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Medicare in Illinois

Learn about Medicare Plans in Illinois

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Andrew Hall.

Key Takeaways

  • You are eligible for Medicare in Illinois at age 65. You may be eligible earlier if you have disabilities or certain diseases.

  • To sign up for Medicare, the Initial Enrollment Period is three months before the month you turn 65, the month you turn 65, and the three months after your birth month. If you miss this window, you can enroll during the General Enrollment Period from January 1 – March 31.

  • There are various assistance programs if you need help with healthcare costs, including the Medicare Savings ProgramMedicare Savings Programs help those with low incomes pay premiums and sometimes co-insurance for Medicare expenses., Medicare Extra HelpExtra help is a financial assistance program that helps people with low incomes pay for Medicare Part D coverage. and Programs for All-Inclusive Care for the Elderly (PACE).

 

Medicare eligibility in Illinois and across the nation begins at 65. People that receive SSDI or Railroad Retirement Board benefits may be eligible before 65. Living with end stage renal disease or ALS may also make a person qualified under 65. Although Medicare is not free insurance in IL, it is worth comparing plans to find the coverage you need at an affordable cost. GoHealth agents are licensed in IL and can help you better understand your options.

If you’re wondering what you need to know about Medicare, you’re not alone. When the time comes to enroll in Medicare, you have several choices to make. At the most basic level, how do you enroll in Medicare? Or how does Medicare work? We will answer these questions and more as we take you through the basic elements of Medicare in IL, and how they work for your situation.

Who Is Eligible for Medicare in Illinois?

You are eligible for Medicare in Illinois if you are ages 65 and older and a U.S. citizen or a permanent legal resident who has lived in the U.S. for more than five years. Younger Americans under 65 and/or living with disabilities and receiving Social Security can be eligible. Additionally, those living with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) are also eligible before 65.

Note: If you have Lou Gehrig’s disease (ALS), you can qualify to receive Medicare.

How Do I Apply For Medicare In Illinois?

Suppose you live in Illinois and are already receiving Social Security or Railroad Retirement Board (RRB) benefits. In that case, you are typically automatically enrolled in Medicare Part A and Part B. If this is the case, you will receive instructions during the Initial Enrollment Period from the Social Security Administration. However, if you are not receiving Social Security, you can find enrollment dates for Medicare below.

Enrolling in Medicare in IL

If you are eligible for Medicare in Illinois, you can enroll in several different Medicare plans, depending on your personal needs. You can enroll during the Initial Enrollment Period or the General Enrollment Period.

Initial Enrollment Period

  • The Initial Enrollment Period (IEP) occurs from three months before the month you turn 65, the month you turn 65, and the three months after your birth month. Your IEP is a seven-month window. However, if you miss this window, you can enroll during the General Enrollment Period from January 1 through March 31 each year.

If you are enrolled in Medicare in IL, make a note of the important dates below.

Medicare Part C & D Annual Enrollment Period

  • You can enroll in a Medicare Advantage or Part D plan during the Annual Enrollment Period from Oct. 15 to Dec. 7.

Medicare General Enrollment Period

  • You can enroll in Medicare if you miss the Initial Enrollment Period by signing up during the Medicare General Enrollment Period. Medicare’s General Enrollment Period, no matter which state you live in, takes place from January 1 to March 31. If you enroll during this period, your coverage will start on July 1.

Medicare Advantage Open Enrollment Period

  • The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 every year. You have the option to switch to another Medicare Advantage plan with or without drug coverage. Also, you have the option to switch back to Original Medicare and enroll in a drug plan (Part D) if you choose.

What Does Medicare Cover in Illinois?

If you are eligible for Medicare and living in Illinois, you have several options for coverage. Below are the options that are available to you.

Original Medicare (Part A and Part B)

Below is a summary of what is covered by Original Medicare’s Part A and Part B.

  • Part A: Medicare Part A, also known as Hospital Insurance, is often provided at no cost for participants with enough earned credits based on their work history or a spouse who is at least 62 years of age. You are not required to pay a monthly premium for Medicare Part A if you or your spouse has worked 10 years while paying Medicare taxes.
  • Part B: Medicare Part B covers medical services and has a monthly premium. In some cases you can delay Part B enrollment, but anyone that neglects enrollment during an eligible enrollment period will be required to pay late penalties if they choose to enroll later.

Medicare Advantage (Part C)

  • Part C: Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Additional coverage for Medicare

Besides Original Medicare and Medicare Advantage, there are additional coverage options that fall under Medicare. These options include Medicare Part D and Medigap.

Medicare Part D (Prescription Drug Plan)

Medicare Part D, also known as Prescription Drug Insurance, is not required for plan participants enrolled in any of the state programs (such as CIP, TRIP, LGHP or State). This coverage does have a monthly premium. Assistance programs like Extra Help may cover some or all of your Part D premium.

Medicare Supplement (Medigap)

Medigap is a Medicare Supplement insurance. The purpose of Medigap is to help with your Part A and Part B out-of-pocket costs, including deductibles and copayments. Medigap plans are offered by private insurance companies, but you are not able to choose a Medigap plan if you have a Medicare Advantage plan.

Assistance Programs

If you are worried about affording any costs associated with a Medicare plan, there are a few assistance programs that can help. These include the Medicare Savings Program, Medicare Extra Help and Programs for All-Inclusive Care for the Elderly (PACE).

Medicare Savings Program

Medicare Savings Programs help Medicare-eligible individuals who are not able to pay the out-of-pocket expenses that Medicare does not cover. Anyone in Illinois can apply for these programs. However, most programs are designed to help people with Medicare who have lower incomes or certain disabilities.

Medicare Extra Help

The Medicare Part D Extra Help program, also known as Medicare Extra Help, is a program that assists people with limited income and resources to pay for prescription drugs. This program might lower your premiums and copays or insurance. It can also cover you throughout the coverage gap and waives any Part D late enrollment penalty.

Programs for All-Inclusive Care for the Elderly (PACE)

Programs for All-Inclusive Care for the Elderly, or PACE, is a program that provides comprehensive medical and social services to certain elderly people who are still living in the community. [1]  Most participants are dually eligible for both Medicare and Medicaid.

How much is Medicare in Illinois?

Although you typically need to pay a premium for Medicare Part B, many people are eligible for Part A without a premium. If you (or your spouse) have worked at least ten years while paying Medicare taxes, you are not required to pay a monthly premium for Medicare Part A.

Additionally, there are other costs involved in Original Medicare (Part A and Part B), including deductibles, copayments and coinsurance. Original Medicare does not include prescription coverage (unless you are in the hospital, or have medications administered to you in a doctor’s office).

Medicare in Illinois by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 2,044,149 people are enrolled in Medicare in Illinois. The total number of beneficiaries enrolled in Medicare Advantage in Illinois is 600,852. The previous year, 555,468 enrolled in Medicare Advantage. Medicare Advantage participation in Illinois went from 27.67% to 29.39% year over year. If you’d like to dive deeper into how Medicare in Illinois breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Illinois
2,044,149
Beneficiaries with Part A & Part B
600,852
Medicare Advantage Beneficiaries
29.39%
Medicare Advantage Participation Rate
55.54%
% Female
44.46%
% Male
1.01
Average HCC Score
$11,057.15
Actual Per Capita Costs
17.86%
% Eligible for Medicaid
32.34%
% of Beneficiaries with an Emergency Department Visit
18.97%
Hospital Readmission Rate
79.80%
% Non-Hispanic White
10.01%
% African American
5.55%
% Hispanic
4.64%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Illinois Medicare Resources & Contacts

Beneficiaries spend an average of $11,057.15 each year on Medicare in Illinois. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Illinois-based resources, like these, may be able to help:

Illinois Department of Insurance

1-877-527-9431

https://insurance.illinois.gov/

What should I know about the Illinois Department of Insurance?

The Illinois Department of Insurance educates and protects consumers while regulating the state’s insurance market.

Illinois Department of Healthcare and Family Services

1-800-843-6154

https://www.illinois.gov/hfs/Pages/default.aspx

What should I know about Illinois DHFS?

If the cost of health coverage is a problem or you have questions about Medicaid eligibility or existing benefits, contact DHFS.

Illinois Department of Human Services

1-800-843-6154

1-866-324-5553 (TTY)

https://www.dhs.state.il.us/

What should I know about the Illinois DHS?

If you have questions about an open case, benefits, health services, or eligibility, contact the DHS.

Illinois Department of Veterans’ Affairs

1-(217)-782-6641 (Springfield)

1-(312)-814-2764 (Chicago)

https://www2.illinois.gov/veterans/Pages/default.aspx

What should I know about the IDVA?

The IDVA is not responsible for your federal benefits. IDVA employees are highly knowledgeable with federal benefits and regularly assist Illinois veterans in applying for their federal VA benefits and providing assistance.

Nationwide Resources

Speak with an insurance agent that is licensed in Illinois about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in IL, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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