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Illinois Medicare Advantage Plans | Care in the Land of Lincoln

Updated on July 1st, 2021

We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.

What Are Medicare Advantage Plans in Illinois?

Thinking about Medicare coverage in Illinois? Medicare Part A and B, or Original Medicare, doesn’t cover all your medical bills and won’t limit your out-of-pocket costs. Medicare Advantage (MA) plans, or Medicare Part C, are offered by private insurance companies mandated to follow Medicare guidelines. Most plans include Medicare Part D, or prescription drug coverage.

What You Need to Know

Medicare Advantage plans are required to include Medicare Part A and B coverage.

Most plans include coverage for prescription drugs.

Some MA plans are zero-premium, while others carry a monthly cost.

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What Types of Medicare Advantage Plans Are Available in Illinois?

There are several different Medicare Advantage plans to choose from.

  • HMO: Health maintenance organization, which limits members to a contracted provider network. Typically you need to choose a primary care provider (PCP) and must get a referral to see a specialist.
  • PPO: Preferred provider organization, which offers a wider network than an HMO but at an increased cost. You don’t need to select a PCP and don’t need a referral to see a specialist.
  • SNP: Special needs plans, for those who need more specialized care. These come in three types:
    • Chronic condition (C-SNP):1 For those who have ongoing medical issues such as diabetes or cancer. 
    • Dual eligible (D-SNP):2 For those who are eligible for both Medicare and Medicaid.
    • Institutional (I-SNP):3 For those who need care in a nursing home or other long-term facility.
  • PFFS: Private fee-for-service.4 Services are offered by a contracted provider group at preset rates. You won’t need to choose a PCP.
  • MSA: Medicare medical savings account, which is a hybrid of a medical savings account and a high-deductible plan.5

Save Money

You can save money with most Medicare Advantage plans by going to in-network providers.

What Are Prescription Drug Options with Medicare Advantage?

For MA plans in Illinois, there are two options for prescription drug coverage: a separate plan or as part of the MA plan. 

If there are specific medications you need, check your plan’s formulary, or list of covered medications, to make sure yours are included. 

Under an MA-PD plan, most Medicare Advantage HMO and PPO plans in Illinois provide prescription drug coverage. 

How Do You Choose Medicare Advantage Plans in Illinois?

Consider the costs of the plan as well as the type of coverage you want.

Your premium is the amount you pay for the plan each month. There are zero-premium plans available, though you’d still pay the Medicare Part B premium ($148.50 in 2021). However, your other out-of-pocket costs may be higher with a zero-premium plan. 

Other costs include:

  • Coinsurance, the percentage you pay for services (usually 20%) after meeting your deductible. 
  • Copays, a standard fee you pay for most services.
  • Deductibles, the yearly amount you pay before your coverage begins.
  • Maximum out-of-pocket, which in 2021 is $7,550 for in-network services.6

 Plan benefits include:

  • Vision, including eye exams and glasses or contact fittings.
  • Dental, including exams and cleanings. 
  • Telehealth, including medical office visits and psychotherapy.
  • Other perks, including access to fitness programs and hearing aids.

Additional Benefits

Most MA plans also offer vision and dental coverage.

 When Can You Enroll in Medicare Advantage?

You’re eligible for Medicare Advantage as soon as you’re eligible for Original Medicare. Your Initial Enrollment Period runs from the three months before you turn 65 years old to the three months after you turn 65.

The Medicare Annual Election Period, or Open Enrollment Period, runs October 15 through December 7. 

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. You can switch to a different Medicare Advantage plan or switch back to Original Medicare.

The General Enrollment Period runs January 1 to March 31. Your coverage begins on July 1.

You may qualify for a Special Enrollment Period in certain situations, including:

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  • Relocation
  • Loss of coverage, or losing Medicaid eligibility
  • Gain of coverage, or qualifying for employer or union coverage
  • Plan changes, such as Medicare termination of a current plan’s contract
  • Being diagnosed with a chronic condition best served by another plan

How Much Do Medicare Advantage Plans Cost in Illinois?

In 2020, the Illinois average7 was $16.96. Monthly premiums vary by location. In parts of Chicago, premiums range from $0 to $145. In Dekalb, premiums range from $0 to $165.8

What If You Want to Change Your Medicare Advantage Plan?

Provided you’re already enrolled in Medicare Advantage, you can join your chosen plan during the corresponding enrollment period.

What Are Alternatives to Medicare Advantage?

Alternatives to an MA plan in Illinois include:

  • Original Medicare. If Medicare Part A and B offer enough coverage for you, you can stick with it. 
  • Medicare Supplement. Also known as Medigap, these policies help pay costs not covered by Original Medicare.
  • Medicare Supplement with a Part D plan. You’ll likely need separate prescription drug coverage with a Medigap policy. 
  • Medicare Cost Plan.9 If you have Original Medicare and go to an out-of-network provider, Medicare will cover the service. 

What Are Medicare Resources in Illinois?

  • The Senior Health Insurance Program10 (SHIP) is a free statewide counseling service for Medicare recipients and their caregivers.
  • The Illinois Department of Human Services11 helps residents get access to healthcare, including Medicare.
  • Medicaid12 helps pay medical costs for those with low income or disability.

Next Steps

If a Medicare Advantage plan best fits your needs, reach out to an enrollment agency or to Medicare to find an insurance company. Make sure you’re selecting the level of coverage and cost that are right for you before you sign up. 

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  1. Centers for Medicare & Medicaid Services. “Chronic Condition Special Needs Plans (C-SNPs).” (accessed December 23, 2020).

  2. Centers for Medicare & Medicaid Services. “Dual Eligible Special Needs Plans (D-SNPs).” (accessed December 23, 2020)

  3. Centers for Medicare & Medicaid Services. “Institutional Special Needs Plans (I-SNPs).” (accessed December 23, 2020).

  4. Centers for Medicare & Medicaid Services. “Private Fee-for-Service Plans.” (accessed December 10, 2020).

  5. U.S. Government Website for Medicare. “Medicare Medical Savings Account (MSA) Plans.” (accessed December 23, 2020).

  6. Freed, Meredith, Anthony Damico, and Tricia Neuman. “A Dozen Facts About Medicare Advantage in 2020.” (accessed December 23, 2020).

  7. Centers for Medicare & Medicaid Services. “Medicare Advantage Average Monthly Premiums, 2007-2021.” (accessed December 23, 2020).

  8. U.S. Government Website for Medicare. “Find a Medicare plan.” (accessed December 23, 2020).

  9. U.S. Government Website for Medicare. “Medicare Cost Plans.” (accessed December 23, 2020).

  10. Illinois Department on Aging. “Senior Health Insurance Program.” (accessed December 11, 2020).

  11. Illinois Department of Human Services. “Medical Assistance Programs.” (accessed December 11, 2020).

  12. State of Illinois. “Application for Benefits Eligibility.” (accessed December 23, 2020).