Medicare is a federal health insurance program that helps people age 65 and older pay for necessary medical care. You may also be eligible if you are younger than age 65 and living with certain disabilities. In Illinois, about 2.2 million people are enrolled in Medicare.
This article will explain Medicare options in Illinois in 2021, including Medicare Advantage plans and what to consider as you shop for coverage.
When you sign up for Medicare in Illinois, you can choose either original Medicare or a Medicare Advantage plan.
Part A covers hospital stays and other inpatient care, while Part B covers many necessary medical services, including doctors’ visits and preventative services.
If you enroll in original Medicare, you can choose to sign up for some additional types of coverage. Medigap policies cover some of the healthcare costs that original Medicare doesn’t, such as your copayments and deductibles. If you want drug coverage, you can also sign up for a stand-alone drug plan, known as Part D.
Medicare Advantage (Part C) plans give you another way to get your Medicare coverage. These plans are offered by private insurance companies, and they include all Medicare parts A and B services.
Medicare Advantage plans in Illinois may offer many other benefits that aren’t included in original Medicare, such as:
- hearing, vision, and dental care
- prescription drug coverage
- wellness programs
- over-the-counter drug coverage
Many Medicare Advantage plans are available to Illinois residents. The following insurance carriers offer Medicare Advantage plans in Illinois:
- Aetna Medicare
- Ascension Complete
- Blue Cross and Blue Shield of Illinois
- Bright Health
- Clear Spring Health
- Lasso Healthcare
- Zing Health
Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
The eligibility rules for Medicare vary depending on your age. If you’re younger than age 65, you may become eligible in either of these situations:
- you’ve been diagnosed with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
- you’ve been on Social Security Disability Insurance (SSDI) for 2 years.
If you’re turning 65 years old, you’re eligible for Medicare in Illinois in either of these situations:
- you live in the United States and are a U.S. citizen or permanent resident
- you already receive Social Security retirement benefits or qualify for them
If you’re eligible for Medicare, you can sign up at certain times throughout the year. These times include:
- Initial enrollment period. This 7-month period is available for people who become eligible for Medicare when they turn age 65. It starts 3 months before the month you turn 65 years old and ends 3 months after your birthday month.
- Annual open enrollment period. The annual open enrollment period runs from October 15 to December 7. If you sign up for a Medicare Advantage plan during this period, your new coverage will start on January 1.
- Medicare Advantage open enrollment period. From January 1 to March 31 every year, you can switch to a different Medicare Advantage plan. If you make changes, your new coverage starts on the first day of the month after the insurer gets your request.
- Special enrollment period. If you experience certain life events, you’re allowed to sign up for Medicare outside of the annual enrollment periods. You could have a special enrollment period if you lose your employer health coverage, for example.
In some circumstances, you may be signed up for Medicare automatically. If you’re eligible for Medicare due to a disability, you’ll be enrolled after you receive SSDI checks for 24 months. If you get Railroad Retirement benefits or Social Security retirement benefits, you’ll be enrolled when you turn 65 years old.
There are many things to consider as you evaluate the many Medicare plans in Illinois. To find the plan that best suits your needs, consider these factors:
- Covered services. Medicare Advantage plans may cover services that original Medicare doesn’t, such as dental, vision, or hearing care. Some even offer perks, such as gym memberships. Look for plans that cover the services you want or need.
- Cost. The cost of Medicare Advantage plans varies. For some plans, you may be charged a monthly plan premium in addition to the Medicare Part B premium. Copayments, coinsurance, and deductibles will also affect your out-of-pocket costs.
- Provider network. If you join a Medicare Advantage plan, you may need to get care from doctors and hospitals in your plan’s network. You may want to ask your current healthcare providers if they participate in plans you are considering.
- Service area. Original Medicare provides nationwide coverage, while Medicare Advantage plans serve more limited areas. If you plan to travel, you may prefer a Medicare plan that offers travel or visitor benefits.
- Ratings. Every year, the Centers for Medicare & Medicaid Services (CMS) rates plans from one to five stars. These star ratings are based on customer service, quality of care, and other factors. To check a plan’s rating, go to CMS.gov and download the Star Ratings Fact Sheet.
Medicare is a complex program, but there are resources that can help you understand your options.
For more information about Medicare in Illinois, you can contact the Senior Health Insurance Program, which provides free, one-on-one counseling about Medicare and other health insurance options.
When you’re ready to shop for a Medicare plan, here’s what you can do next:
- To sign up for Medicare parts A and B, contact the Social Security Administration. You can call 800-772-1213, visit your local Social Security office, or use Social Security’s online Medicare application.
- If you’re interested in Medicare Advantage plans in Illinois, you can compare plans at Medicare.gov. If you see a plan you like, you can enroll online.
This article was updated on October 2, 2020 to reflect 2021 Medicare information.
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