Since 2010, Medicare Part C enrollment has nearly doubled. More commonly known as Medicare Advantage (MA), more than half of the eligible Medicare population had an MA plan in 2023. On this page, we describe Medicare Advantage plans in Illinois as well as how Part C works, and how to find the best plan for your needs.
What is Medicare Advantage in Illinois?
Every Medicare Advantage plan must provide the same benefits that you get with Original Medicare, which includes:
- Medicare Part A covers inpatient services such as you'd receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more
Prescription drug coverage is not included with Original Medicare. If you do not have creditable drug coverage elsewhere, you need a Medicare Part D plan. (Creditable means a plan that is comparable to Medicare in terms of both cost and coverage.)
Medicare Advantage plans are not limited to the benefits provide by Parts A and B. In fact, over 90 percent of them offer additional coverage. The most common items are:
- Prescription drug coverage
- Routine vision and dental care
- Fitness programs like SilverSneakers
Please note that joining a Medicare Advantage plan in Illinois does not exempt you from the Medicare Part B premium.
Illinois Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) account for 90% of all MA plans. These all-in-one plans combine your Medicare Parts A, B, and D benefits into a single plan.
Who is eligible for Medicare Advantage in Illinois?
You become eligible for Medicare Advantage in Illinois as soon as you have Medicare Parts A and B.
If you are an American citizen or permanent legal resident aged 65 or older, you qualify for Medicare. Enrollment in Parts A and B is automatic if you began collecting Social Security benefits at least 4 months before your 65th birthday. Otherwise, you need to apply for Medicare.
Collecting Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months also qualifies you for Medicare, even if you aren't yet 65. Enrollment occurs automatically during month 25.
When can you sign up for a Medicare Advantage plan in Illinois?
You may first sign up for Medicare Advantage during your Initial Enrollment Period (IEP). It lasts for 7 months and starts 3 months before you become eligible for Medicare. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in June, your IEP begins on March 1 and extends through September 30.
The General Enrollment Period is for people who did not sign up for Medicare Part A and/or Part B during their IEP. It runs from January 1 until March 31. Once General Enrollment ends, you have from April 1 until June 30 to sign up for a Medicare Advantage plan.
The Medicare Annual Enrollment Period (AEP) and allows current Medicare beneficiaries to make any necessary change to their coverage, including signing up for an Advantage plan. It lasts from October 15 until December 7.
From January 1 through March 31, the Medicare Advantage Open Enrollment Period lets people who already have a Medicare Part C plan change to a new MA plan. You can also choose to return to Original Medicare. If you lose your prescription drug coverage due to that change, you can also sign up for a standalone Part D plan.
Experiencing certain life changes qualifies you for a Special Enrollment Period (SEP). There are dozens of ways to qualify. The full list of special circumstances is on Medicare.gov.
Types of Medicare Advantages plans in Illinois
There are four common types of Medicare Advantage plans in Illinois.
Over half of all MA plans are health maintenance organizations. HMO plans help manage costs by using a provider network. Most HMO plans will not cover non-emergency care received from an out-of-network provider. If you join an HMO, you'll also need to choose a primary doctor and get a referral to visit a specialist.
Networks are also used by preferred provider organizations. The difference is that PPO plans allow members to receive out-of-network care, they'll just pay more for the service. You don't have to choose a primary doctor or get a referral to see a specialist with a PPO plan.
Private fee-for-service (PFFS) plans set price points for all covered services. Most use a provider network but are like PPOs in that they allow members to receive out-of-network care for a higher price and don't require enrollees to have a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people who:
- Have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
- Live in an institution, such as a nursing home, or require at-home care
- Qualify for both Medicare and Medicaid (known as dual eligibility)
Guidelines vary from plan to plan. SNPs also require their members to choose a primary doctor who coordinates care and provides specialist referrals.
How to choose a Medicare Advantage plan in Illinois
To get the best Medicare Advantage plan for your unique needs and budget, consider the following:
- Costs: May include an annual deductible, monthly premium, and copays at the time of service.
- Coverage: Benefits vary from plan, so look closely at coverage to understand what you get with your monthly premium. Don't forget to review the drug formulary of an MA-PD plan.
- Network: Any entity that provides healthcare services may be included in the plan's network.
- Ratings: Medicare releases Advantage plan ratings every fall before Annual Enrollment.
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Illinois. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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