Health Insurance in Round Lake Beach, Illinois

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

Round Lake Beach residents can choose from 5 health insurance carriers on GetCoveredIllinois for 2026, including Blue Cross and Blue Shield of Illinois.
Marketplace plans in Illinois include HMO, EPO, and PPO options, with subsidies available for incomes up to 400% FPL.
Illinois Medicaid covers adults up to 138% FPL, pregnant women up to 213% FPL, and children up to 313% FPL.
The uninsured rate in Round Lake Beach is 15.6%, according to U.S. Census Bureau ACS 2024 5-year estimates.

For residents of Round Lake Beach, Illinois, securing comprehensive health insurance coverage is essential. In 2026, the GetCoveredIllinois marketplace offers a range of options, including plans from 5 confirmed carriers such as Blue Cross and Blue Shield of Illinois and Ambetter. Illinois operates a state-based marketplace, allowing residents to access financial assistance in the form of tax credits and cost-sharing reductions to make coverage more affordable. Whether you're looking for an HMO, EPO, or PPO plan, understanding your eligibility for subsidies and Illinois Medicaid is the first step toward finding a plan that fits your needs and budget.

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What Types of Health Insurance Plans Are Available in Round Lake Beach?

Residents of Round Lake Beach purchasing health insurance through GetCoveredIllinois have access to a variety of plan structures designed to meet different needs and budgets. In Illinois, you can choose from Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO), and Preferred Provider Organization (PPO) plans. Unlike some states, PPO plans are available on-exchange in Illinois, providing greater flexibility to see out-of-network providers, though often at a higher cost.

HMO (Health Maintenance Organization): These plans typically require you to choose a primary care provider (PCP) within the plan's network and get referrals from your PCP to see specialists. They generally have lower monthly premiums and out-of-pocket costs.
EPO (Exclusive Provider Organization): EPO plans offer a network of doctors and hospitals, but you typically don't need a referral to see a specialist. However, they generally won't cover care outside their network, except in emergencies.
PPO (Preferred Provider Organization): PPO plans offer the most flexibility. You don't need a PCP, and you can see any doctor or specialist without a referral, both in and out of network. Out-of-network care usually costs more. Blue Cross and Blue Shield of Illinois offers PPO plans on the Illinois marketplace.

Understanding the differences between these plan types is crucial for choosing coverage that aligns with your healthcare preferences and financial situation. All plans sold on GetCoveredIllinois cover essential health benefits, including prescription drugs, mental health care, and maternity care.

Health Insurance Carriers in Round Lake Beach

For 2026, residents of Round Lake Beach have 5 confirmed health insurance carriers offering plans on the GetCoveredIllinois marketplace. These carriers provide a range of options across different metal tiers (Bronze, Silver, Gold, Platinum), allowing you to compare benefits and costs. The availability of multiple carriers fosters competition, which can lead to more diverse plan choices and competitive pricing within Rating Area 3, which covers Lake and McHenry counties.

The confirmed carriers offering marketplace plans in Round Lake Beach for 2026 include:

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

When selecting a plan, it's important to research each carrier's specific offerings in your ZIP code, paying attention to provider networks, formulary lists for prescription drugs, and customer service ratings. An independent licensed agent can help you navigate these choices and find a plan that includes your preferred doctors and hospitals.

Understanding Eligibility and Subsidies in Round Lake Beach

Many Round Lake Beach residents qualify for financial assistance to make health insurance more affordable. The Affordable Care Act (ACA) provides premium tax credits and cost-sharing reductions through GetCoveredIllinois. Eligibility for these subsidies is primarily based on your household income relative to the Federal Poverty Level (FPL).

Premium Tax Credits: These reduce your monthly premium payments. You may qualify if your household income is between 100% and 400% of the FPL. The amount of your credit depends on your income, household size, and the cost of the benchmark Silver plan in your area.
Cost-Sharing Reductions (CSRs): These lower your out-of-pocket costs, such as deductibles, copayments, and coinsurance. You must enroll in a Silver-level plan to receive CSRs, and eligibility is for incomes up to 250% of the FPL.

Round Lake Beach, with a population of 27,079 and a median age of 33.8 years, is part of Lake County and falls within Illinois Rating Area 3, which also covers McHenry County. This area is served by 5 confirmed health insurance carriers on the GetCoveredIllinois marketplace. The city's uninsured rate stands at 15.6%, according to U.S. Census Bureau ACS 2024 5-year estimates, indicating a significant need for affordable coverage options within the community. Major healthcare providers serving Lake County include Vista Medical Center East and Advocate Condell Medical Center.

Illinois Medicaid and CHIP Eligibility

Illinois expanded its Medicaid program in 2014, known as Illinois Medicaid, making coverage available to many low-income adults. Adults in Round Lake Beach with household incomes up to 138% of the Federal Poverty Level may qualify for Illinois Medicaid, which provides comprehensive coverage with no monthly premiums or deductibles. For a single individual in 2026, this threshold is approximately $20,783 per year.

Additionally, Illinois has one of the country's most expansive programs for pregnant women and children:

Pregnant Women: Illinois Medicaid covers pregnant women with incomes up to 213% FPL. This includes comprehensive prenatal care, labor, delivery, and 12 months of postpartum care.
Children (Illinois All Kids/CHIP): The Illinois All Kids program (the state's Children's Health Insurance Program equivalent) provides low-cost coverage for children with incomes up to 313% FPL.

You can apply for Illinois Medicaid or Illinois All Kids through the Application for Benefits Eligibility (ABE) website at abe.illinois.gov or by calling the Illinois Department of Human Services (DHS) helpline.

Local Healthcare Landscape: Hospitals Serving Lake County

Access to quality healthcare facilities is a critical consideration when choosing a health insurance plan. Round Lake Beach is situated in Lake County, which is home to several acute care hospitals. These facilities provide essential medical services, from emergency care to specialized treatments.

Major hospitals in Lake County include:

Vista Medical Center East (located in Waukegan)
Midwestern Region Medical Center, Inc (located in Zion)
Northwestern Lake Forest Hospital (located in Lake Forest)
Advocate Condell Medical Center (located in Libertyville)
Advocate Good Shepherd Hospital (located in Barrington)

When selecting a health insurance plan, it is vital to verify that your preferred doctors and any hospitals you frequent are included in the plan's network. This ensures you can access care without incurring higher out-of-network costs. The median income in Lake County is $110,416, and the uninsured rate is 6.9%, per U.S. Census Bureau ACS 2024 5-year estimates, reflecting the diverse healthcare needs of the county's 714,223 residents.

Finding the Right Plan: Next Steps for Round Lake Beach Residents

Navigating health insurance options can feel overwhelming, but understanding your personal situation can simplify the process:

If your income is below 138% FPL: You likely qualify for Illinois Medicaid. Apply directly through ABE (abe.illinois.gov) or contact the DHS helpline.
If your income is between 100% and 400% FPL: You are likely eligible for significant premium tax credits through GetCoveredIllinois. Consider Silver plans for potential cost-sharing reductions if your income is below 250% FPL.
If your income is above 400% FPL: You can still enroll in a plan through GetCoveredIllinois or directly with a carrier. While you may not qualify for federal subsidies, you'll benefit from the consumer protections of the ACA.

Comparing plans based on premiums, deductibles, copayments, and maximum out-of-pocket costs is essential. Pay close attention to the network of doctors and hospitals to ensure your preferred providers are covered. A licensed health insurance producer can provide personalized guidance, help you compare plans from various carriers, and assist with the enrollment process – all at no cost to you.

Frequently Asked Questions

What types of health insurance plans are available in Round Lake Beach?

In Round Lake Beach, residents can find Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO), and Preferred Provider Organization (PPO) plans through GetCoveredIllinois. PPO plans are available on-exchange in Illinois, offering more flexibility to see out-of-network providers for a higher cost.

How many health insurance carriers offer plans in Round Lake Beach?

For the 2026 plan year, 5 health insurance carriers offer marketplace plans in Rating Area 3, which includes Round Lake Beach. These carriers are Ambetter, Blue Cross and Blue Shield of Illinois, Molina Healthcare, Oscar Health, and United Healthcare.

Can I qualify for financial assistance to lower my health insurance costs in Round Lake Beach?

Yes, many Round Lake Beach residents qualify for subsidies through GetCoveredIllinois. These include premium tax credits that reduce your monthly payment and cost-sharing reductions that lower your deductibles, copayments, and out-of-pocket maximums. Eligibility is based on household income, generally up to 400% of the Federal Poverty Level (FPL) for tax credits, and up to 250% FPL for cost-sharing reductions.

What are the income limits for Illinois Medicaid in Round Lake Beach?

Illinois Medicaid is expanded and covers adults with household incomes up to 138% of the Federal Poverty Level. Pregnant women can qualify with incomes up to 213% FPL, and children are covered under Illinois All Kids (CHIP equivalent) with incomes up to 313% FPL. You can apply for Illinois Medicaid through ABE (abe.illinois.gov) or by calling the DHS helpline.