Can contractors in Lombard get health insurance through the marketplace?

Yes, contractors in Lombard, Illinois can purchase health insurance through GetCoveredIllinois, the state's official health insurance marketplace. Depending on your income, you may qualify for subsidies (premium tax credits and cost-sharing reductions) to lower your monthly premiums and out-of-pocket costs.

Do contractors qualify for Medicaid in Illinois?

Illinois expanded Medicaid in 2014, meaning adults with household income up to 138% of the Federal Poverty Level (FPL) may qualify for Illinois Medicaid. This includes contractors who meet the income criteria. Pregnant women and children have higher income thresholds for coverage through Illinois Medicaid and Illinois All Kids (CHIP equivalent).

How much does health insurance cost for contractors in Lombard?

The cost of health insurance for contractors in Lombard varies significantly based on age, income, chosen plan tier (Bronze, Silver, Gold, Platinum), and whether you qualify for subsidies. Individuals with incomes between 100% and 400% FPL can receive premium tax credits, and those between 100% and 250% FPL may also get cost-sharing reductions, significantly lowering out-of-pocket expenses.

Health Insurance for Contractors in Lombard, Illinois

Q: What types of health plans are available to contractors in Lombard?

In Lombard, contractors can choose from various plan types on GetCoveredIllinois, including Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), and Preferred Provider Organizations (PPOs). For 2026, 5 carriers offer marketplace plans in Rating Area 2, which covers DuPage and Kane counties.

Contractors in Lombard, IL can access health insurance through GetCoveredIllinois, the state's official marketplace.
For 2026, 5 carriers offer marketplace plans in Rating Area 2, which includes DuPage and Kane counties.
Illinois Medicaid is expanded, offering coverage to adults with incomes up to 138% of the Federal Poverty Level.
Lombard's uninsured rate is 4.8%, lower than the DuPage County average of 5.2%, per U.S. Census Bureau ACS 2024 5-year estimates.
PPO plans are available on-exchange in Illinois, offering more flexibility than HMO or EPO options in some states.

Navigating health insurance as a contractor in Lombard, Illinois means understanding your options for comprehensive, affordable coverage. The Affordable Care Act (ACA) marketplace, known as GetCoveredIllinois in our state, is the primary avenue for self-employed individuals to find plans and potentially qualify for financial assistance. This guide will walk you through the specifics of obtaining health insurance in Lombard, from understanding marketplace plans and subsidies to exploring Medicaid eligibility and local carrier options.

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Understanding Health Insurance Options for Lombard Contractors

As a contractor, you are responsible for securing your own health benefits, which can seem daunting compared to employer-sponsored plans. However, the ACA provides robust protections and financial assistance. Through GetCoveredIllinois, you can compare a range of plans, much like those offered by large employers, and find coverage that fits your needs and budget. Key considerations for contractors include plan flexibility, out-of-pocket costs, and the network of doctors and hospitals.

Marketplace Plans and Subsidies in Lombard, Illinois

GetCoveredIllinois offers a variety of health plans categorized by "metal tiers": Bronze, Silver, Gold, and Platinum. These tiers indicate how you and your plan share costs, with Bronze plans having lower monthly premiums but higher out-of-pocket costs, and Platinum plans offering the opposite. Bronze: Lowest premiums, highest deductibles. Best for those who rarely visit the doctor and want protection against catastrophic costs. Silver: Moderate premiums and deductibles. The only tier eligible for Cost-Sharing Reductions (CSRs), which lower your deductibles, copayments, and out-of-pocket maximums if your income is below 250% of the Federal Poverty Level (FPL). Gold: Higher premiums, lower deductibles and out-of-pocket costs. Good for those who expect to use medical services regularly. Platinum: Highest premiums, lowest out-of-pocket costs. Best for those with significant expected medical needs. Many contractors in Lombard will qualify for financial assistance through GetCoveredIllinois. Premium tax credits, which reduce your monthly premium payments, are available to individuals and families with incomes between 100% and 400% of the FPL. If your income is between 100% and 250% FPL, you may also qualify for Cost-Sharing Reductions (CSRs) on Silver plans, which significantly lower your deductibles, copayments, and out-of-pocket maximums. For example, a single contractor in Lombard earning $40,000 (around 280% FPL) would likely qualify for substantial premium tax credits.

Illinois Medicaid and CHIP for Contractors and Families

Illinois is an Expanded Medicaid state, which means many contractors and their families in Lombard may qualify for low-cost or free health coverage. Illinois Medicaid covers adults with household incomes up to 138% of the Federal Poverty Level. For a single individual, this threshold is approximately $20,783 annually (based on 2024 FPL figures, which are typically used for 2025 coverage). The state also offers generous coverage for pregnant women and children:

Pregnant Women: Illinois Medicaid covers pregnant women with income up to 213% FPL, providing comprehensive prenatal, labor, delivery, and 12 months of postpartum care. This is one of the highest thresholds among states.
Children: Illinois All Kids (the state's Children's Health Insurance Program, or CHIP equivalent) covers children up to 313% FPL with low-cost coverage, making it one of the most expansive child coverage programs in the country.

Applications for Illinois Medicaid and All Kids can be submitted online through ABE (abe.illinois.gov) or by calling the DHS helpline.

Health Insurance Carriers in Lombard

For 2026, 5 carriers offer marketplace plans in Rating Area 2, which covers DuPage and Kane counties. This provides Lombard contractors with a range of choices when selecting a health plan. These carriers include:

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

When choosing a plan, consider the specific plan types (HMO, EPO, PPO) offered by each carrier, their provider networks, and the overall cost structure.

Understanding Plan Types: HMO, EPO, and PPO in Illinois

In Illinois, marketplace shoppers in Lombard can choose from Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), and Preferred Provider Organizations (PPOs). This offers more flexibility compared to states where PPO plans are not available on-exchange. HMO (Health Maintenance Organization): Typically requires you to choose a primary care provider (PCP) within the plan's network, who then refers you to specialists. Out-of-network care is generally not covered, except in emergencies. EPO (Exclusive Provider Organization): Does not typically require a PCP referral for specialists, but you must stay within the plan's network for care to be covered. Out-of-network care is usually not covered, except in emergencies. PPO (Preferred Provider Organization): Offers the most flexibility. You don't need a PCP referral and can see both in-network and out-of-network providers. However, out-of-network care will cost more. Blue Cross and Blue Shield of Illinois offers PPO plans on-exchange in Illinois.

Finding Care: Hospitals in DuPage County

Lombard is situated in DuPage County, which has a population of 930,024, per U.S. Census Bureau ACS 2024 5-year estimates. According to the fact sheet, DuPage County currently has no acute care hospitals within its boundaries (has_acute_care: false). This means residents needing acute care will need to travel to a neighboring county for hospital services. When selecting a health plan, contractors in Lombard should carefully review the provider network to ensure it includes convenient access to hospitals and specialists in nearby counties that meet their needs. Lombard, Illinois, with a population of 43,619 and a median income of $100,362, has an uninsured rate of 4.8%, significantly lower than the national average, per U.S. Census Bureau ACS 2024 5-year estimates. This reflects the strong access to coverage options in Rating Area 2, which covers DuPage and Kane counties, where 5 carriers compete to offer plans.

Decision Guide for Lombard Contractors

Choosing the right health insurance plan depends on your unique circumstances as a contractor:

If your income is below 138% FPL: You likely qualify for Illinois Medicaid. Apply through ABE (abe.illinois.gov) for comprehensive, low-cost coverage.
If your income is between 100% and 400% FPL: Focus on plans through GetCoveredIllinois. You'll receive premium tax credits to lower your monthly costs. Consider Silver plans if your income is below 250% FPL to benefit from Cost-Sharing Reductions.
If your income is above 400% FPL: You can still use GetCoveredIllinois to compare plans, but you won't qualify for subsidies. You might also explore off-marketplace plans directly from carriers.
Consider your health needs: If you expect frequent doctor visits or have chronic conditions, a Gold or Platinum plan with lower out-of-pocket costs might be more economical in the long run, even with higher premiums. If you are generally healthy, a Bronze or high-deductible Silver plan could be a good fit.

A licensed health insurance producer can help you navigate these options, compare plans, and ensure you receive all eligible subsidies, all at no cost to you.

Frequently Asked Questions

What is GetCoveredIllinois?

GetCoveredIllinois is the official state-based health insurance marketplace for residents of Illinois. It's where individuals, including contractors, and families can compare and enroll in ACA-compliant health insurance plans and apply for financial assistance like premium tax credits and cost-sharing reductions.

Can I get a PPO plan on the Illinois marketplace?

Yes, PPO plans are available on-exchange through GetCoveredIllinois in Lombard. Blue Cross and Blue Shield of Illinois is one of the carriers that offers PPO plans, providing more flexibility in choosing healthcare providers compared to HMO or EPO plans.

Is there a deadline to enroll in health insurance each year?

Generally, there is an annual Open Enrollment Period (OEP) during which you can enroll in a new plan or change your existing one. Outside of OEP, you can only enroll if you experience a Qualifying Life Event (QLE), such as losing other coverage, getting married, or having a baby.

What is the uninsured rate in Lombard?

The uninsured rate in Lombard, Illinois is 4.8%, which is lower than the DuPage County average of 5.2%. These figures are based on U.S. Census Bureau ACS 2024 5-year estimates, indicating strong access to health coverage options in the area.