You can still get a nationwide PPO in Illinois, and around Peoria the marketplace PPO sits close enough to the HMO that it deserves a fair look. Here's how heating and cooling owners there are deciding.
Hi, I'm Sam. I'm a licensed broker who sells health insurance and nothing else, my office is in Tampa, Illinois is one of my states, and I do everything by phone.
Imagine you own a heating and cooling company in East Peoria with three vans working both sides of the river, from Peoria Heights and Morton to Pekin and Washington. Winters here are long and cold, so the heating side carries the business, and summers bring enough AC work to keep everyone moving. You've bought your own health insurance for a few years and always clicked the HMO without much thought. It's worth some thought, because the Peoria area has an unusual marketplace.
Through me, you can still get a nationwide PPO in Illinois. Around Peoria, though, the marketplace's own PPO is a real contender.
In Peoria, Tazewell, Woodford, Marshall and Stark counties, every individual medical plan on Get Covered Illinois for 2026 comes from one insurer, which sells both HMOs and PPOs. Illinois rates are filed by CMS rating area, and Rating Area 7, the Peoria area, has rates for 9 HMOs and 10 PPOs. On silver for a 40-year-old before subsidies, the lowest-priced PPO costs 14% more than the lowest-priced HMO, the narrowest gap in Illinois. An HMO generally covers out-of-network care only in an emergency, while a PPO also pays toward outside doctors, at a higher cost to you and without referrals.
The credit depends on household income for the coverage year, which for an HVAC owner is net self-employment income: revenue minus equipment, parts, the vans, refrigerant, your licensing and insurance. You estimate it at enrollment and update it whenever it moves.
A January cold snap that keeps every van out on no-heat calls can make the year bigger than you planned. When you see that coming, raise the estimate, and the credit shrinks for the months that are left instead of being settled on your return.
With the PPO only 14% above the HMO before any credit, a household that qualifies for the credit can often have out-of-network coverage for modest extra money each month. That's worth considering if you'd like the freedom to see a specialist outside the network, in Chicago or St. Louis for example, or you just don't like being held to one network. If everyone you see is already in the HMO, the HMO keeps more money in your pocket.
Next step: Call me with your county, your family's ages and last year's profit, and I'll price the Peoria-area HMO and PPO with your credit included.
Three vans and a book of maintenance agreements usually put a household past the credit range, and then both marketplace plans are full price. A healthy family should price a medically underwritten nationwide PPO as well. The application includes health questions, and the insurer will approve it, approve it with one past condition excluded, or decline it. A healthy profile is what lets that premium come in under the marketplace's full rate, and the network doesn't stop at the Illinois line. Each plan has its own benefit rules, which we'll go over together.
Next step: Send me your zip code and the ages on your plan, and I'll quote a nationwide PPO beside the Peoria-area marketplace plans.
A mild winter can leave a heating company short. In a truly lean year, Illinois's Medicaid expansion is there for adults whose income doesn't exceed 138% of the federal poverty level. If someone at home has a chronic condition, stay on Get Covered Illinois at any income; no plan there can refuse you or charge more for health. Here, the narrow PPO gap may let that person keep a specialist outside the network without much added cost.
Next step: Tell me the doctors and prescriptions that matter and I'll check them against the Peoria-area plans.
Straight answers, no sales pitch.
For 2026, one. Every individual medical plan on Get Covered Illinois in Peoria County comes from a single insurer, which offers both HMOs and PPOs.
In Rating Area 7, for a 40-year-old on silver before subsidies, the lowest-priced PPO costs 14% more than the lowest-priced HMO.
For a household that gets the credit, often yes. Above the credit range, compare it with a nationwide PPO priced on your health.
No. Illinois runs its own marketplace, Get Covered Illinois.
Tell me your county, everyone you want covered and last year's profit. You'll see the Peoria-area marketplace HMO and PPO, plus a nationwide PPO, all with prices, and I'll tell you which I'd pick.
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