Medicare Plan Options
Health insurance isn’t one-size-fits-all, and depending on your needs, you may want more coverage than Original Medicare provides. Illinois’ Medicare Advantage program has plenty of options to account for varying budgets and health care needs. For those seeking more than basic coverage, Medicare Advantage Plans and Medicare Supplement Insurance can help you take better control of your health care costs. If you rely on prescription medications to maintain good health, Medicare prescription drug coverage may be the best way to ensure that drug costs aren’t a burden.
Original Medicare is health insurance that’s managed by the federal government. This coverage, which becomes available to you when you turn 65 or if you have certain disabilities, is made up of two parts. Part A covers hospital stays, hospice, home health care services, and nursing home care. Part B covers preventative care, clinical research, ambulance services, mental health services, durable medical equipment, and a few outpatient prescription drugs. With Original Medicare, you aren’t required to choose a primary care doctor, and you usually don’t need a referral to see a specialist. You generally pay a deductible before your coverage kicks in and a copay for services. There are no annual out-of-pocket limits.
Medicare Advantage Plans
Medicare Advantage Plans are comparable to the health insurance plans available through employers and the Get Covered Illinois Marketplace. They’re offered by Medicare-approved private companies and include Medicare Part A and B coverage. Depending on the plan, they may have additional coverage options such as prescription drug coverage, vision and dental services, and personal care services. There are several types of plans available, including health maintenance organization plans, preferred provider organization plans, private fee-for-service plans, and special needs plans. Each has its own benefits and rules regarding costs and health care network requirements for seeing a specialist.
Medicare Prescription Drug Coverage Plans
Original Medicare doesn’t pay for most prescription drugs, so you need to purchase a prescription drug plan if you want this coverage. Also called Part D, prescription drug coverage plans are optional and offered to all Medicare enrollees. Even if you don’t use prescription drugs when you sign up for Medicare, it’s generally a good idea to purchase a prescription drug plan at initial enrollment to avoid a late enrollment penalty. This coverage can only be added to certain Medicare plans, including private fee-for-service plans, medical savings account plans, cost plans, and some employer-sponsored Medicare plans.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance plans, also called Medigap, are sold by private insurance companies and are available to those with Original Medicare Parts A and B. These plans cover some health costs not covered by Original Medicare, including copays and deductibles. In general, Medigap plans don’t provide coverage beyond what’s included in Original Medicare, though some Medigap plans cover foreign travel emergency health care.
Medicare in Illinois by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|1,581,169||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Illinois
Your health care needs are unique, and obtaining an insurance policy that accommodates your needs and budget now and in the future can be a challenge. Illinois offers a wide range of resources to help you understand your health care benefits, determine whether Original Medicare or a Medicare Advantage Plan is more cost-effective, and navigate billing errors and denied claims. The state has many ways for you to connect with trained counselors who can help you get the most from your health coverage.
City of Chicago Senior Services
The City of Chicago Senior Services Division is one of the state’s 13 Area Agencies on Aging. This agency partners with the state’s Senior Health Insurance Program to provide one-on-one health insurance counseling for area residents aged 60 and over. SHIP counselors are unbiased and aren’t affiliated with a health insurance company or licensed to sell policies. They are trained to answer questions regarding Original Medicare coverage and Medigap and Medicare Advantage Plans. They can also help visitors organize and understand their medical bills and file disputes for denied coverage.
Contact Information: Website | 312-744-4016
Illinois Department of Human Services
Through the Department of Human Services, seniors can access the Illinois Healthcare Portal and sign up for prescription drug programs or affordable health coverage. The department also oversees SHIP, a state-sponsored health insurance counseling service for Medicare-eligible residents. Through this program, you can get more information about the Medigap and Medicare Advantage Plans available in your area and discuss the most affordable coverage options for your health care needs.
Contact Information: Website | 800-252-8966
Senior Health Insurance Program
SHIP is a free statewide program that provides unbiased counseling services for Medicare beneficiaries. Through SHIP, you can receive one-on-one guidance from a volunteer counselor who can help you understand your medical bills, identify and compare Medicare Advantage Plans in your region, and address medical billing issues. Counselors can also help you determine your eligibility for need-based Medicare Savings Programs, which can reduce your out-of-pocket expenses.
Contact Information: Website | 800-252-8966
Senior Medicare Patrol
Medicare fraud, which occurs when someone bills your health insurance for services you didn’t receive, is prevalent in Illinois. The state’s Senior Medicare Patrol program helps you recognize the signs of health care and Medicare fraud and learn how to protect yourself. Through SMP, volunteers and program staff provide presentations to the community on health care scams, waste, and fraud. You can also contact the program if you find a claim or charge for a service that you didn’t receive for guidance on resolving the issue.
Contact Information: Website | (800) 699-9043; ask for “SMP”