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

Small Business Health Insurance for Medical Practices in Lombard, Illinois

What Small Business Health Insurance Options Are Available in Lombard?

1. Small Group Health Plans: These are traditional employer-sponsored plans purchased through the Small Business Health Options Program (SHOP) via GetCoveredIllinois, or directly from carriers. They offer a range of plan designs, including PPO, HMO, and EPO options. In Illinois, PPO plans are available on-exchange, providing greater flexibility for practices whose employees may seek care beyond a local HMO network. Eligibility usually requires at least two employees, and generally, a minimum of 70% of eligible employees must participate.
2. Individual Coverage Health Reimbursement Arrangements (ICHRAs): An ICHRA allows employers to provide tax-free funds that employees can use to purchase individual health insurance plans through GetCoveredIllinois or directly from an insurer. This approach offers employees more choice in their plans and allows practices to set predictable budgets for benefits.
3. Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs): For practices with fewer than 50 full-time equivalent employees that do not offer a group health plan, a QSEHRA allows reimbursement for individual health insurance premiums and medical expenses on a tax-free basis, up to a set limit.

Key Considerations for Medical Practices in DuPage County

• Local Carrier Availability: In 2026, 5 carriers offer marketplace plans in Rating Area 2, which covers DuPage and Kane counties. These carriers include Ambetter, Blue Cross and Blue Shield of Illinois, Molina Healthcare, Oscar Health, and United Healthcare. This ensures a competitive market with diverse plan offerings.
• PPO Options: Unlike some states, Illinois offers PPO plans on-exchange through GetCoveredIllinois. This is particularly beneficial for medical professionals who may value the broader network access that PPO plans provide, allowing employees to choose specialists or facilities without a primary care physician referral.
• Tax Advantages: Premiums paid by a medical practice for employee health insurance are generally 100% tax-deductible as a business expense. Additionally, the value of health benefits provided to employees is typically tax-free for them, making it a valuable compensation component.
• Employee Retention: Offering competitive health benefits is a significant factor in attracting and retaining skilled medical staff in a competitive market like Lombard. A robust benefits package can differentiate your practice.
• Illinois Medicaid and CHIP: While primarily for individual coverage, it's important to note Illinois' expansive Medicaid program, Illinois Medicaid. Adults with income up to 138% of the Federal Poverty Level (FPL) qualify. Pregnant women up to 213% FPL and children up to 313% FPL are covered through Illinois All Kids, one of the most comprehensive child coverage programs in the country. This context is important for employees who may not qualify for group coverage or have family members who might benefit from these state programs.

How to Choose the Right Plan for Your Medical Practice

1. Assess Your Team's Needs: Consider the demographics of your employees. Do they prefer lower premiums with higher deductibles (Bronze, Silver plans), or are they willing to pay more for lower out-of-pocket costs (Gold, Platinum plans)? Do they need broad network access (PPO) or are they comfortable with a more managed care approach (HMO, EPO)?
2. Determine Your Budget: Understand how much your practice can realistically contribute to premiums. Small group plans require employers to contribute a minimum percentage, usually 50%, of employee-only premiums. ICHRAs and QSEHRAs offer more control over monthly expenses.
3. Review Carrier Options: In Lombard's Rating Area 2, you have 5 carriers to choose from. Compare their plan networks, formulary lists for prescription drugs, and customer service ratings. Blue Cross and Blue Shield of Illinois is a prominent carrier offering both HMO and PPO plans.
4. Understand Plan Types:
   • HMO (Health Maintenance Organization): Generally lower premiums, requires choosing a Primary Care Physician (PCP) and referrals for specialists.
   • EPO (Exclusive Provider Organization): Similar to HMOs but may not require a PCP referral for specialists within the network. No out-of-network coverage.
   • PPO (Preferred Provider Organization): Higher premiums, offers flexibility to see specialists without a referral and includes some out-of-network coverage (at a higher cost). PPOs are available on GetCoveredIllinois.
5. Consider Tax Credits: Small businesses that purchase coverage through the SHOP marketplace (GetCoveredIllinois) may be eligible for the Small Business Health Care Tax Credit, which can cover up to 50% of the employer's premium contributions. Eligibility depends on the number of employees and average wages.

Health Insurance Carriers in Lombard

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

Next Steps for Your Medical Practice

1. Gather Employee Information: Have a clear understanding of your current employee count, their ages, and any existing coverage needs.
2. Define Your Budget: Determine what your practice can comfortably allocate to health insurance benefits on a monthly or annual basis.
3. Contact a Licensed Producer: A local expert can provide personalized quotes from all available carriers in Rating Area 2, explain the nuances of plan types, and help you understand your eligibility for tax credits or alternative arrangements like ICHRAs. They can also guide you through the enrollment process on GetCoveredIllinois.
4. Review and Enroll: Compare the detailed proposals, focusing on premiums, deductibles, out-of-pocket maximums, and network access. Once a decision is made, the producer will assist with the enrollment paperwork.

Frequently Asked Questions

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