Medicare in Illinois

Medicare is a federal health care program for adults over 65 and younger people with specific disabilities. As of 2022, 65 million Americans have enrolled, 57.3 million of whom are seniors. According to 2023 data, 2.3 million beneficiaries reside in Illinois, at a cost to the state of $17 billion annually. Medicare Advantage is less burdensome for the state, but Illinoisans have been slow to adopt it. Data for 2023 shows 37% have signed up, which, although 3% more than in 2022, is below the national average of 48%. However, 2023’s figures show the rate of enrollment was 8.85% higher than the previous year, suggesting the program is becoming more popular.

Original Medicare, also known as Part A and Part B, is the foundation program. Part A provides coverage for essential services, such as hospital stays, nursing home care, blood transfusions and parts of home health care. Part B covers outpatient services, including medical transportation, doctors’ services and medical equipment and supplies. Most beneficiaries don’t pay a premium for Part A, but, as of 2023, Part B’s monthly premium is $164.90. Medicare Part D covers prescription drug costs. Premiums vary as each beneficiary has a different drug prescription and their medications are assigned different tiers. Medicare doesn’t cover co-pays, coinsurance or deductibles, so some seniors purchase Medicare Supplement Insurance, or Medigap, to cover this shortfall.

Medicare Advantage, or Part C, combines the coverage of Part A and B into a single plan, minus hospice care. There are 173 plans available in Illinois in 2023, up from 2022’s 166. Whereas the Centers for Medicare and Medicaid Services (CMS) manage Original Medicare, approved private insurance companies handle Medicare Advantage Plans. The premium for every plan starts at 0%, but this increases as seniors add additional coverage options, such as prescription drugs, vision and dental care. Consequently, the median monthly premium in Illinois is $11.39, which is 20% cheaper than in 2022. 

This guide covers Medicare options in Illinois, including how to tailor plans and get financial advice. It also lists some nonprofits dedicated to helping seniors benefit more from Medicare.

Options for Medicare Coverage in Illinois

Older residents of Illinois have several Medicare options to help them get the best coverage to suit their needs. The federal government provides Original Medicare, which has basic coverage that works well for many seniors. There are also alternatives and supplemental policies that private health insurance companies offer to ensure they meet an individual’s unique health care needs.

Original Medicare (Parts A & B)

Original Medicare provides the same coverage to beneficiaries, regardless of where they are in the country, including when they’re on vacation or relocating to another state. However, it rarely pays medical care costs incurred outside the United States. Therefore, it’s advised that citizens purchase appropriate medical insurance for the country they’re visiting. 

Original Medicare beneficiaries must pay an annual deductible of $1,600 for Part A and $226 for Part B as of 2023. They must also pay for their medical care upon receipt. Medicare subsequently pays 80% of the eventual cost, with the senior handling the remaining 20%.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

While Original Medicare’s coverage is fixed, Medicare Advantage is flexible. There are five standard plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee-for-Service plans (PFFS)
• Special Needs Plans (SNPs)
• Medicare Savings Account (MSA)

Approved private insurance companies adapt these to provide customers with personalized coverage. For example, PPO plans ensure seniors can use any Medicare-approved physician, while HMO plans limit care services to providers within a network. The trade-off is HMO premiums are often lower than PPO premiums. Regardless of which plan a senior chooses, it must conform to the rules and regulations set by the CMS.

Who Should Consider Medicare Advantage

Medicare Advantage can be a good choice for people who:

• Want more control over out-of-pocket expenses
• Need additional benefits such as dental and hearing services
• Would benefit from low benefits and are generally healthy
• Want managed care

The Top 10 Medicare Advantage Plans in Illinois

There is a wide range of highly rated Medicare Advantage plans available to Illinois residents. The table below shows the top Medicare Advantage providers based on the total number of people enrolled in its plans. As each provider offers multiple plans, prices are a range rather than an average. This information is up to date as of August 2023. Seniors can find more information about plan options on the Medicare Advantage Plan in Illinois page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Illinois

Seniors looking for the best coverage for their health care needs must first navigate Medicare’s enrollment process and the different public and private options available. The following resources assist Illinois’s Medicare-eligible residents. Beneficiaries can get individual assistance to help them understand the options, research local Medigap and Medicare Advantage plans and enroll in an appropriate plan.