You can still get a nationwide PPO in Illinois, and a builder in the western suburbs has good reason to look beyond Get Covered Illinois for it. Here's how DuPage and Kane County contractors are handling coverage.
Hi, I'm Sam Jaber. I'm a health insurance broker, I work from Tampa, Illinois is one of the states I'm licensed in, and every client I help, I help over the phone.
Think of a remodeler in Naperville who has built a solid name over fifteen years: kitchens, additions, and now and then a teardown and rebuild on a big lot in DuPage or across the line in Kane County. The company carries two lead carpenters and a list of subs he trusts. His wife recently left her corporate job to run the office, and the family's group health plan left with her. So he logs in to Get Covered Illinois, the state's own marketplace now, and goes looking for a PPO.
Let me say it plainly up front: you can still get a nationwide PPO in Illinois, and I can arrange it.
Get Covered Illinois does sell PPOs, 130 of its 285 medical plans for 2026, all from one insurer and available in every county. What stops our remodeler is the price. The state's plan data sets premiums by CMS rating area rather than by county, so that's how I compare them, and Rating Area 3 is DuPage and Kane. There, for a 40-year-old on a silver plan before any subsidy, the lowest-priced PPO comes in 81% above the lowest-priced HMO or POS plan. The median across Illinois's rating areas is 57%. Private plans sold outside the marketplace use medical underwriting, run on PPO networks covering the whole country, and price you on your health.
First, does the household qualify for the premium tax credit? That turns on net self-employment income for the coverage year: what the company keeps after materials, subs, the trucks, dumpsters, permits, insurance and your bond. You estimate it for the year and change it whenever the year changes. A remodeler's profit follows when jobs start and finish, and an addition that slips past the winter freeze can shove a lot of income from one year into the next.
Second, is everyone at home healthy? For context, the Illinois Department of Insurance put the 2026 statewide weighted average increase for individual plans at 28.8%, and that lands in full on any household that gets no credit.
This is the Naperville remodeler. Without the credit he pays every dollar of the Get Covered Illinois premium, and choosing the PPO there is the most expensive way to do it.
A private, medically underwritten nationwide PPO is the comparison to make. You complete a health questionnaire, and based on the answers the insurer issues the policy, issues it with one prior condition left out, or turns you down. That review is why a healthy household can often pay less than the full marketplace price. The network also follows the family to a Wisconsin lake house or a kid's college out of state. Every plan writes its own benefits, so we read through them together first.
Next step: Phone me with your county and the birth dates on your plan, and I'll quote a nationwide PPO alongside the DuPage and Kane marketplace prices.
When a big job's final draw lands in January instead of December, the household's net for the year can drop into the credit range. Then Get Covered Illinois is usually where coverage costs least, because the credit can only be used there. In the western suburbs the HMOs are where it stretches furthest, and there are plenty to choose from, so we pick the one whose network your family's doctors already belong to. If the year falls much further, Illinois expanded Medicaid, and an adult whose income stays at or below 138% of the federal poverty level can qualify.
Next step: Send me last year's return and your job schedule, and we'll build an income estimate and match a plan to it.
If a family member sees a specialist on a schedule, or takes a medication every day, keep the household on Get Covered Illinois at any income. Marketplace plans take everyone and can't price a health history. After that the choice is about network: if that care is with doctors the HMOs leave out, the PPO's extra cost may be worth paying; if they're inside an HMO, keep the savings.
Next step: Give me the doctors and prescriptions you can't give up, and I'll check them against the DuPage and Kane plans.
Straight answers, no sales pitch.
Yes. For 2026, 130 of its 285 individual medical plans are PPOs, all from one insurer, sold in every Illinois county.
In Rating Area 3, which is DuPage and Kane, the lowest-priced silver PPO costs 81% more than the lowest-priced silver plan of another network type, for a 40-year-old before subsidies.
The Illinois Department of Insurance reported a statewide weighted average increase of 28.8% for individual plans.
No. Illinois runs its own marketplace, Get Covered Illinois.
I need your county, the people you want covered and a rough idea of what the company cleared last year. In return you get Get Covered Illinois prices next to a nationwide PPO quote, and my honest call on which to buy.
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