Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare is a federal health care program that serves U.S. residents over the age of 65 as well as some younger residents with special health conditions. Original Medicare includes Part A (hospitalization costs) and Part B (general care, from doctor’s office visits to other health-related costs).
Medicare Advantage (MA) plans take Medicare Parts A and B and add other health care costs not associated with Original Medicare. MA coverage is also called Medicare Part C, and it is a little different than Original Medicare because it comes not from the federal government, but from private health insurance providers. To be a Medicare Advantage Plan, these providers must offer the same coverage that Original Medicare provides, and they often add other options that are not part of Original Medicare. One exception to this rule is hospice coverage, which is part of Medicare Part A.
Many beneficiaries who have Original Medicare must purchase supplemental prescription drug coverage. Most Medicare Advantage Plans will include prescription drug coverage, which eliminates the need to purchase additional coverage. These plans do vary in cost, though, because they can set their own deductible and copay costs. They can also establish rules for things like in-network and out-of-network providers.
In this guide, those interested in Medicare Advantage Plans in Illinois will find information about what they cover, who is eligible and how they can find and enroll in these plans.
The Top 10 Medicare Advantage Plans in Illinois
Medicare Advantage has several plans available in Illinois. Since these plans come from private insurance providers, they vary significantly in coverage options and cost.
The table below offers the 10 most popular Medicare Advantage Plans in Illinois based on enrollment figures. As most providers will have more than one plan option, the cost is shown as a range. The number of enrollees represents the total number from that provider in Illinois, even if they have different plans.
This information is current as of April 2022. Applicants can learn more about the plans that are available in various regions of Illinois by visiting Medicare.gov.
HMO, PPO, PFFS
Blue Cross and Blue Shield of IL, NM
Health Alliance Medicare
Clear Spring Health
How Medicare Advantage Plans Work in Illinois
Before choosing a Medicare Advantage Plan, it is important to understand how the six different types of plans work. Insurance companies will offer a number of different plan types, and Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most common.
The insurance companies that offer these plans have their own rules and regulations about everything from networks to referral requirements, so participants should carefully review the terms of the particular plan they are considering. Below are detailed descriptions of the four most common plan types in Illinois.
What Medicare Advantage Plans Cover in Illinois
Medicare Advantage plans must cover all of the things Original Medicare covers, with the exception of hospice which is part of Medicare Part A. Beneficiaries can receive their preventive appointments, labs, imaging and hospital care under these plans. Many plans offer additional coverage options, such as hearing aids, vision or dental services. Again, this is where plans may vary depending on the terms of the plan.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Illinois
To take part in a Medicare Advantage Plan, seniors must first enroll in Original Medicare. If they are eligible for Part A and Part B, they are also eligible for most Medicare Advantage Plans, although these plans can have additional eligibility requirements.
In Illinois, only those who are at least 65 or who have a specific disability can enroll in Medicare. The law requires enrollees to have U.S. citizenship or be lawful immigrants to enroll.
Medicare enrollees must enroll during the limited enrollment periods or face delays and fines. These enrollment periods are also when beneficiaries can change their plans if they wish. The list below details the laws and schedule for Medicare enrollment.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Illinois
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The Senior Health Insurance Program (SHIP) is a free counseling service for Medicare beneficiaries and their caregivers. It hosts a range of Medicare education and application information on its website and seniors can also watch Medicare webinars. The Good Start Medicare page details the steps seniors should take as they approach their 65th birthday to ensure they can make an informed decision about their health insurance. SHIP counselors are located throughout the state to provide advice on the best plan for an individual’s needs, how to apply for Medicare and information about Medicare fraud and abuse.
Seniors can ring SHIP on 1-800-252-8966 to get information about Medicare and other health insurance options. Staff can also direct callers to their nearest SHIP office to arrange a meeting with a trained SHIP counselor. Contact details for local sites can also be found on their website.
Senior HelpLine provides free information to seniors aged 60 and older and their caregivers throughout Illinois. The service connects seniors to local services and provides information about a range of topics, such as Medicare Advantage. Professional staff can also evaluate individual caller’s needs and answer questions that can help seniors clarify their options. Staff members have a thorough knowledge of the programs and services available to older adults in the state, including local resources. The service operates Monday through Friday from 8.30 a.m. to 5.00 p.m.
Northwestern Illinois Area Agency on Aging (NIAAA) has an Information and Assistance service that provides free information to older adults and their caregivers. Individual consultations can provide seniors with advice about Medicare and Medicaid programs and eligibility. Staff also help seniors apply for benefits. The service is available over the phone, in NIAAA offices or in the home, if required. There are offices in each county of the northwestern region of Illinois, so seniors can easily connect with local resources.
The contact number for the Information and Assistance service depends on the county the senior resides in. NIAAA lists all the contact details on their website.
AgeOptions is the Area Agency on Aging in suburban Cook County. It has trained professionals available to help older adults make informed choices and is a central point of contact for people looking for information about Medicare and other programs. Staff can also help seniors access benefits and other senior services. AgeOptions has a number of advocacy and education programs, including Advisory and Make Medicare Work, which work to educate the professionals who work with older adults and the wider community about Medicare, Medicaid and senior options. AgeOptions can also help seniors with questions about Medicare fraud and abuse.
Information and assistance can be accessed through a number of channels. Seniors can contact AgeOptions on (708) 383-0258 or via email on [email protected]. Staff is also available for in-person consultations.
The Central Illinois Agency on Aging (CIAOA) is an independent nonprofit organization serving people in the central Illinois region. Its mission to empower older adults to control their own lives is furthered by the Information and Assistance program. The service provides information about benefits and services available in the area and connects seniors to community resources that meet their needs. CIAOA also conducts education programs about Medicare fraud and helps seniors with Medicare Part D. The staff are specialists, certified by the Alliance of Information & Referral Systems, and are available Monday through Friday, 8.30 a.m. to 5.00 p.m.
Seniors can contact CIAOA Information and Assistance on (309) 674-2071 or toll-free on (877) 777-2422. The service can also be reached via email on [email protected], or seniors can drop into the Peoria office.
Heartland Human Services provides a range of programs to improve the health and wellness of people in Effingham and Clay Counties. An Information and Assistance program is one of the services available to help seniors. The main focus of the program is directing clients to relevant services. Specialists also offer assistance filling out applications for different benefit programs, including Medicare Advantage, and with legal aid. This is a free service.