, but they also can’t afford a plan through the ACA, Alavi said. The patient is now unable to maintain regular care to treat two chronic conditions. Another patient still has health insurance through the ACA but the costs have quadrupled, Alavi said. That makes it more difficult to buy medication.

“I had to prioritize which of the many priorities are important to address this year solely knowing that she now has more higher costs from her insurance plan,” Alavi said. “Not because it’s medically the right thing to do for my patients — it’s because I’m trying to make sure she can financially afford the medical care she needs.”