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.
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:
- 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
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.
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:
- 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?
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.
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.