Medicare in Illinois

The federal government provides health insurance to eligible individuals through Medicare. Retirees aged 65 and over are the primary participants in Medicare, but the program is also available to people with certain disabilities and those with end-stage renal disease. In 2020, around 2.2 million Illinoisans enrolled in Medicare, an increase from just over two million in 2015. These participants comprise almost 18% of the state’s total population. In 2021, more than 600,000 Medicare recipients have Medicare Advantage. This represents about 30% of all Medicare enrollees, less than the national average of 42%.

Original Medicare consists of Part A and Part B. Part A covers inpatient hospital care, hospice, nursing home and some home health care, which is free to people who paid Medicare payroll taxes for a certain number of years, as well as their spouses. Part B covers medical services such as outpatient care, medical supplies and doctor’s visits. Most people must pay a premium for Part B based on income. The 2022 Part B premiums starting cost is $170.10.

Seniors can choose to enroll in Medicare Advantage, also known as Medicare Part C, offered by Medicare-compliant private companies. They must provide all the same benefits as Original Medicare, except for hospice care, which Part A covers. The providers can also offer additional benefits such as prescription drugs assistance, dental and vision care. Part D has prescription drug coverage and is an Original Medicare add-on. Medicare Advantage plans often include Part D. Medicare supplement plans, or Medigap, are also available from private health insurers to reduce out-of-pocket costs for policyholders.

This guide provides detailed information about Medicare in Illinois. Seniors can find an overview of Medicare options and links to resources that can help them make smart health insurance decisions.

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 is administered by the Centers for Medicare & Medicaid Services and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Also known as Medicare Part C, Medicare Advantage is an alternative to Original Medicare. Private health insurance companies provide it, and, except for hospice care, it includes the same benefits as Medicare Part A and Medicare Part B. Medicare Advantage plans can also offer additional benefits Original Medicare doesn’t include, such as wellness programs and dental care. Many Medicare Advantage plans have medication coverage, so seniors don’t need a separate prescription drug plan.

Medicare Advantage has enrolled around 30% of Medicare-eligible Illinoisans in 2021. There are four main Medicare Advantage plan types to choose from: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee For Service (PFFS) plans and Special Needs Plans (SNPs). Each plan has different rules regarding out-of-pocket costs, referrals, use of in-network providers and more.

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 April 2022. 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 2022 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.