Is Ambetter health insurance available in Round Lake Beach, Illinois?

Yes, Ambetter is one of five health insurance carriers offering marketplace plans in Round Lake Beach, Illinois, and the wider Rating Area 3 for the 2026 plan year. You can enroll in Ambetter plans, alongside options from other carriers, through GetCoveredIllinois.

What types of Ambetter plans can I find on GetCoveredIllinois?

On GetCoveredIllinois, Ambetter typically offers Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans. These plans require you to use a network of doctors and hospitals, often needing referrals for specialists with HMOs. PPO plans are also available on-exchange in Illinois from other carriers.

Can I get financial assistance for an Ambetter plan in Round Lake Beach?

Yes, if your household income falls between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for premium tax credits and cost-sharing reductions (CSRs) to lower your monthly premiums and out-of-pocket costs on Ambetter plans purchased through GetCoveredIllinois. Illinois also expanded Medicaid, so adults below 138% FPL may qualify for free or low-cost coverage.

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

Ambetter Health Insurance in Round Lake Beach, Illinois

Ambetter is one of five health insurance carriers offering marketplace plans in Round Lake Beach for the 2026 plan year.
Round Lake Beach is part of Illinois Rating Area 3, which covers Lake and McHenry counties.
Illinois residents with incomes up to 138% of the Federal Poverty Level (FPL) may qualify for Illinois Medicaid.
Marketplace plans in Illinois, including Ambetter, offer HMO, EPO, and PPO options through GetCoveredIllinois.

Navigating your health insurance options in Round Lake Beach, Illinois, requires understanding local availability and state-specific programs. If you're looking for Ambetter health insurance, you'll find it among the marketplace plans offered in your area. For 2026, Ambetter is one of five confirmed carriers providing coverage options through GetCoveredIllinois, the state's official health insurance marketplace. These plans are available to residents of Round Lake Beach, which is located in Lake County and falls within Illinois Rating Area 3. Whether you're seeking individual, family, or small business coverage, understanding the local landscape and financial assistance options is key to making an informed decision.

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What Ambetter Health Insurance Options Are Available in Round Lake Beach?

In Round Lake Beach, Ambetter offers a range of health insurance plans primarily structured as Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans. These plans are available on GetCoveredIllinois, where you can compare them against offerings from other local carriers. Illinois is an expansion state, meaning that marketplace shoppers have a choice of HMO, EPO, and PPO plans on-exchange, giving you flexibility in how you access care. Ambetter plans, like all marketplace plans, cover essential health benefits, including doctor visits, hospital care, prescription drugs, mental health services, and maternity care. The specific benefits, deductibles, copayments, and out-of-pocket maximums will vary by plan tier (Bronze, Silver, Gold, Platinum). Bronze plans typically have the lowest premiums but highest out-of-pocket costs, while Gold and Platinum plans have higher premiums but lower costs when you need care.

Understanding Your Eligibility and Financial Assistance in Illinois

Many Round Lake Beach residents qualify for financial assistance to make health insurance more affordable. This assistance comes in two main forms:

Premium Tax Credits: These subsidies reduce your monthly premium payments and are available to individuals and families with household incomes between 100% and 400% of the Federal Poverty Level (FPL).
Cost-Sharing Reductions (CSRs): Available exclusively with Silver plans, CSRs lower your deductibles, copayments, and out-of-pocket maximums. You must have an income between 100% and 250% FPL to qualify.

For those with lower incomes, Illinois expanded Medicaid in 2014, allowing adults with income up to 138% FPL to qualify for comprehensive, low-cost health coverage through Illinois Medicaid. Additionally, Illinois Medicaid covers pregnant women with income up to 213% FPL, providing extensive prenatal, delivery, and 12 months of postpartum care. Children in Illinois are covered by Illinois All Kids (the state's CHIP equivalent) up to 313% FPL, making it one of the most expansive child coverage programs nationally.

Health Insurance Carriers in Round Lake Beach

Round Lake Beach is located in Lake County, part of Illinois Rating Area 3. This rating area also covers McHenry County. In 2026, 5 carriers offer marketplace plans in Rating Area 3, providing residents with multiple options. These carriers include:

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

When choosing a plan, consider not only the premium but also the plan type (HMO, EPO, PPO), the network of doctors and hospitals, and the out-of-pocket costs. Lake County, with a population of 714,223, is served by several major hospital systems, including Vista Medical Center East in Waukegan and Northwestern Lake Forest Hospital in Lake Forest, alongside Advocate Condell Medical Center in Libertyville, Advocate Good Shepherd Hospital in Barrington, and Midwestern Region Med Center, Inc in Zion. Ensuring your preferred providers are in-network is crucial.

Making the Right Choice: Next Steps for Round Lake Beach Residents

Choosing the right health insurance plan, whether from Ambetter or another carrier, depends on your specific health needs, budget, and desired level of coverage. Here's a general guide:

If your income is below 138% FPL: You likely qualify for Illinois Medicaid. Apply directly through ABE (abe.illinois.gov) or call the DHS helpline.
If your income is between 100% and 250% FPL: Consider a Silver plan on GetCoveredIllinois. You may qualify for premium tax credits and significant cost-sharing reductions, making a robust plan more affordable.
If your income is between 250% and 400% FPL: You're eligible for premium tax credits. Compare Bronze, Silver, and Gold plans to find the best balance of premium and out-of-pocket costs.
If your income is above 400% FPL: While you won't qualify for subsidies, you can still purchase a plan through GetCoveredIllinois or directly from an insurer. Focus on the plan that best meets your health needs and budget.

Round Lake Beach, with a population of 27,079 and a median income of $86,059 per U.S. Census Bureau ACS 2024 5-year estimates, faces an uninsured rate of 15.6%. This figure is higher than Lake County's overall uninsured rate of 6.9%, highlighting the critical need for accessible and affordable health coverage options in the city. An independent licensed health insurance producer can provide personalized guidance, help you compare plans, and assist with enrollment, all at no cost to you.

Frequently Asked Questions

Is Ambetter a PPO plan in Round Lake Beach?

Ambetter typically offers HMO and EPO plans on GetCoveredIllinois in Round Lake Beach. While PPO plans are available on-exchange in Illinois, they are usually offered by other carriers like Blue Cross and Blue Shield of Illinois. Always verify the specific plan type and network when enrolling.

What is Illinois Rating Area 3?

Illinois Rating Area 3 is a geographic region used by health insurance companies to set plan prices. Round Lake Beach, in Lake County, is part of this rating area, which also includes McHenry County. All carriers offering plans in this rating area use the same community rating factors for pricing, adjusted for age, tobacco use, and plan tier.

Can I enroll in Ambetter plans outside of the Open Enrollment Period?

Generally, you must enroll during the annual Open Enrollment Period. However, you may qualify for a Special Enrollment Period (SEP) if you experience a qualifying life event, such as marriage, birth of a child, loss of other coverage, or moving to a new rating area. Contact GetCoveredIllinois or a licensed agent to see if you qualify.

What hospitals are in-network for Ambetter plans in Lake County?

Ambetter plans will have a specific network of hospitals and providers. In Lake County, major hospitals include Vista Medical Center East in Waukegan, Northwestern Lake Forest Hospital, and Advocate Condell Medical Center in Libertyville. It is essential to confirm that your preferred hospital and doctors are within your chosen Ambetter plan's network before enrolling to avoid unexpected out-of-pocket costs.