- In 2019, there were 101 Medicare Advantage Plans available in Illinois.
- 22% of the total Medicare population in Illinois was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,525 per beneficiary in Illinois, which is 4% higher than the national average.
- Available Medicare Advantage Plans range from three to 62 across Illinois’s 102 counties.
Medicare Advantage Plans are offered by private health insurance companies and are similar to employer-sponsored plans or those purchased on the Marketplace. The plans available to you depend on various factors, such as where you live and whether you have certain disabilities or illnesses.
Medicare Advantage Plans in Illinois
Type of Medicare Advantage Plans
Illinois’s Medicare Advantage program features four main plan types. Each type has its own unique sets of benefits and drawbacks, coverage options, and cost-sharing responsibilities. Regardless of plan type, Medicare Advantage Plans all cover the services included in Original Medicare.
Health Maintenance Organizations (HMO)
HMO plans, one of the least expensive options, are among the most common Medicare Advantage Plans. In most cases, these plans only pay for health care services you obtain from in-network providers, although some provide out-of-area coverage for emergencies. Under normal circumstances, if you use a provider outside of your plan’s network, you’re financially responsible for 100% of the services you receive. Most plans require that you choose a primary care doctor and get a referral to see a specialist, and most include prescription drug coverage.
Preferred Provider Organizations (PPO)
Like HMO plans, PPO plans require that you use in-network providers. However, because these plans typically cover at least some of the cost of services you get from doctors, hospitals, and specialists outside of the network, you enjoy a greater degree of flexibility. Most plans include prescription drug coverage, and you don’t have to choose a primary care doctor or get a referral to see a specialist.
Private Fee-for-Service Plans (PFFS)
PFFS plans work differently from HMOs and PPOs. Instead of having in-network doctors, specialists, and hospitals, these plans cover services from any provider that agrees to their payment terms and conditions. Some PFFS plans include prescription drug coverage, but if yours doesn’t, you can add a Medicare drug plan to your policy for an additional monthly premium. You don’t need to select a primary care doctor or get a referral before scheduling an appointment with a specialist.
Special Needs Plans (SNP)
Medicare SNPs are tailored for people who meet certain enrollment criteria. These plans only cover services received from in-network providers, except for emergency or urgent care you obtain when you’re away from the service area. The plan’s benefits, in-network doctors and specialists, and covered prescription drugs are all customized for those with specific diseases or conditions. Examples include members with diabetes or dementia, who live in a nursing home, or are dual-eligible for Medicare and Medicaid. All SNPs include prescription drug coverage, and in most cases, you have to choose a primary doctor and get a referral to see a specialist.
Enrollment and eligibility for Medicare Advantage Plans in Illinois
To sign up for a Medicare Advantage Plan in Illinois, you must be enrolled in or eligible for Original Medicare Parts A and B (over 65 or permanently disabled). If you have a Medigap plan when you sign up for Medicare Advantage, you need to drop it, as it can’t be used toward your new plan’s copays, premiums, or deductibles. You must live within the service area of your selected plan. If you often travel or split your time between two states, find out if your plan covers you in both places.
There are scheduled enrollment periods during which you can sign up for Medicare Advantage, switch to a different plan, or go back to Original Medicare coverage.
- The Initial Enrollment Period is a seven-month period that begins three months before your 65th birthday, includes your birth month, and remains open the three months after.
- During the Open Enrollment Period, which goes from October 15th to December 7th, you can join a plan, switch plans, or drop your MA Plan altogether. Any changes you make take effect the following January 1st.
- The Medicare Advantage Open Enrollment Period runs from January 1st through March 31st and is just for those enrolled in Medicare Advantage. You can switch back to Original Medicare and join a prescription drug plan or switch to a different Medicare Advantage Plan during this time frame.
Aside from these standard enrollment periods, a special enrollment period opens up in certain circumstances. These include moving into or out of a nursing home, moving to a new address, becoming newly eligible for different Medicare Advantage Plans, or having an opportunity for alternative coverage.
Prescription drug coverage
Medicare’s prescription drug coverage, called Part D, helps you pay for the medications your doctor prescribes. Even if you don’t take any medicines when you first enroll in Original Medicare, it’s a good idea to sign up for a Part D plan to avoid late enrollment penalties. Most Medicare Advantage Plans include prescription drug coverage. If not, you may add prescription drug coverage to certain PFFS plans but not to HMO or PPO plans.
Medicare Advantage Resources in Illinois
Illinois seniors have access to a large network of legal experts and counselors who can help them obtain the best health insurance coverage for their retirement years. Through the following agencies, seniors can get help with comparing Medicare Advantage Plans, filing and following up on claims, and finding programs that can help them pay for their coverage.
Illinois Department on Aging
The Illinois Department on Aging administers and oversees a variety of programs for older adults in the state, including those that can help you find appropriate health insurance coverage, such as the Legal Assistance Program, Older Adult Services, and the Senior Health Insurance Program. The department maintains a database of local agencies that provide support for financial and aging-related issues and operates the statewide Senior Helpline, which can be reached on weekdays between 8:30 a.m. and 5 p.m.
Contact Information: Website | 800-252-8966
Senior Health Insurance Program
SHIP is a statewide program administered by the Department on Aging that provides free, unbiased information and guidance on Medicare-related issues. SHIP counselors aren’t representatives of any health insurance company, and they’re not authorized to sell policies. They’re trained to help you determine which Medicare Advantage Plans are available in your region, compare the coverage options and out-of-pocket costs of each plan, and dispute denied claims or canceled policies.
Contact Information: Website | 800-252-8966
City of Chicago Senior Services
Chicago Senior Services is among the state’s 13 Area Agencies on Aging. It receives funds through the federal Older Americans Act to provide a range of services and programs, directly or through local partners, to residents aged 60 and over. Through the AAA, you can connect with SHIP counselors who can help you understand your Medicare benefits or sign up for a Medicare Advantage Plan that fits your needs. In Chicago, health insurance counselors provide one-on-one appointments at the Regional Senior Centers.
Contact Information: Website | 312-744-4016
Senior Medicare Patrol
Medicare fraud, abuse, and waste are significant issues that can drive up costs, compromise the quality of care you receive, and lead to billing and coding errors that result in denied medical claims. To help you recognize and address health care fraud, the state funds the Senior Medicare Patrol. Through this program, you get up-to-date information on avoiding and recognizing fraud, knowing the right questions to ask a health insurance agent, and obtaining financial assistance for covering Medicare copays and premiums. SMP also fields and investigates reports of fraud.
Contact Information: Website | 800-699-9043
Learn More from Our Sources
- Medicare | How Do Medicare Advantage Plans Work?
- Medicare | Health Maintenance Organization (HMO)
- Medicare| Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Medicare | Special Needs Plans (SNP)
- Medicare | Who Can Join a Medicare Advantage Plan?
- Medicare | Medigap & Medicare Advantage Plans
- Medicare | Joining a Health or Drug Plan
- Medicare | Special Circumstances (Special Enrollment Periods)
- Medicare | How to Get Prescription Drug Coverage