Medicare Advantage Plans in Illinois

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits such as dental, vision, hearing, fitness programs, and telehealth services.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most individuals become eligible for Medicare enrollment at age 65, although some may qualify earlier due to disability, ALS, or ESRD. It’s essential to understand enrollment windows to avoid late penalties:

• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Periods

What Types of Medicare Advantage Plans Are Available in Illinois?

Illinois offers a variety of Medicare Advantage (MA) plan types:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and typically require referrals for specialists.
• Preferred Provider Organizations (PPOs): Provide access to out-of-network care at higher costs and typically do not require referrals.
• Private Fee-for-Service (PFFS) Plans: Allow visits to any provider who accepts the plan’s terms. Some PFFS plans also include networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For individuals with chronic conditions such as diabetes, cancer, or heart disease.
  • I-SNPs: For those who live in institutions or require nursing home-level care.
  • Dual Eligible Special Needs Plans (D-SNPs): For people who qualify for both Medicare and Medicaid. These plans often provide enhanced care coordination, drug coverage, and dental benefits at little to no cost.
• Medical Savings Accounts (MSAs): Pair a high-deductible health plan with a savings account funded by the insurer to help pay for medical expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most Medicare Advantage plans in Illinois include Part D drug coverage. However, MSAs and some PFFS plans do not. If your plan doesn’t include drug coverage:

• You may be eligible to enroll in a separate Part D plan (only with certain plan types).
• You may face a late enrollment penalty if you delay obtaining prescription coverage without having creditable coverage.

Always check your plan’s formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Before enrolling, understand Medicare Advantage costs and compare:

• Premiums: Some plans have $0 premiums; others may charge a monthly fee.
• Deductibles, Coinsurance & Copays: Evaluate your out-of-pocket costs for medical services.
• Out-of-Pocket Maximums: A yearly cap that limits how much you’ll spend on covered care.
• Extra Benefits: Many plans offer perks such as dental, vision, telehealth, gym memberships, over-the-counter allowances, and hearing aids.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: Begins 3 months before your 65th birthday month and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, drop, or switch MA plans.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Medicare Part B for the first time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch between MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by:
  • Moving to a new service area
  • Gaining or losing employer/union or Medicaid coverage
  • Plan contract termination
  • Diagnosis of a chronic condition that qualifies for a C-SNP

What If You Want to Change Your Medicare Advantage Plan?

You may switch your Medicare Advantage plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Plan changes typically take effect on the first day of the following month.

Understanding Medicare Advantage Star Ratings

CMS star ratings help consumers evaluate Medicare Advantage plan performance:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect quality and service measures for both Medicare Advantage (Part C) and Part D prescription drug plans.

What Are Medicare Resources in Illinois?

Illinois offers several Medicare-related resources to support beneficiaries:

• Senior Health Insurance Program (SHIP): Provides free Medicare counseling to residents and caregivers.
• Illinois SMP Program: Educates beneficiaries on avoiding Medicare fraud and abuse.
• Illinois Department of Insurance: Accepts insurance complaints.
• Illinois Department of Human Services: Offers support with accessing healthcare services, including Medicare.
• Illinois Medicaid: Assists low-income residents with healthcare costs. Call 1-800-843-6154 for assistance.

Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover costs like deductibles, coinsurance, and copays not covered by Original Medicare.

• You must be enrolled in Medicare Parts A and B.
• Enroll during your six-month Medigap Open Enrollment Period (begins when you enroll in Part B).
• These plans don’t cover drug costs—you’ll need a separate Part D plan.
• There are 10 standardized Medigap plans; F, G, and N are the most popular.
• Medicare Supplement Plan G had the highest enrollment in 2023 and continues to grow rapidly.
• Plan F is no longer available to people newly eligible for Medicare after 2020.

Learn more about Medicare Supplement plans in Illinois.

Next Steps

If a Medicare Advantage plan in Illinois aligns with your health needs and budget, compare plans available in your area. Review provider networks, covered benefits, and total out-of-pocket costs. Once ready, enroll during the appropriate period to get started with the plan that’s right for you.