Medicare Advantage Plans in Illinois
Written by: Malini Ghoshal, RPh, MS
Reviewed by: Cassandra Parker, Licensed Insurance Agent
In 2023, there are more options for Medicare Advantage plans in Illinois.
A majority of Medicare Advantage plans are Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans.
Several Medicare Advantage plans in Illinois offer $0 premium in 2023.
The majority of Illinois Medicare Advantage plans in 2023 offer prescription drug coverage.
All Medicare Advantage plans offer the same basic coverage Parts A and B of Original Medicare, and most also offer other benefits like prescription drug coverage, dental, vision and more. Whether you’re new to Medicare or are looking to change to a Medicare Advantage plan, there’s a lot to consider before you join a Medicare Advantage plan in Illinois.
Read on to learn more about coverage, eligibility and Medicare Advantage plan options in Illinois in 2023.
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Illinois Medicare Advantage Plan Coverage
According to recent data, more than 30% of Medicare-eligible residents had Medicare Advantage plans in Illinois. Medicare Advantage plans, also called Part C plans, give you the benefit of getting extra coverage over what Original Medicare covers. All plans are approved by Medicare and offered by private insurance companies.
Medicare Advantage plan coverage and availability depends on the specific plan you choose and where you live in the state.
Additional coverage may include:
- Prescription drugs
- Fitness and wellness
In addition, many Medicare Advantage plans now offer increased coverage benefits like telehealth, telemedicine, lower-cost monthly insulin ($35 or less), acupressure and more.
In 2023, Most people can choose from several Medicare Advantage plans in Illinois. This is great news since it allows you to find a plan that suits your individual healthcare needs.
A few points to consider when looking at Medicare Advantage plans:
- Are your current providers in-network with the plan?
- Does the plan offer prescription drug coverage?
- Are all of your drugs covered?
- Are wellness and preventive screening benefits important to you?
- Do you live in different states in a given year– does the plan cover all locations?
- What is the plan star rating?
Before you decide on a type of Medicare Advantage plan, talk to an expert to understand your options based on your healthcare costs annually.
To learn more about coverage options, you can:
- Speak to a GoHealth license insurance agent.
- Call 1-800-MEDICARE or visit Medicare.gov.
- Contact the Medicare Advantage plan directly.
- Call the State Health Insurance Assistance Program for free advice at 1-800-432-4040.
IL Medicare Advantage Plan Costs
Medicare Advantage plans have a range of options and costs depending on the type of plan you select and the benefits you want. Keep in mind, no matter which plan you choose, you’ll still need to pay your Part B premium, which is usually $164.90 a month in 2023. Many Medicare Advantage plans offer $0 premiums.
Popular plan types include:
- Health Maintenance Organization (HMO) — These plans have low premiums with network providers to keep costs down. They are the most popular type of Medicare Advantage plan.
- Preferred Provider Organization (PPO) — These plans offer in- and out-of-network coverage, but costs are higher for out-of-network services.
- Private Fee for Service (PFFS) — These plans don’t require you to choose a primary care provider but may have higher premiums and out-of-pocket costs.
- Special Needs Plan (SNP) — These plans have specific eligibility criteria for enrollment (financial, health condition based).
Suppose you’re considering a new Medicare Advantage plan or switching from Original Medicare to a Medicare Advantage plan in Illinois. In that case, it’s a good idea to check specific cost and coverage details carefully based on what works best for you.
For example, if you have a Medigap plan currently to help pay for premiums, deductibles, coinsurance and copays, consider these costs and benefits when compared with a Medicare Advantage plan. You cannot have a Medigap plan to help pay for premiums, deductibles and copays if you have a Medicare Advantage plan.
Some cost factors to consider:
- What do you spend on vision, dental or other services annually?
- What are the premiums, deductibles and other costs for each plan you’re considering?
- Do you take any specialty drugs? Are they covered? What is the copay?
- What is the typical in-patient hospital cost for the plan?
These are just a few questions to factor into your decision when selecting an Illinois Medicare Advantage plan. Remember, you can always reach out to a GoHealth insurance expert or call Medicare to get answers to your particular questions.
Are you eligible for cost-saving Medicare subsidies?
Medicare Advantage Plan Eligibility and Enrollment in Illinois
Let’s take a closer look at Medicare Advantage plan eligibility and enrollment in Illinois. The basic eligibility requirements to join a Medicare Advantage plan are that you must be enrolled in Original Medicare first, and the plan must be available where you live in Illinois. The specific plan may have additional requirements.
Medicare eligibility is based on age (65 years or older) and a few other criteria. You can also qualify if you’re younger than 65 but have certain chronic health conditions or have a qualifying disability.
When you first become eligible, this is called your Initial Enrollment Period (IEP). You have seven months to enroll. This period begins three months before you turn 65 and continues for three months after the month of your birthday.
You can enroll in Medicare:
- By calling the Social Security Administration (SSA) at 1-800-772-1213.
- Online with SSA.
- By connecting with your local SSA office.
You can enroll with a Medicare Advantage plan:
- During the Initial Enrollment Period after you join Medicare.
- During the Annual Enrollment Period (October 15 to December 7).
- During the Medicare Advantage Open Enrollment Period (January 1 to March 31), you can switch Medicare Advantage plans or go back to Original Medicare.
- During a Special Enrollment Period.
Are There Illinois Medicare Advantage Plans with Prescription Drug Coverage?
Yes, most Illinois Medicare Advantage plans have prescription drug coverage as part of their coverage benefits.
A majority of Medicare Advantage plans offer Part A and B coverage along with Part D prescription drug benefits. Each private health plan has different coverage limits, costs and rules, so it’s important to carefully review each plan before choosing one. Once you join a plan, you usually stay with the plan for at least one year before you can make a change during specific enrollment periods.
Medicare Advantage plans with drug coverage have lists of covered drugs based on a tier system. There are typically five tiers with the lowest cost drugs on Tier 1. Learning where your medications fall on a plan’s tier formulary will help you budget your prescription drug expenses in a year.
What extra benefits and savings do you qualify for?
Medicare Learning Guides
If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you!
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status