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Medicare and Medicare Advantage in Illinois

Medicare and Medicare Advantage in Illinois

If you’re 65 or older or have specific permanent disabilities or kidney problems, you may know that you qualify for Medicare in Illinois. However, many Illinois residents have questions about how Medicare works.

This article will help you understand the eligibility requirements, costs, and options available for Medicare and Medicare Advantage in Illinois.

How Does Medicare Work in Illinois?

Because Medicare is a Federal program, there aren’t many differences by state. Still, we often come across many location-specific Medicare questions. Medicare works the same way in Illinois as it does in other locations and we’ll help you understand the different types of Medicare; each part provides a different type of coverage. The goal is to provide health insurance to those individuals who qualify for Medicare, such as those who are 65 and older, have certain disabilities.

The parts of Medicare include:

  • Medicare Part A: known as hospital insurance
  • Medicare Part B: Medical insurance for seeing a doctor
  • Medicare Part C: known as Medicare Advantage; a full replacement for Original Medicare with additional benefits
  • [Medicare Part D]: prescription drug coverage for Original Medicare

What Does Medicare Cover in Illinois?

Original Medicare in Illinois covers the same medical services as in all the other states. Original Medicare includes only Part A and Part B, although you can purchase prescription drug coverage with Part D.

If you have Original Medicare, you have insurance to help pay for hospital inpatient care, doctor’s visits, and preventive care. Original Medicare also helps with care in a skilled nursing facility, hospice, home health care, and medical supplies.

Adding Part D assists you with prescription drug costs for an additional monthly fee. For example, if you need regular blood pressure medication, heart medication, or other common name brand and generic drugs, Part D will help.

If you have Medicare Advantage, you can receive coverage for services like inpatient hospital stays, skilled nursing services and in-home care, doctor’s visits, lab and diagnostic testing (like bloodwork), mental health services, and in most cases, prescription drug coverage. Medicare Advantage plans may also provide extra benefits such as transportation to medical appointments, vision care, hearing care, and telemedicine.

When you use these services, you may be responsible for paying a deductible or coinsurance while Medicare covers the rest.

Medicare Eligibility

Who is eligible for Medicare and Medicare Advantage? Medicare is available for specific people who are age 65 or older or who have specific disabilities or end-stage kidney disease.

What Are the Eligibility Requirements for Medicare?

To qualify for Medicare, you must be a U.S. citizen or permanent resident who’s lived in the United States for at least five years, for whom at least one of the following apply:

  • Age 65 or older
  • Under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
  • Diagnosed with Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s disease
  • Diagnosed with end-stage renal disease (ESRD)

How to Apply for Medicare in Illinois

If you qualify for Medicare, make sure you apply and enroll. If you start receiving Social Security benefits more than four months before you turn 65, you’ll automatically be enrolled in Medicare the first day of the month you turn 65.

If that’s not the case, you’ll need to apply. Be sure to do one of the following:

  • Contact your local Social Security office
  • Call 1-800-772-1213 to enroll over the phone
  • If you retired from a railroad, call the Railroad Retirement Board at 1-877-772-5772
  • Sign up for Part A online at and Part B using Form CMS-40B

Keep in mind that there are specific times you can enroll in Medicare or make changes to your chosen plan.

What Documents Do I Need to Apply for Medicare?

It’s important to make sure you have all your documents on hand before applying for Medicare.

You will need information that proves your eligibility, for example:

  • SSN
  • Citizenship status
  • Birthdate
  • Work history

If you don’t have the right documentation, you can apply for new copies.

Medicare Supplement Insurance in Illinois

A Medicare Supplement plan works with Original Medicare to help cover costs like coinsurance, copayments, and deductibles. These plans are often known as “Medigap” and should not be confused with Medicare Part C, which is a full replacement plan for Original Medicare.

Medicare Supplement Plans are subdivided into plans, lettered A-N, each with different benefits and costs. These plans do not offer coverage for vision, dental, hearing care, or prescription drug coverage — you must buy a separate prescription drug plan.

You cannot have a Medicare Advantage Plan (Part C) and a Medicare Supplement Plan at the same time, the supplement only works with Original Medicare. Medicare Supplement Insurance is underwritten, which means that your health status and other factors are considered in determining eligibility and premium.

If you’re interested in a Medicare Supplement plan, take one of the following steps:

  • Search for a Medicare Supplement Plan
  • Contact the Illinois Senior Health Insurance Program (SHIP)
  • Contact a licensed insurance agent (866) 955-0898 (TTY 711)

All Illinois Medicare Supplement plans with the same letter offer the same benefits. The only difference is the price.

What is the Best Medicare Advantage Plan For You in Illinois?

Medicare Advantage is an option many Americans prefer because they get Medicare with additional benefits, such as vision, dental, and even assistance with a health club or gym fees.

How do you pick the right Medicare Advantage plan? Consider the following:

  • Do you have to pay extra premiums on top of your Part B cost?
  • What benefits do they offer, including prescription drug coverage?
  • Do the doctors in-network work for you?
  • Are the out-of-pocket costs reasonable and predictable for your budget?

The best Medicare Advantage plan depends on your individual health needs. Find and compare plans to learn more about your coverage options.

Who is Eligible for Medicare Advantage in Illinois?

In general, if you’re eligible for Medicare, you can choose a Medicare Advantage plan. You must also meet the additional eligibility requirements for Medicare Advantage too - such as have both Parts A and B and live in the area served by that plan. Medicare Advantage is simply Medicare Part C — it replaces Original Medicare to provide additional benefits and more predictable out-of-pocket costs.

How Do I Apply for Medicare Advantage in Illinois?

It’s simple to sign up for Medicare Advantage in Illinois: contact a licensed insurance agent or find and compare Medicare Advantage options. However, enrollment in these plans are generally limited to certain times of the year, unless you qualify for a special enrollment period or are newly eligible for Medicare.

You’ll need to let the insurance company know your Medicare number and the date you started your Part A and/or Part B coverage. They’ll use this information to enroll you in their Advantage plan.

Keep in mind that Medicare plans aren’t allowed to call you unless you request it. If you receive an unsolicited call, never give out your personal, Medicare, or financial information.

Medicare Advantage or Original Medicare?

Many people prefer Medicare Advantage because they can receive prescription drug care along with their medical care in a single plan. Many Advantage plans also include vision, dental, and other additional benefits.

A Medicare Advantage plan may make your out-of-pocket expenses more predictable as well. Instead of a 20% coinsurance payment, you’ll pay a specific deductible or copayment.

If you choose to stick with Original Medicare, in most cases you will pay a predetermined amount for healthcare until Medicare begins to pay - , this is your deductible. Once you’ve reached this limit, you will pay a coinsurance or copayment for covered services. There is no annual limit for what you pay out of pocket. With Original Medicare, you do not need a primary care doctor and can choose almost any provider or specialist. Your plan will cover most of your medical needs, besides cosmetic procedures, dental services, or hearing and vision care. Original Medicare covers doctor visits, X-rays and diagnostic tests, bloodwork, outpatient surgery, and hospital stays.

When Can I Apply for a Medicare Advantage Plan?

You might be wondering, “Can I apply for Medicare Advantage any time?” Unfortunately, you only can enroll or change plans during specified times of the year.

Your initial eligibility is seven months, starting three months before you turn 65. After that, you can only apply for Medicare Advantage or make changes to your plan during the open enrollment period each year, unless you qualify for a Special Enrollment Period.

Find and Compare Medicare Plans in Illinois

Are you interested in Medicare plans in Illinois? We’re here to help. Call us or visit our website to find Medicare plans in your area.

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