Medicare Advantage in Illinois

Medicare is a government-run health care insurance program for people aged 65 and older and other qualifying individuals. Medicare Advantage, which is sometimes called Part C Medicare, offers a highly customizable alternative to Original Medicare. Medicare Advantage is administered by private insurers, and recipients pay a single monthly premium for extensive health care coverage. This arrangement may be advantageous when it comes to managing personal budgets. Unlike Original Medicare, Medicare Advantage providers set their own annual out-of-pocket limits, which means seniors always know the maximum they may potentially need to pay for their yearly health care. Plan prices vary between providers, and companies may have different deductible and copay amounts.

Medicare Advantage Plans must include the same benefits as Parts A and B of traditional Medicare, with the exception of hospice care. Most options also feature some prescription drug coverage, meaning seniors often don’t need to obtain separate Medicare Part D coverage. Many policies also include extra benefits above regular Medicare, such as vision and dental care. 

Nationally, 51% of all Medicare-eligible individuals have enrolled in Medicare Advantage. Illinois lags somewhat behind, with 37% of potential enrollees signed up for coverage in 2023 — 860,000 out of almost 2.4 million. However, Medicare Advantage is gaining traction in Illinois, with an increase of 8.85% from the previous year in the percentage of total eligible people enrolled for private Part C plans. In 2022, roughly 774,000 out of 2.3 million qualifying candidates signed up for Medicare Advantage, representing 34%. Between 2022 and 2023, the number of qualifying individuals rose by 2.12%, and the number of enrollees increased by 11.15%. Statistics may indicate that Medicare Advantage plans are becoming more popular in Illinois.

Read further to grasp the essentials of Medicare Advantage Plans in Illinois, featuring coverage details, eligibility requirements and enrollment guidance.

The Top 10 Medicare Advantage Plans in Illinois

Illinois seniors have several Medicare Advantage providers to choose between, many of which offer a selection of plans at different price points. The table below shows the 17 most popular Plan C providers in Illinois and details costs as a range to account for plan variations. Enrollment figures include all plans from each company. Data is correct as of July 2023, and individuals can obtain further information from Medicare.gov.

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.

*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.

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.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources