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Medicare Options in Illinois

More than 2.3 million Illinois citizens, or 18% of the state’s population, were enrolled in Medicare in 2021. The state has required Medigap insurers to cover policyholders under 65 since the 1980s. Thanks to the recent ” birthday rule ” option, even more, Medigap participants will be able to make changes to their plans after 2022, thanks to the recent “birthday rule” option.

Even with all these laws and plans, many people fail to enroll in the right plan. Or they get so overwhelmed by the hundreds of options that they don’t know where to start. Trusting a licensed Medicare insurance agent to handle all your health insurance needs would be best.

Integrity Now Insurance Brokers know the ins and outs of Illinois Medicare plans and the different state laws that govern them. They narrow your options and compare their prices and benefits to find a plan that fits your requirements and budget.

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Original Medicare

This is the standard Medicare that is governed by federal law. Original Medicare includes Parts A (hospital insurance) and Part B (medical insurance). Part A covers includes inpatient care, hospice care, and some home care and specialist nursing homes.

Part B deals with all your medical expenses. It covers doctor’s visits, outpatient care, preventive treatments, and medical equipment. Vaccinations and testing that help you stay healthy and safe from illness are also part of this plan.

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Medicare Supplement (Medigap) Plans in Illinois

In Illinois, Medicare Supplement or Medigap plans cover all or part of the costs that Medicare beneficiaries would otherwise pay out-of-pocket for their healthcare. Since Original Medicare doesn’t have a limit on its out-of-pocket expenses, most beneficiaries prefer to have supplemental coverage.

As of 2022, you can select from 41 Medigap providers in Illinois, depending on where you reside. Discuss your options with a Medicare insurance agent to make sure you choose the right plan from the right provider.

Illinois Medigap for People Younger than 65

About 300,000 persons under the age of 65 are enrolled in Medicare in Illinois — that counts for 13% of Illinois Medicare beneficiaries. Federal regulations do not guarantee people younger than 65 access to Medigap insurance, but most states have their own policies that allow them to do so.

Illinois was one of the first states to implement regulations that ensured at least some private Medigap coverage for disabled individuals under 65. Medigap insurance policies for Illinois Medicare recipients with disabilities have been mandatory since 1989.

When a beneficiary under 65 enrolls in Medicare Part B, the six-month guaranteed-issue window opens for all Medigap policies.


The Birthday Rule

Illinois passed a bill in 2021 establishing a new Medicare Supplement Annual Open Enrollment Period, which will be available in 2022. Even though enrollment capacity is limited, it offers coverage to age groups beyond those specified by the federal government.

According to this law, Medigap participants between the ages of 65 and 75 get an annual enrollment window to switch between Medigap plans. The enrollee’s current provider must offer the new plan, which cannot carry more benefits than the previous one. The 45-day window begins on the beneficiary’s birthday.

Since most beneficiaries under 65 enroll due to health conditions, insurers set higher premiums to account for the higher loss ratio. However, insurers can’t charge under 65-year-olds more than the maximum on-file rate for persons over 65. For instance, Medigap insurers could charge the same premiums for people aged 45 or 85. But they can’t have a completely different, higher premium rate for people under 65.

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Illinois Medicare Advantage Plans (Part C)

Even though Illinois Medicare Supplement plans provide the most comprehensive coverage, beneficiaries can also enroll in Medicare Advantage plans. Private companies that have a contract with Medicare offer these policies. You can keep your copays low using the plan’s provider network.

As of 2018, 22% of Illinois residents had Medicare Advantage coverage, which is much lower than the national average of 34%. However, following the nationwide trend, enrollment in private insurance rose to 44% in 2021.

There are four types of Medicare Advantage plans in Illinois:

Health Maintenance Organization (HMO)

Most HMOs mandate that you use only in-network providers for all healthcare services:

  • A PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions are required.
  • Plans typically provide drug coverage.
  • You can’t get stand-alone drug coverage.
  • Costs are lower if you stick to the provider network.

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended network of providers, but you can always choose out-of-network doctors or healthcare facilities for a higher price.

  • No PCP or specialist referral is required.
  • Most plans cover prescriptions.
  • You cannot purchase drug coverage separately.
  • Higher out-of-network charges and premiums.

Private Fee-For-Service (PFFS)

PCPs and specialist referrals aren’t necessary under PFFS programs:

  • You can consult any Medicare-approved doctor or healthcare facility, provided they agree to the plan’s terms.
  • Drug coverage may be included or purchased separately.
  • You’ll pay more to consult a provider who disagrees with the plan’s terms.

Special Needs Plan (SNP)

SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:

  • You require a PCP and specialist recommendations.
  • Plans always include drug coverage.
  • Anybody meeting the eligibility criteria can join SNPs at any time.

Illinois Medicare Part D

Original Medicare Parts A and B do not offer outpatient prescription coverage. Illinois enrollees seeking drug coverage can get it through Medicaid plans, their employer, or Medicare Part D.

Approximately 1.8 million Illinois residents enrolled in Medicare Part D. 58% of these enrollees had stand-alone plans, while the rest had Medicare Part C plans that offer Part D coverage. Beneficiaries can choose from 23 different stand-alone Part D plans in 2022, depending on where they reside.

Note: Keep in mind that you can’t enroll in Medicare Part C and Part D plans simultaneously. A Medicare insurance agent can help you decide which one is appropriate for your needs.


A Medicare insurance agent talking to a client

Comparing Medicare Advantage Plans in Illinois

By 2020, 606,775 Illinois residents had enrolled in Medicare Advantage. A licensed Medicare insurance agent will ensure you choose a plan that covers all your needs, falls within your budget, and offers perks beyond its basic benefits.

Consider the following factors when evaluating your Medicare options:

Provider Network

Some Medicare plans require that you only refer to PCP, specialists, and other healthcare facilities within the plan’s network. If you choose any other option, you will pay those medical bills yourself. To keep these medical expenses at a minimum, make sure your doctors and hospitals are in the network.

Amount of Coverage Required

We always ask our clients about the goals they want to achieve with their Medicare plans. Medicare Advantage and Medigap plans often include additional dental, vision, and hearing benefits that the original Parts A and B aren’t covered. Our Medicare insurance agents then advise a plan that meets all their requirements.

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Check Plan Ratings

The Centers for Medicare & Medicaid Services (CMS) releases Part C and Part D performance data annually. Check these ratings before opening the enrollment period, or ask your insurance agent to tell you more about them.

Out-of-Pocket Expenses

Out-of-pocket costs include deductibles, copayments, and coinsurance. This is the maximum amount you bear on your own if you stay within the service provider network. You can contact one of our Medicare Agents to learn more about the costs of different plans in your area.

Monthly Premium

Medicare Advantage and Supplement plan premiums are an additional expense affecting your monthly budget. You must pay the Part B deductible even if you don’t use your benefits. Make sure you have at least one zero-premium plan with reasonable prescription coverage in your area to keep these costs low. Your insurance agent can guide you on the premium rates in your area.

For beneficiaries under 65 years of age, this is a key consideration when deciding between Medicare Part C and Medigap plans. Since the latter have higher premiums, you might want to discuss which one is better for you with your Medicare insurance agent.

Drug Coverage

Look at the policy’s formulary to determine if your prescriptions are covered and how much they will cost. Ask your doctor if they can advise an alternative or generic option for medicine not on the list.

Deductibles, Coinsurance & Copays

You pay these costs when you use your Medicare benefits. Ensure you know all your plan’s hospital and medical coverage details before enrolling. This includes everything from doctor’s visits to medicines.


A Medicare insurance agent examining a document

Freedom to Travel

Illinois residents who frequently travel outside of the state prefer travel plans that offer travel courage. Medicare plans often require that you stick to their provider network, while Medigap policies allow you to receive treatment anywhere. Find out how much travel coverage you need before deciding on a plan.

Medicare Eligibility in Illinois

You must be at least 65 years old to be eligible for Medicare benefits. In Illinois, people under 65 can also apply for Medicare supplement policies. Patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), also qualify for Medicare at any age.

A senior couple enrolling for Medicare online

Medicare Enrollment in Illinois

Medicare will register you automatically if you have received at least four Social Security or Railroad Retirement Board payments before your 65th birthday. Otherwise, you can apply online or mail your application to your local Social Security Office. We recommend going the online route since it is a much quicker process.

Enrollment in Medicare is open during the following time frames:

Initial Enrollment

This is a 7-month window that includes the month of your 65th birthday, the three months before it, and ends three months after it. If you enroll before 65, your coverage will begin during your birthday month. If you register after this period, your coverage will be delayed.

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Note: You may be subject to lifetime Part D penalties if you don’t register by the deadline and don’t have creditable prescription drug coverage to back you up. Even though it is voluntary, late fees apply.

General Enrollment

From January 1 to March 31, you get another chance to sign up for Original Medicare, Medicare Advantage, and Part D Plans. You may be charged a late fee if you enroll later than the deadline.

Open Enrollment

You get a 3-month window from October 15 to December 7 each year when you can switch between Original Medicare and Medicare Advantage Plans or make changes to your current plan. You can also sign up for a Part D plan during this period.

Special Enrollment

You may be eligible for a special enrollment period if you lose your coverage due to an unexpected event like getting unemployed or moving to an out-of-coverage area.


Why Should You Rely on Medicare Hope Insurance Agents?

At Integrity Now Insurance Brokers, we make sure our Medicare Insurance Agents are certified annually by America’s Health Insurance Plan (AHIP). We work with the elderly, youth with disabilities, and others who need help taking care of their healthcare expenses.

Medicare plans go through changes almost every year. New plans come in place, existing plans face adjustments, and states keep making legislative amendments to make plans more inclusive. Keeping up with all these changes can be overwhelming. That’s where we come in. Our insurance agents track all the developments in the industry, so you don’t have to.

A Medicare insurance agent with an elderly client

A Medicare insurance agent in Illinois will review your healthcare needs and weigh all your options. This includes figuring out if a Medicare Supplement Plan or a Medicare Advantage Plan is best for you.

With our guidance, you can compare quotes and find the best Medicare insurance plan for your needs. We have all the information you need to live a debt-free and stress-free life.

Call us to speak with one of our representatives and get started today!

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