Medicare Advantage Plans in Illinois

All Medicare Advantage plans offer the same basic coverage as Parts A and B of Original Medicare, and most also offer other benefits like Part D 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.

Medicare Advantage plans, also called Part C plans, can give you extra benefits on top of what Original Medicare covers. All plans are approved by Medicare and offered by private insurance companies.

All Medicare-eligible Illinois residents have access to a Medicare Advantage plan. However, the availability of specific plans depends where you live in the state. Based on the plan you choose, the coverage may include:

• Dental
• Vision
• Prescription drugs
• Transportation
• Fitness and wellness

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 Medicare Advantage plan, seek out guidance so you can fully understand your options and likely costs. To learn more about your choices, you can:

• Speak to a GoHealth licensed 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.

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 $174.70 a month for most people in 2024.

As of 2024, the average monthly premium for a Medicare Advantage plan in Illinois was $11.95. Everyone in the state has access to a plan that offers $0 premiums.

Plan types include:

• Health Maintenance Organization (HMO) — These plans have low premiums with network providers to keep costs down. They are the most common 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.

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.

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.