Medicare Advantage Plans in Illinois

Medicare beneficiaries choose which way they receive their Medicare Part A and Medicare Part B benefits: through Original Medicare or Medicare Advantage (MA).

Here's how Medicare Advantage plans in Illinois work:

  • Private insurance companies contract with Medicare to sell and administer MA insurance plans. That means you deal with the insurance company for claims questions and customer service, not the federal government.
  • To stay eligible for an Advantage plan, you must continue enrollment in Original Medicare. That means you have to continue paying your Part B premium.
  • Almost all Illinois Advantage plans are linked to a specific network of healthcare providers.
  • MA is becoming increasingly popular partly because it includes extra benefits such as vision, transportation, wellness programs, and over-the-counter medication.
  • Many Advantage plans are MAPD (Medicare Advantage Prescription Drug), including Part D drug benefits.
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Top-rated Medicare Advantage Plans in Illinois

Illinois's "best" Medicare Advantage plan centers around your preferences, finances, and health condition. In general, here's how the coverage options fit those needs.

Best network freedom: Medicare Advantage PPO

  • Wider network
  • No referrals needed
  • Premiums from $0 to $100 per month

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Monthly premiums are generally $0 per month.
  • Low out-of-pocket costs because it uses referral network providers

Best for low-income or health conditions: Medicare Advantage D-SNIP

Illinois Enrollment facts:

  • Advantageous for those with limited income or chronic health conditions
  • Lower out-of-pocket costs due to Medicare and Medicaid coverage
  • Number enrolled in Medicare Advantage in Illinois: 594,000
  • Percentage of Medicare beneficiaries enrolled in Medicare Advantage in Illinois: 27%
  • Number enrolled in Medicare Advantage nationwide: 26 million
  • Percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide: 42%
  • Number enrolled by plan:
  • Local HMO: 227,933 (Illinois) 12,169,392 (nationally)
  • Local PPO: 250,293 (Illinois) 5,597,050 (nationally)
  • Regional PPO: 6,775 (Illinois) 1,293,348 (nationally)

How much does Medicare Advantage in Illinois cost?

Illinois Medicare beneficiaries' monthly premium depends on gender, service area, tobacco use, and other factors. The Centers for Medicare and Medicaid Services reports that Illinois had 147 Advantage plans available in 2021. Here's a closer look:

  • The average cost for an Illinois Medicare Advantage plan decreased compared to last year, dropping from $16.96 to $14.76.
  • Compared to a national average of $33.57, the average cost for an Illinois MAPD plan is $30.58

PPO Plan $0.00 to $30.58

HMO Plan $0.00

When can you enroll in a Medicare Advantage plan?

Initial Enrollment Period

Your Initial Enrollment Period is when you're first eligible for Medicare benefits.

  • Eligibility spans seven months: the month you turn 65 and the three months before and after your birthday month.
  • Choose how to receive your benefits: Original Medicare or an Illinois Medicare Advantage plan.
  • If you choose Original Medicare, you can apply for additional coverage through Medigap and Part D.
  • Those with end-stage renal disease or under 65 get a second IEP when they turn 65.

Open Enrollment Period – AKA Annual Election Period

The Open Enrollment Period applies to all Medicare beneficiaries.

  • It runs from October 15 to December 7
  • You can switch from Original Medicare to Medicare Advantage for your Medicare Part A and B coverage.
  • Can change from Medicare Advantage back to Original Medicare
  • Changes become effective January 1.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period applies only to those enrolled in Medicare Advantage.

  • It runs from January 1 to March 31
  • Can change from Medicare Advantage to Original Medicare
  • Eligible to buy Part D plan
  • Won't necessarily have guaranteed-issue rights if looking to buy a Medigap plan to supplement Original Medicare
  • Can change from one MA plan to another MA plan
  • Limited to one plan change a year

Special Enrollment Periods

If extenuating circumstances occur, you might qualify for a Special Enrollment Period (SEP) with your Medicare Advantage or Part D plan. Here are a few examples:

  • Moving out of your plan's service area
  • Moving within your plan's service area, but you have more coverage options available at your new address.
  • Losing group health insurance coverage
  • Moving out of or into a long-term care facility

Each SEP has different rules. Calling one of our licensed insurance agents will help determine whether you qualify for an SEP.

5-star Special Enrollment Period

Medicare uses a rating system to evaluate health and drug plans. A 5-star rating is the highest. You can only use the 5-star SEP if a 5-star plan is available in your service area.

Special Enrollment Periods if you get "Extra Help."

Two SEPs apply to Medicare Advantage for individuals who get special help:

  • Eligible for Medicare and Medicaid: You can join, drop, or change MA or prescription drug plans from January-March, April-June, and July-September.
  • State Pharmaceutical Assistance Program (SPAP): If you're enrolled or lose eligibility from SPAP, you can join a Part D or MA plan with drug coverage.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation's top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

Key Takeaways

  • In Illinois, PPO Medicare Advantage plans are very popular for many Medicare beneficiaries.
  • A Medicare Advantage plan might have valuable benefits that you can use to save money, such as prescription drug coverage in the form of an included Medicare prescription drug plan (Medicare Part D).
  • The "best" Medicare Advantage plan in Illinois centers around your preferences, finances, and health condition.
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