Can contractors get health insurance through GetCoveredIllinois?

Yes, independent contractors and self-employed individuals in Franklin County can purchase health insurance plans through GetCoveredIllinois, the state-based marketplace. These plans are compliant with the Affordable Care Act (ACA) and may be eligible for premium tax credits and cost-sharing reductions based on household income and size.

What types of health plans are available to contractors in Franklin County?

In Franklin County, contractors can choose from HMO, EPO, and PPO health plan structures available through GetCoveredIllinois. These plans are offered by multiple carriers and vary in their network restrictions, referral requirements, and out-of-pocket costs, allowing you to select one that best fits your needs.

How do income subsidies work for self-employed individuals in Illinois?

Income subsidies, known as premium tax credits, are available to self-employed individuals and contractors whose household income falls between 100% and 400% of the Federal Poverty Level (FPL). These credits reduce your monthly premium, making coverage more affordable. Cost-sharing reductions are also available for those with incomes up to 250% FPL, lowering deductibles, copayments, and out-of-pocket maximums.

What if my income is too low for marketplace subsidies?

If your income as a contractor or self-employed individual in Illinois falls below 138% of the Federal Poverty Level, you may qualify for Illinois Medicaid. Illinois expanded its Medicaid program, providing comprehensive, low-cost health coverage to eligible adults. You can apply through ABE (abe.illinois.gov) or contact the DHS helpline.

Health Insurance for Contractors in Franklin County, Illinois

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

Contractors in Franklin County can enroll in ACA-compliant plans through GetCoveredIllinois during Open Enrollment or with a Special Enrollment Period.
In 2026, 5 carriers offer marketplace plans in Rating Area 9, which includes Franklin County: Ambetter, Blue Cross and Blue Shield of Illinois, Molina Healthcare, Oscar Health, and United Healthcare.
Premium tax credits are available for individuals earning between 100% and 400% FPL, significantly reducing monthly costs.
Franklin County's uninsured rate is 7.3%, below the state average, but residents must travel to neighboring counties for acute care as there are no hospitals within the county.

As an independent contractor or self-employed individual in Franklin County, Illinois, securing affordable and comprehensive health insurance is crucial, yet it often presents unique challenges compared to traditional employer-sponsored coverage. Fortunately, the Affordable Care Act (ACA) marketplace, GetCoveredIllinois, provides a robust solution. Through GetCoveredIllinois, you can access a range of health plans, including HMOs, EPOs, and PPOs, and potentially qualify for significant financial assistance based on your household income. This assistance, known as premium tax credits and cost-sharing reductions, can make quality health insurance much more accessible. Understanding your options and eligibility is the first step toward finding a plan that protects your health and your finances.

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How Do Contractors Get Health Insurance in Franklin County?

Independent contractors and self-employed individuals in Franklin County primarily obtain health insurance through GetCoveredIllinois, the official state-based marketplace. This platform is designed to help individuals and families compare and enroll in ACA-compliant health plans. Plans purchased through GetCoveredIllinois cover essential health benefits, including doctor visits, prescription drugs, mental health services, and maternity care, without annual or lifetime limits. Enrollment typically occurs during the annual Open Enrollment Period, which usually runs from November 1 to January 15. However, if you experience a qualifying life event, such as moving to Franklin County, getting married, having a baby, or losing other coverage, you may be eligible for a Special Enrollment Period (SEP) outside of the standard window.

Understanding Your Eligibility for Subsidies

One of the most significant advantages of purchasing health insurance through GetCoveredIllinois is the availability of financial assistance. As a contractor, your income determines your eligibility for two main types of subsidies:

Premium Tax Credits (PTC): These credits reduce your monthly health insurance premium. Eligibility is based on household income relative to the Federal Poverty Level (FPL). In Illinois, if your income is between 100% and 400% FPL, you will likely qualify for a PTC. The exact amount depends on your income, household size, and the cost of the benchmark Silver plan in Franklin County.
Cost-Sharing Reductions (CSRs): Available to those with incomes up to 250% FPL, CSRs lower your out-of-pocket costs, such as deductibles, copayments, and coinsurance. To receive CSRs, you must enroll in a Silver-tier plan. These enhanced Silver plans offer significantly better benefits than standard Silver plans for the same premium.

It is important to accurately estimate your annual income when applying, as this directly impacts the amount of financial assistance you receive. If your income falls below 138% FPL, you may qualify for Illinois Medicaid instead of marketplace subsidies.

Illinois Medicaid for Low-Income Contractors

Illinois expanded its Medicaid program in 2014, making it available to adults with household incomes up to 138% of the Federal Poverty Level. If your income as a contractor in Franklin County falls within this range, you may be eligible for comprehensive, low-cost health coverage through Illinois Medicaid. This program provides extensive benefits with minimal or no out-of-pocket costs. You can apply for Illinois Medicaid through ABE (abe.illinois.gov) or by calling the Illinois Department of Human Services (DHS) helpline. Additionally, pregnant women in Illinois are covered up to 213% FPL, with 12 months of postpartum care, and children may qualify for Illinois All Kids (CHIP equivalent) up to 313% FPL, making it one of the most expansive child coverage programs in the country. Franklin County, part of Illinois Rating Area 9, is one of the state's more rural areas, with a population of 37,323 and an uninsured rate of 7.3%, per U.S. Census Bureau ACS 2024 5-year estimates. The median income for the county is $56,740. Residents needing acute care typically travel to neighboring counties, as Franklin County has no acute care hospitals within its boundaries. Rating Area 9 covers a total of 26 counties, including Alexander, Clay, Edwards, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jasper, Jefferson, Johnson, Lawrence, Marion, Massac, Monroe, Montgomery, Perry, Pope, Pulaski, Randolph, Richland, Saline, Union, Wabash, Washington, and Wayne counties.

Health Insurance Carriers in Franklin County

For 2026, 5 carriers offer marketplace plans in Rating Area 9, which serves Franklin County. These carriers provide a variety of plan options, including Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO), and Preferred Provider Organization (PPO) plans. PPO plans are indeed available on-exchange in Illinois, offered by Blue Cross and Blue Shield of Illinois, giving marketplace shoppers more flexibility in provider choice. The confirmed carriers for Franklin County's Rating Area 9 are:

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

When selecting a plan, contractors should consider not only the monthly premium but also the deductible, copayments, coinsurance, and annual out-of-pocket maximum. It is also important to verify that your preferred doctors and any specialists you see are in the plan's network.

Choosing the Right Plan for Your Contractor Business

As a contractor, your health insurance needs may vary depending on your health status, financial situation, and risk tolerance. Here's a guide to help you make an informed decision:

Income Level (as % FPL)	Recommendation	Key Benefits
Below 138% FPL	Apply for Illinois Medicaid	Comprehensive coverage with low or no costs; includes prenatal and postpartum care for pregnant women up to 213% FPL.
100% - 250% FPL	Consider an Enhanced Silver Plan	Significant premium tax credits and cost-sharing reductions, leading to lower deductibles, copays, and out-of-pocket maximums. Excellent value.
251% - 400% FPL	Bronze, Silver, or Gold Plans with Premium Tax Credits	Premium tax credits reduce monthly costs. Bronze plans have lower premiums but higher out-of-pocket costs; Gold plans have higher premiums but lower out-of-pocket costs. Silver plans offer a balance.
Above 400% FPL	Bronze, Silver, or Gold Plans (no subsidies)	You'll pay the full premium, but still benefit from ACA-compliant coverage. Compare plan tiers based on your expected healthcare usage.

For many contractors, a Silver plan offers a good balance between monthly premiums and out-of-pocket costs. If you qualify for Cost-Sharing Reductions, an Enhanced Silver plan becomes an exceptionally good value, providing benefits similar to a Gold plan at a lower price point. If you anticipate high healthcare usage, a Gold plan might be more cost-effective in the long run due to its lower deductibles and copays. Conversely, if you are generally healthy and want to minimize monthly expenses, a Bronze plan could be suitable, but be prepared for higher out-of-pocket costs if you need significant medical care.

Frequently Asked Questions

Can I deduct health insurance premiums as a self-employed individual?

Yes, if you are self-employed and not eligible to participate in an employer-sponsored health plan, you can generally deduct the health insurance premiums you pay for yourself, your spouse, and your dependents. This is an above-the-line deduction, meaning it reduces your adjusted gross income (AGI). Consult with a tax professional for specific advice regarding your individual tax situation.

What if I have pre-existing conditions as a contractor?

Under the Affordable Care Act, health insurance plans sold on GetCoveredIllinois cannot deny you coverage or charge you more due to pre-existing conditions. All ACA-compliant plans must cover essential health benefits, and your coverage begins even if you have a pre-existing condition. This offers significant protection for contractors who might otherwise struggle to find affordable coverage.

What is the difference between an HMO, EPO, and PPO plan in Franklin County?

HMO (Health Maintenance Organization): Generally has lower premiums and requires you to choose a primary care provider (PCP) who coordinates your care and provides referrals to specialists. You must stay within the plan's network for coverage, except in emergencies.
EPO (Exclusive Provider Organization): Does not typically require a PCP referral for specialists, but you must use doctors and hospitals within the plan's network for services to be covered.
PPO (Preferred Provider Organization): Offers the most flexibility. You don't need a PCP or referrals to see specialists. You can see out-of-network providers, but you'll pay a higher cost for those services. PPO plans are available on-exchange in Illinois, including Franklin County.

When can I enroll in a health insurance plan?

The primary time to enroll is during the annual Open Enrollment Period, which typically runs from November 1 to January 15. However, contractors who experience a Qualifying Life Event (QLE) such as losing existing health coverage, getting married, having a baby, or moving to Franklin County, can enroll during a Special Enrollment Period (SEP) outside of Open Enrollment. SEPs usually last for 60 days from the date of the QLE.