Ingestible hydrogels have long been used in food and therapeutic applications. Their polymeric composition endows these materials with programmable and dynamic properties to operate within the complex gastrointestinal tract. Recent advances have pushed the boundaries of hydrogel behavior and function; incorporating these features may enable new strategies to manage gastrointestinal and systemic diseases. In this perspective, we highlight some commercial ingestible hydrogel products to establish their current capabilities. We then discuss some recent advances of ingestible hydrogels that push these capabilities in the areas of tissue-specific activity, ultralong retention within the gastrointestinal tract, and incorporation into ingestible electronics and robots. Finally, we discuss some key considerations for translating ingestible macroscale hydrogels, which requires early consideration of in vivo models and regulation, safety, and manufacturing.