If you live in Illinois and buy health insurance, 2026 is bringing some of the biggest changes to coverage requirements in years. New laws are expanding what your health plan must cover—from gender-affirming care to pain management alternatives to opioids. And if you're caring for aging parents, there's a significant new option that could help.
But here's what makes 2026 particularly important: while coverage is expanding, costs are rising too. Illinois saw twelve billion-dollar weather disasters in 2024—the most in state history—and insurance companies are responding with rate increases. Meanwhile, the number of insurers offering marketplace plans is shrinking, and federal subsidies that kept premiums affordable may be reduced.
Let's break down what's changing, what it means for your coverage and costs, and how to make the most of these new benefits.
Major New Coverage Requirements Starting January 2026
Illinois legislators passed several bills in 2025 that fundamentally reshape what health insurance must cover. These aren't optional add-ons—they're mandated benefits that your insurer must provide if you have a fully insured plan.
House Bill 3248 requires insurance companies to cover medically necessary laser hair removal for three specific conditions: gender-affirming care, hidradenitis suppurativa, and polycystic ovary syndrome. This addresses a gap that left many patients paying thousands out-of-pocket for a treatment their doctors deemed essential. The bill passed the Senate 37-19 and takes effect January 1, 2026. One important caveat: Medicaid plans are excluded from this requirement.
Senate Bill 1238 tackles the opioid crisis from a different angle. Instead of restricting access to pain medication, it expands coverage for non-opioid alternatives. Your insurer can't deny coverage of a non-opioid prescription in favor of an opioid. Starting in 2027, insurance companies must develop comprehensive plans covering non-medication pain management services like physical therapy and acupuncture. This gives you and your doctor more options when managing chronic pain without automatically turning to opioids.
Women's health gets substantial attention in the 2026 reforms. Senate Bill 773 mandates coverage for annual menopause health visits for women aged 45 and older, plus diagnosis and treatment of infertility. House Bill 4180 requires coverage for molecular breast imaging or breast MRI when medically necessary. House Bill 2385 ensures medically necessary colonoscopies are covered. These provisions recognize that preventive and diagnostic care saves lives—and money—in the long run.
The New Parent Coverage Mandate: What You Need to Know
Here's a change that could be a game-changer if you're supporting aging parents: House Bill 5258 requires fully insured health plans to offer dependent parent coverage starting January 1, 2026.
To qualify, your parent or stepparent must have gross income below $5,050 annually (the 2025 threshold), depend on you for more than half their support, and not qualify as a dependent for another taxpayer. This is particularly valuable in that gap period when your parent is too young for Medicare at 65 but no longer has employer coverage. Before this law, many families faced a choice between buying expensive individual coverage for a parent or going uninsured.
Keep in mind this applies to fully insured plans—if your employer self-funds their health insurance (common with large employers), they're not required to offer this benefit, though they may choose to. Check with your HR department to understand your specific plan type and whether parent coverage will be available.
Why Your Premiums Are Rising—And What's Driving the Increase
More coverage sounds great, but it comes with trade-offs. Early filings suggest Illinois health insurance premiums will rise 6-8% in 2025-2026, above the national average. Expanded mandates are one factor, but they're not the only driver—or even the biggest one.
Illinois experienced twelve billion-dollar weather disasters in 2024, the most since recordkeeping began in 1980. Nine were severe storms with tornadoes, hail, and high winds. When your neighbor's roof gets destroyed by golf-ball-sized hail, insurance companies pay out claims. When that happens across entire regions repeatedly, premiums rise for everyone. Health insurance isn't directly tied to property damage, but the same severe weather that damages homes also creates health emergencies—heat-related illnesses, injuries from storms, mental health impacts from displacement.
There's another wrinkle: marketplace competition is shrinking. Seven insurance companies will offer coverage through Get Covered Illinois in 2026, down from eleven in 2025. Aetna CVS, Health Alliance, and Quartz are exiting the market. Fewer insurers typically means less competitive pricing. And the enhanced federal subsidies that made marketplace coverage affordable for millions of Americans are set to expire. Unless Congress extends them, enrollees could pay 78% more per month on average in 2026.
Navigating the 2026 Marketplace: What's Changed
If you buy insurance through the marketplace, the enrollment window for 2026 coverage runs from November 1, 2025 to January 15, 2026. Illinois now operates its own state-based marketplace—Get Covered Illinois—which replaced the federal Healthcare.gov platform.
The subsidy picture is murky heading into 2026. The 400% of federal poverty guideline income limit for subsidy eligibility is returning, which means higher-income enrollees who qualified for help in recent years may lose assistance. If you're close to that threshold, you could see a dramatic increase in what you pay. Run the numbers during open enrollment—the difference between qualifying for subsidies and not can be hundreds of dollars per month.
With fewer insurers in the marketplace, comparison shopping becomes even more important. Don't just renew your existing plan automatically. Network coverage may have changed, and the plan that was the best value last year might not be in 2026. Check whether your doctors and preferred hospitals are still in-network, and compare total costs—not just premiums, but deductibles, copays, and out-of-pocket maximums.
How to Make the Most of Your Expanded Coverage
These new mandates only help if you use them. If you're a woman over 45, schedule that menopause health visit. If you've been putting off a colonoscopy, 2026 is the year to get it done. If you're managing chronic pain with opioids and wish you had alternatives, talk to your doctor about what non-opioid options your insurance now covers.
If you're considering adding a parent to your coverage, do the math before open enrollment ends. Compare the cost of adding them to your plan versus buying separate marketplace coverage. Factor in their specific health needs, prescription costs, and preferred doctors. The parent coverage mandate creates an option, but it's not automatically the cheapest choice for everyone.
Document everything. When new coverage mandates roll out, insurance companies sometimes deny claims initially, even for services they're required to cover. If you get pushback on a covered service—whether it's laser hair removal for a qualifying condition or a non-opioid pain treatment—get documentation from your doctor that it's medically necessary and file an appeal. The Illinois Department of Insurance can help if your insurer wrongly denies mandated coverage.
Illinois is betting that broader coverage requirements will improve health outcomes and reduce long-term costs. Whether you're managing a chronic condition, supporting aging parents, or simply want comprehensive preventive care, these 2026 changes expand your options. But with rising premiums and shifting subsidies, choosing the right plan requires more attention than ever. Don't wait until the last week of open enrollment—start researching your options now, understand what your plan will cover, and make sure you're getting the best value for your healthcare dollar.
