Medicare in Illinois - Plan Options
Illinois residents who are 65 years old or have a qualifying disability are eligible to receive medical insurance through Medicare, a federal program. Over 1.5 million people in Illinois are currently covered by Original Medicare.
Medicare Plans in Illinois
In Illinois, Medicare plans offer different levels of coverage tailored to your health needs and lifestyle. If you have multiple health conditions or a disability, Original Medicare might not fully cover your expenses, resulting in higher out-of-pocket costs. Medicare Advantage can be an excellent option for more comprehensive care. However, a Medigap plan can help bridge the remaining gaps if you desire maximum coverage.
Let’s start with the basics. Here are the five types of Medicare plans in Illinois:
Original Medicare (Parts A & B)
In Illinois, the Medicare program is built upon Original Medicare, which comprises Part A (hospital insurance) and Part B (medical insurance). Part A is typically available at no premium cost for individuals who have worked and paid Medicare taxes for at least ten years. Part B requires a monthly premium based on income. While Original Medicare covers a wide range of healthcare services, it does not include everything, such as prescription drug coverage.
Medicare Advantage (Part C)
Illinois offers Medicare Advantage (MA) plans through private insurers approved by Medicare. These plans include Original Medicare benefits and added coverage for prescription drugs, vision, dental, and hearing. With lower out-of-pocket costs compared to Original Medicare, there’s a variety of MA plans to choose from in Illinois. Take time to compare and find the one that fits your needs.
Medicare Supplement Insurance (Medigap)
Private insurers offer Medigap plans in Illinois to fill the coverage gaps of Original Medicare. These plans cover expenses like deductibles, co-payments, and coinsurances. There are ten standardized Medigap plans (A through N), with Medigap Plan G being the most popular. Regardless of the insurance company, the government ensures standardized benefits for each plan. Medigap policies require a monthly premium in addition to your Original Medicare premium.
Medicare Prescription Drug Plans (Part D)
Original Medicare in Illinois does not provide coverage for prescription drugs. However, you can obtain this coverage through a standalone Medicare prescription drug plan, which private insurers approved by Medicare offer. It’s important to note that each plan has a specific formulary, a list of prescription drugs covered. Therefore, choosing a plan that includes the medications you require carefully is crucial. Additionally, please keep in mind that formulary changes may occur annually.
Special Needs Plans (SNPs)
In Illinois, individuals with certain chronic conditions or specialized care needs, such as those with Medicare and Medicaid, have access to Medicare Advantage plans known as Special Needs Plans (SNPs). Three types of SNPs are available: Chronic Condition SNPs, Dual Eligible SNPs, and Institutional SNPs. It is important to note that the availability of SNPs may vary by location in Illinois, and not all individuals are eligible for SNP plans.
Medicare Eligibility in Illinois
In Illinois, Medicare benefits are available to individuals aged 65 and older, as well as to younger individuals with disabilities and those diagnosed with End-Stage Renal Disease (ESRD).
You must meet the Social Security Administration (SSA) national standards to qualify for Illinois Medicare. Once you have worked in jobs that require Medicare taxes for a minimum of ten years as a U.S. citizen or permanent resident, you become eligible to apply for Medicare benefits upon reaching 65. It is important to note that before applying for Medicare, you must have resided in the United States for five consecutive years.
Individuals younger than 65 may be eligible if they have received Social Security disability benefits for at least 24 months or have ESRD. Individuals with ESRD must also meet residency requirements to be eligible.
In addition to meeting specific eligibility requirements, applicants must apply for Medicare coverage before their 65th birthday or within three months after their disability begins to avoid late enrollment penalties. Applicants can use the Social Security website or visit a local office for assistance and advice.
With regard to cost, if you are not eligible for automatic qualification for Part A, you might have to pay as much as $506 per month (as of 2023). The Part B standard premium is $164.90 monthly (as of 2023), but your premium could be higher if you have a higher income.
How Do I Apply for Medicare in Illinois?
Applying for Medicare in Illinois is an easy process. You can apply online or by phone.
If you apply online, you must visit the Social Security Administration website and complete an application. The website includes a helpful tutorial that walks you through the process step-by-step. Once your application has been submitted, completing the process typically takes less than 10 minutes.
If you prefer to apply over the phone, call 1-800-772-1213 (TTY users should call 1-800-325-0778).
As you can see, each plan type has unique features and benefits. Although choosing the right plan may seem overwhelming, take the time to do some research, ask questions, and determine which plan aligns with your healthcare needs and budget.
Illinois Medicare Resources
Illinois residents are strongly encouraged to familiarize themselves with the Medicare options. In the state of Illinois, there is a wide array of resources specifically tailored to seniors and caregivers. These include Area Agencies on Aging (AAAs), local public health agencies, and nonprofit groups. These organizations provide invaluable information and offer programs designed to enhance the well-being of seniors.