This Illinois Medicare guide will help you get to know the basics you need to know about Medicare to make the right decisions and get the best value from Medicare.
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There are 2.3 million Illinois Medicare beneficiaries, making up 18% of the state’s population. The majority of beneficiaries are on Medicare due to age, but about 11% are on Medicare due to disability. 17% of Illinois Medicare enrollees are also receiving Medicaid benefits.
When it comes to Original Medicare vs. Medicare Advantage, beneficiaries have a choice. 66% of Illinois Medicare beneficiaries choose to remain on Original Medicare and 34% choose Medicare Advantage.
All US citizens who meet one of the following requirements are eligible for Medicare:
You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease
As we mentioned before, the overwhelming majority of Illinois Medicare beneficiaries enroll in Medicare because of their age. You become eligible for Medicare at 65, but can enroll up to three months prior, at the start of your Initial Enrollment Period (IEP). Your IEP is a seven-month period that starts three months before the month you turn 65 and ends three months after. If you’re still working and receiving employer-linked coverage, you may choose to delay your enrollment in Part B. Just be sure you meet the requirements for a Special Enrollment Period, or you may be charged a Part B late enrollment penalty.
Once you’re enrolled, you can choose to stay on Original Medicare or switch to Medicare Advantage. With Original Medicare, you also have the option to enroll in a Medigap plan and a prescription drug plan. We’ll explain more about how each program works later on. For now, just know that you’ll need to take note of your healthcare needs to make the best decision for your specific health and financial situation. That means you can’t just ask your best friend or your nextdoor neighbor which plan they picked!
Once you’ve selected the right coverage for your needs, you’re done enrolling in Medicare. We recommend that you review any changes to your coverage or your healthcare needs each year to be sure you don’t need to switch to get better value. Each year, Medicare Advantage and Part D plans can change. You can use the Open Enrollment Period, which occurs from October 15 - December 7 to change to a better suited Medicare plan without consequence.
There are 157 Medicare Advantage plans in Illinois. Your specific pricing and availability will depend on the county you live in. For example, Cook County has 59 Medicare Advantage plans offered by twelve insurance carriers and Rock Island County has 42 plans from eight different carriers (in 2023).
To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed Illinois Medicare Advisors.
Medicare Advantage plans must provide at least the same coverage as Original Medicare. They’re popular among beneficiaries because they also often provide prescription coverage, dental, vision, and hearing coverage, and other added benefits. They offer these extras and tend to have low premiums (note that Medicare Advantage enrollees do still pay their Part B premium).
More coverage for no or low additional cost sounds great. So, why isn’t everyone on a Medicare Advantage plan? Unfortunately, Medicare Advantage plans also have disadvantages. To keep their costs low so that they can offer more benefits, they rely on provider networks that limit which doctors you can see. Medicare Advantage plans are also known for requiring prior authorization for covered services—and frequently denying coverage. Finally, when compared to Original Medicare with an added Medigap plan, Medicare Advantage out-of-pocket costs are much higher.
Many Illinois Medicare beneficiaries add a Medigap plan to help cover the 20% of costs that Original Medicare doesn’t pay. Because these plans significantly reduce beneficiaries’ out-of-pocket costs, they allow for better financial predictability. The most comprehensive plan (Medicare Supplement Plan G) covers everything except your Part B deductible, which means after meeting the $226 deductible in 2023, you owe nothing else for covered services!
In addition to much lower out-of-pocket costs, Medigap plans have two other big benefits. First, unlike with Medicare Advantage plans, you can see any doctor who accepts Medicare, which is about 90% of doctors nationwide. For example, even though you live in Illinois, you can still see doctors for the same cost down in Florida. Medigap plans and Original Medicare also don’t require prior authorization for covered services, which improves your access to care.
Enrollment for Medigap plans is more restrictive than enrollment for Medicare Advantage plans. If you enroll during your Medigap Open Enrollment Period, insurance companies cannot deny you coverage or charge you more because of your health history. Your Medigap Open Enrollment Period lasts for six months, following your Part B effective date.
Outside of your Medigap Open Enrollment Period (and a handful of other guaranteed issue periods), insurance carriers can ask you questions about your health history (underwriting questions) and can deny you coverage.
Illinois is one of a handful of states with a Medigap Birthday Rule. This rule allows current Medigap plan holders to switch to another Medigap plan each year during the 60 days following their birthday. If Medigap plan holders choose to switch to a plan with equal or lesser benefits compared to their existing policy, insurance companies cannot ask health history questions or establish a coverage waiting period.
Original Medicare doesn’t provide prescription drug coverage, which is why we have Part D. Many Medicare Advantage enrollees receive Part D coverage from their Medicare Advantage plan. Medicare beneficiaries can also enroll in a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Illinois. The plans and pricing available to you are determined by where you live.
If you don’t have any prescriptions when you first enroll in Medicare, we still recommend enrolling in a low-cost option. This way, you’ll avoid the Part D penalty later in life when you do need prescription coverage.
If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Illinois Medicare Advisors or give us a call at (888) 604-0055.
There are three government programs that can help those with low incomes and resources pay for Medicare.
Medicaid is a jointly run state and federal government healthcare program to help those with low incomes and resources. The Illinois Department of Healthcare and Family Services (HFS) has specific programs available for seniors, which you can explore here.
Illinois also has a Persons who are Elderly waiver, which grants benefits to individuals who are dually eligible for Medicaid and Medicare. There are also three Illinois Medicare Savings Programs that can help Medicare beneficiaries save on Medicare costs:
Qualified Medicare Beneficiaries (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB or SLIB) Program
Qualified Individuals-1 (QI-1) program
Learn more about the eligibility requirements and application instructions here.
Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.
You automatically qualify for Extra Help if you:
Receive full Medicaid coverage from Illinois
Illinois pays your Part B premium
Are eligible for Supplemental Security Income (SSI)
Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:
You are 65 and older, blind, or have a disability
You have limited income and limited resources