You can still get a nationwide PPO in Illinois through me. Here is how contractors who live in the Metro East and work across the river in Missouri are thinking about networks and price.
Hi, I'm Sam. I'm a health insurance broker in Tampa, licensed in 36 states, and much of my work is with people whose income arrives on a 1099. Illinois contractors can work with me over the phone.
Here's a picture from the Metro East. A contractor lives in Edwardsville and does commercial interior work, cabinetry installs and punch lists for builders. Most of her jobs are in St. Louis County and the city, a twenty-five minute drive across the Mississippi. Her favorite urgent care is in Chesterfield, and her doctor practices on the Missouri side too. Because she lives in Illinois, her marketplace is Get Covered Illinois, and the question that matters is which plan treats her Missouri doctors as in network.
Madison, St. Clair and Monroe counties each have 37 individual medical plans on Get Covered Illinois for 2026, from three insurers: 27 HMOs and 10 PPOs. Illinois prices these plans by rating area, and those three counties share one. There, for a 40-year-old with no subsidy, the most affordable silver PPO is priced 57% above the most affordable silver HMO.
If you're healthy, you can still get a nationwide PPO in Illinois through me and skip that markup. It's a private plan, underwritten on your answers, and its network covers Missouri as fully as Illinois.
Outside its network, an HMO typically covers only emergencies, while a PPO keeps paying at a reduced rate that leaves more of the bill with you. So a Metro East contractor should test each HMO on three questions before looking at price: is my doctor in it, is the urgent care near my job sites in it, and is the hospital I'd want in it? If the honest answers are on the Missouri side and the network says no, the low premium is a mirage.
If your doctors and most of your work are in Illinois, a local HMO may suit you perfectly well.
For the credit, what counts is your net from self-employment over the coverage year: 1099 pay minus tools, the truck, fuel, tolls on the bridges, materials and insurance. Revise it when a big job starts or a builder stops calling, rather than waiting for tax season.
The credit only works through Get Covered Illinois, so that's where to buy. Price the HMOs first and test them against your Missouri providers. The PPO costs 57% more before the credit, and the credit doesn't grow to cover it, but if your doctor across the river appears in no HMO network, the PPO's out-of-network coverage may be worth paying for. That's a call we can make with real numbers.
Next step: Send me your doctors and job locations, and I'll check each Metro East plan against them with your credit applied.
At full price, the local choices are HMOs that may not reach Missouri and a PPO priced well above them. A privately underwritten plan often fits better. You answer health questions; the outcome is approval, approval with a particular condition excluded, or a decline. Healthy contractors frequently pay less than the marketplace's full rate, and benefits vary by plan, so we read them together.
Next step: Call me and I'll price a nationwide PPO next to the Get Covered Illinois prices for your county.
If a builder slows down and your year looks lean, check Medicaid. Illinois took the expansion, and adults can qualify up to 138% of the poverty level, per KFF. Months when you're eligible for Medicaid generally aren't months you can get the marketplace credit. Starting by January 1, 2027, federal rules add a work or community-engagement requirement for many adults in the expansion group, so learn the rules before you count on it. When jobs pick back up, report the change and move to a marketplace plan.
Next step: Before you switch programs in a slow year, call me and we'll figure out where your income actually lands.
With a daily medication or a specialist you see regularly, stay on Get Covered Illinois even past the credit range. Its plans take every applicant and can't charge more for your health. Your task is to find the plan whose network includes that specialist, wherever on the river they practice.
Next step: Tell me your doctors and prescriptions, and I'll find the Metro East plans that cover them.
Straight answers, no sales pitch.
It depends on whether the doctor is in that plan's network. Outside it, an HMO typically pays only for emergencies.
Yes. Madison, St. Clair and Monroe counties have ten, and the least expensive silver one costs 57% more than the least expensive silver HMO.
Yes, if household income is at or below 138% of the federal poverty level, subject to the federal work requirement arriving by January 1, 2027.
Yes. If you're in good health, I can place you in one privately.
Give me your county, roughly what share of your work and your doctors sit in Missouri, and what your 1099s netted after expenses last year. I'll come back with the coverage that fits and a price for it.
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