Ambetter Health Insurance in Gurnee, Illinois

Updated July 2026 · IllinoisPlanFinder.com — Licensed Health Insurance Producer (NPN #21249133)

Ambetter is one of 5 carriers offering marketplace plans in Gurnee's Rating Area 3 for 2026.
Ambetter plans are typically HMO or EPO, requiring in-network care, including hospitals like Vista Medical Center East.
Eligible Gurnee residents with incomes between 100% and 400% FPL can receive federal subsidies to reduce Ambetter premiums.
Illinois Medicaid covers adults up to 138% FPL, and pregnant women up to 213% FPL, offering comprehensive, low-cost coverage.

For residents of Gurnee, Illinois, securing affordable and comprehensive health insurance is a key concern. Ambetter is a prominent carrier offering health plans through GetCoveredIllinois, the state-based marketplace. In Gurnee, you can typically find Ambetter plans structured as Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs). These plans provide comprehensive coverage for essential health benefits, including doctor visits, hospital stays, prescription drugs, and preventive care. The availability of subsidies through GetCoveredIllinois can significantly reduce your monthly premiums, making Ambetter plans a viable option for many individuals and families in the area.

Get Your Free Health Insurance Quote

A licensed agent can compare coverage options for you at no cost.

✓

You're all set!

A licensed agent will reach out shortly.

What Ambetter Plans Are Available in Gurnee, Illinois?

In Gurnee, Ambetter primarily offers health plans through the GetCoveredIllinois marketplace. These plans are designed to meet the requirements of the Affordable Care Act (ACA), ensuring they cover essential health benefits. For the 2026 plan year, Gurnee residents, who reside in Rating Area 3, which covers Lake and McHenry counties, have access to Ambetter plans structured as HMOs and EPOs. Health Maintenance Organization (HMO) Plans: HMO plans typically require you to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists. These plans generally have lower monthly premiums and out-of-pocket costs, but they offer less flexibility in choosing providers outside the network. Exclusive Provider Organization (EPO) Plans: EPO plans offer a network of doctors and hospitals, similar to an HMO, but usually do not require a PCP referral to see a specialist. However, like HMOs, they generally do not cover out-of-network care except in emergencies. Illinois is one of the states where PPO plans ARE available on-exchange, with carriers like Blue Cross and Blue Shield of Illinois offering them. While Ambetter typically focuses on HMO and EPO models, it is always recommended to compare all available plan types and carriers on GetCoveredIllinois to find the best fit for your healthcare needs and budget.

Understanding Ambetter Costs and Subsidies in Gurnee

The cost of Ambetter health insurance in Gurnee can vary significantly based on your income, age, family size, and the specific plan tier you choose (Bronze, Silver, Gold, or Platinum). However, many Gurnee residents qualify for financial assistance, known as Premium Tax Credits (subsidies), through GetCoveredIllinois. These subsidies can substantially lower your monthly premium payments. Eligibility for subsidies is based on your household income relative to the Federal Poverty Level (FPL). For 2026, individuals and families with incomes between 100% and 400% FPL are eligible for Premium Tax Credits. For example, a single person in Gurnee earning between approximately $15,060 and $60,240 (based on 2024 FPL numbers, which are typically updated annually) would likely qualify for assistance. In addition to Premium Tax Credits, some individuals may also qualify for Cost-Sharing Reductions (CSRs). CSRs are available to those with incomes up to 250% FPL and enrolled in a Silver-tier plan. These reductions lower your out-of-pocket costs, such as deductibles, copayments, and coinsurance, making healthcare more affordable when you need it. To determine your exact eligibility and the amount of financial assistance you could receive, it is essential to apply through GetCoveredIllinois. An independent licensed health insurance producer can also help you navigate these options and understand how subsidies apply to Ambetter and other plans.

Health Insurance Carriers in Gurnee

Gurnee, Illinois, located in Lake County, is part of Illinois Rating Area 3. For the 2026 plan year, residents of Rating Area 3 have a choice of five health insurance carriers offering plans on GetCoveredIllinois. This robust competition helps ensure a variety of plan options and price points. The confirmed carriers offering marketplace plans in Rating Area 3, which covers Lake and McHenry counties, for 2026 are:

Ambetter
Blue Cross and Blue Shield of Illinois
Molina Healthcare
Oscar Health
United Healthcare

When choosing a plan, it's important to consider not just the premium, but also the plan type (HMO, EPO, PPO), the deductible, copayments, coinsurance, and the network of doctors and hospitals. Each carrier offers a range of plans across different metal tiers (Bronze, Silver, Gold), allowing you to select coverage that balances cost and benefits according to your needs. Gurnee, Illinois, with a population of 30,510 and a median income of $119,628 per U.S. Census Bureau ACS 2024 5-year estimates, benefits from a diverse range of healthcare options. Lake County, with 714,223 residents, is served by five acute care hospitals, including Vista Medical Center East in Waukegan and Northwestern Lake Forest Hospital in Lake Forest, providing essential medical services for the region. The uninsured rate in Gurnee is 2.6%, significantly lower than Lake County's 6.9%, reflecting strong access to coverage options.

Illinois Medicaid and CHIP Eligibility in Gurnee

For Gurnee residents with lower incomes, Illinois offers robust Medicaid and Children's Health Insurance Program (CHIP) options. Illinois expanded Medicaid in 2014, meaning adults with household incomes up to 138% of the Federal Poverty Level (FPL) may qualify for comprehensive, low-cost health coverage through Illinois Medicaid. This expansion ensures that individuals who might otherwise fall into a coverage gap have access to essential healthcare services. Beyond general adult coverage, Illinois also provides significant support for pregnant women and children:

Pregnant Women Medicaid: Illinois Medicaid covers pregnant women with income up to 213% FPL, one of the highest thresholds among production states. This coverage includes comprehensive prenatal care, labor, delivery, and an extended 12 months of postpartum care, a benefit enacted under the American Rescue Plan. You can apply through ABE (abe.illinois.gov) or by calling the DHS helpline.
Illinois All Kids (CHIP): Children in Illinois can receive low-cost coverage through Illinois All Kids, the state's CHIP equivalent, with eligibility extending up to 313% FPL. This is one of the most expansive child coverage programs in the country, ensuring that a vast majority of children have access to necessary medical care.

If your income falls within these thresholds, applying for Illinois Medicaid or Illinois All Kids should be your first step, as these programs often provide more comprehensive benefits with lower out-of-pocket costs than marketplace plans.

Choosing the Right Ambetter Plan in Gurnee

Selecting the best Ambetter health insurance plan in Gurnee involves considering several factors, including your healthcare needs, budget, and preferred doctors. Here's a guide to help you make an informed decision:

Assess Your Healthcare Needs: If you visit the doctor frequently or have ongoing medical conditions, a plan with a lower deductible and predictable copayments (like a Gold plan) might be more suitable, even if it has a higher premium. If you are generally healthy and only expect preventive care, a Bronze plan with a lower premium but higher deductible could be a good fit.
Understand Metal Tiers:
- Bronze Plans: Offer the lowest premiums but have the highest deductibles and out-of-pocket maximums. They cover 60% of costs, leaving 40% for you. Good for catastrophic coverage.
- Silver Plans: A good balance of premiums and out-of-pocket costs. They cover 70% of costs, leaving 30% for you. Crucially, Silver plans are the only tier eligible for Cost-Sharing Reductions (CSRs) if you qualify based on income.
- Gold Plans: Have higher premiums but lower deductibles and out-of-pocket maximums. They cover 80% of costs, leaving 20% for you. Ideal if you expect to use a lot of medical services.
Check Provider Networks: Ambetter plans are network-based (HMO/EPO). Before enrolling, verify that your preferred doctors, specialists, and hospitals (such as Advocate Condell Medical Center in Libertyville) are included in Ambetter's network for your chosen plan.
Consider Financial Assistance: If your income qualifies you for Premium Tax Credits or Cost-Sharing Reductions, these will significantly impact your effective costs. Ensure you factor these into your decision-making process.

Navigating these choices can be complex. Working with a licensed health insurance producer, like those at IllinoisPlanFinder.com, can provide personalized guidance at no additional cost to you. They can help you compare Ambetter plans alongside options from other carriers and ensure you maximize any available subsidies.

Frequently Asked Questions

What types of Ambetter plans are available in Gurnee?

In Gurnee, Ambetter typically offers HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans. These plans require you to use a network of doctors and hospitals, with EPOs offering a bit more flexibility outside a primary care physician referral.

Can I get a subsidy for Ambetter plans in Gurnee?

Yes, if your household income falls between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for subsidies (Premium Tax Credits) to lower your monthly premiums for Ambetter plans purchased through GetCoveredIllinois. Enhanced subsidies make plans more affordable for many Gurnee residents.

Where can I find doctors and hospitals that accept Ambetter in Gurnee?

Ambetter plans in Gurnee, like all network-based plans, require you to use their specific provider network. You can find in-network doctors and hospitals, including facilities like Vista Medical Center East in Waukegan, by checking Ambetter's official provider directory on their website or by contacting their customer service.

Is Ambetter the only carrier offering plans in Gurnee?

No, Ambetter is one of five carriers offering marketplace health plans in Rating Area 3, which covers Lake and McHenry counties, for the 2026 plan year. Other options include Blue Cross and Blue Shield of Illinois, Molina Healthcare, Oscar Health, and United Healthcare.