You can still get a nationwide PPO in Illinois, and across much of downstate the marketplace sells nothing else. Here's how plumbers in the farm towns around Champaign are choosing.
Hi, I'm Sam Jaber. I'm a health insurance broker based in Tampa, Illinois is on my license, and I work with every client by phone, which is handy when you're out on a farm call twenty miles from town.
Take a plumber who lives in Tolono and runs a two-truck shop out of Champaign County. Half the work is in town: water heaters, sewer lines, remodels for landlords near campus. The other half is out in the country, on farmhouses, wells and the frozen lines that come with an Illinois winter on open prairie. He's busy all year, his income moves with the weather, and when he shops Get Covered Illinois he finds something most of the country never sees: the only medical plans offered are PPOs.
Here's the line that holds everywhere: you can still get a nationwide PPO in Illinois, and I'll set one up when it's the better buy.
Downstate, though, the marketplace story is unusual. In 56 of Illinois's 102 counties, including Champaign, Piatt, Douglas, Vermilion, Coles, McLean and Ford, every individual medical plan on Get Covered Illinois for 2026 is a PPO from a single insurer. In the rating areas around Champaign and Bloomington, the only 2026 rates on file are for PPOs, 10 in each. So the question here isn't whether you can find a PPO. It's whether the marketplace's PPO or a nationwide one bought privately suits your household better. Either way, a PPO pays toward doctors outside its network at a higher cost to you, without a referral.
Your premium tax credit is based on household income for the coverage year, which for a shop owner means net self-employment income: what's left after the trucks, pipe, fittings, fixtures, the jetter, your license, bond and insurance. You give an estimate and update it as the year unfolds.
Get Covered Illinois lists open enrollment from November 1 to January 15. That runs right into the part of winter when frozen lines start filling your calendar, so pick a quiet week in early November to sort it out.
Downstate, this decision is simpler than most places. The marketplace PPO is what the credit buys, and it's a PPO, which is the plan type many people want in the first place. The work is making sure the doctors and hospital you use in Champaign or Urbana are in its network, and choosing the metal level that fits how often your family actually sees a doctor. If the year runs bigger than you guessed, update the estimate so the credit catches up.
Next step: Send me last year's return and your doctors' names, and I'll price the downstate marketplace PPOs with your credit applied.
With no credit, a one-insurer marketplace means one set of full prices. A healthy household should price a medically underwritten nationwide PPO against them. The insurer looks over your medical history and then accepts the application, accepts it without coverage for one prior condition, or declines it. Good health is what can bring that premium below the marketplace's full rate, and the network covers a visit to family in Indianapolis or a winter week somewhere warm. Benefits are specific to each plan, and I'll explain them before you decide.
Next step: Call me with your county and everyone's ages, and I'll show you a nationwide PPO quote beside the Get Covered Illinois price.
A mild, quiet year can leave a rural shop's books thin. Illinois expanded Medicaid, so an adult whose income lands at or under 138% of the federal poverty level may qualify. If anyone at home lives with a long-term illness, stay with Get Covered Illinois at any income, because those plans must take you and can't charge more for health. Workers' comp, if you carry it for a helper, covers injuries on the job and not sickness.
Next step: If either of these is your year, phone me and we'll figure out the right coverage.
Straight answers, no sales pitch.
Not for 2026. Every individual medical plan sold there is a PPO from one insurer.
56 of the 102, mostly downstate, including Champaign, Vermilion, Coles and McLean.
Get Covered Illinois lists open enrollment from November 1 to January 15.
If your household gets the credit, it's usually the plan to buy. Above the credit range, compare it with a nationwide PPO priced on your health.
Send your county, who's going on the plan and what the shop netted last year. I'll price the downstate marketplace PPO with your credit and a nationwide PPO next to it, and tell you plainly which one wins.
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