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Illinois Medicare: Ultimate Guide

Did you know that about 16% of the Illinois population is enrolled in a Medicare plan? That’s over two million people. Of those two million, each individual person has unique financial and health concerns. That’s why major health insurance companies have come up with hundreds of different plans. While it’s great that there are so many options for you to choose from, selecting an Illinois Medicare plan can be a stressful process. Our mission is to make that process as smooth and easy as possible for you.

The Ultimate Guide to Illinois Medicare Includes:

Who is Eligible for Illinois Medicare?

If you are age 65 or older, you are eligible for Illinois Medicare. If you are not old enough, you may still be eligible if you are diagnosed with ALS or ESRD. Alternatively, if you receive SSDI (Social Security Disability Insurance), you will be automatically enrolled in Medicare during your 25th month of SSDI.

Turning 65

What Does Medicare Cover in Illinois?

The Medicare program is divided into five parts. The Original Medicare program includes Part A, which covers hospital and nursing home services, and Part B, which covers doctor visits and other medical services. Once you have Parts A and B, you have a few other choices.

*Don’t forget: If you wait too long to enroll in Medicare, you’ll face a premium increase of up to 10%. Be sure to enroll during your Initial Enrollment Period.

Illinois Medicare Part A

Medicare Part A covers hospital visits, nursing home care, hospice services, and some home health services. Most people will get Part A for free. The exception is for those who have not worked and paid Medicare taxes throughout their lives. If you worked for a little less than ten years, your premium for Part A will most likely be $240 per month in 2019. If you worked for even less than that, your premium will most likely be $437 per month in 2019.

Most people with Illinois Medicare Part A will also be responsible for hospital coinsurance. That means that for every night you spend in the hospital in 2019, you’ll be responsible for $341 per day. Once you exceed 90 hospital days, that fee will go up to $682.

Illinois Medicare Part B

Part B covers most of your basic health care needs: doctor visits, lab tests and x-rays, ambulance transportation, some medical equipment, and mental/behavioral health. Most people will pay a premium of $135.50 for Part B in 2019.

Medicare Part D Plans Illinois

Part D plans are separate plans that provide prescription drug coverage. Each plan will have its own formulary or list of covered drugs. You can have a Part D plan as an addition to your Original Medicare coverage. If you do not select a form of prescription drug coverage during your Initial Enrollment Period, you will face a penalty later.

Prescription Drug Card

Best Medicare Advantage Plans in Illinois

Medicare Advantage plans work a bit differently because they are offered by private carriers. They are still government-regulated, but they are able to offer a bit more. Each Illinois Medicare Advantage plan is required to include the same benefits you can get in Original Medicare (Part A and Part B), but they are allowed to add prescription drug coverage so that you don’t have to buy a separate Part D plan, and they can include additional benefits like fitness, dental, vision, hearing, and even non-emergency medical transportation.

Since there are so many different benefits that Medicare Advantage plans can add, there are a lot of Illinois Medicare Advantage plans for you to choose from. The best plan for you may be different from the best plan for your neighbor, or even your spouse. We can help you select the best Medicare Advantage plan in Illinois for you and your needs.

Medigap Plans Illinois (Medicare Supplements)

Similar to Medicare Advantage, Medicare Supplement plans are offered by private insurance companies and not by the federal government. Differently from Medicare Advantage, Medicare Supplements do not typically provide coverage for additional services. Instead, they help cover your Part A and B deductibles, co-payments, coinsurance, and premiums. They are often called “Medigap” plans because they “fill the gap” between what Medicare covers and what you have to pay out of pocket. Some Medigap plans do include prescription drug coverage or a fitness benefit, but generally, that is not what they are designed to do.

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What is the Cost of Illinois Medicare?

Your Illinois Medicare costs will be different depending on the plan you choose. Part A and Part B costs are generally the same nationally, but you don’t have to go that route. If you choose to enroll in a Medicare Advantage or Medigap plan, you’ll have a different premium. It is possible for some people to enroll in $0 premium plans. In most cases, if your premium is very low or $0, that means that your deductible and co-payments will be a bit higher. You’ll have to decide where you want your money to go. Does it make more sense for your budget and your health to pay a higher amount on a monthly basis, or to have a very low monthly payment and only pay when you need medical services?

Can I Have Medicare and Medicaid in Illinois?

If you qualify for Medicare and also meet the income requirements for Medicaid in Illinois, then yes! You can get both Illinois Medicare and Medicaid benefits. You can even get a dual-eligible special needs Medicare Advantage plan, a plan designed specifically for those eligible for both programs.

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Illinois Senior Resources

These resources are specifically designed for seniors and older adults, but we encourage all Medicare beneficiaries to take a look and see if you can benefit from any of the following Illinois state resources. Many of them allow older adults as young as 55 years old to participate.

  • Adult Protective Services - This is who you want to call if you or a loved one is experiencing any form of neglect, abuse, or exploitation.
  • Area Agency on Aging - AAA’s promote and fight for elder rights. Their mission is to help seniors and disabled people “live with dignity and choices in their homes and communities for as long as possible.” If you’re passionate about elder rights, contact your local AAA for information about becoming a member.
  • Caregiver Resource Centers - Being a primary caregiver for an older adult is no easy task, especially if that older adult is a family member and emotions are involved. Illinois Caregiver Resource Centers can help you find adult day services for when you can’t be there, provide meal delivery, home modification, transportation, housekeeping, and more, and even provide financial guidance, legal services, and caregiver training.
  • Coalition of Limited English Speaking Elderly (CLESE) - Thousands of Illinois Medicare beneficiaries speak a language other than English. It can be especially difficult for the elderly to find proper health care when English is not their first language. The CLESE works to increase and improve the rights granted to non-native English speakers and prevent abuse. CLESE also brought the Refugee Urban Farming Project to Chicago “to promote health and economic independence for newly arrived refugees.”
  • Foster Grandparent Program - Through the Illinois Foster Grandparent Program, older adults can volunteer to assist troubled teens, disabled or premature children, and other youths who need love, comfort, and support from an outside source. Not only would you be helping kids, but you’d also be making friends and giving yourself a wonderful way to spend your days.
  • Long-Term Care Ombudsman Program - If you or a loved one has experienced neglect, abuse, or fraud involving long-term care, you’ll want to contact the Long-Term Care Ombudsman Program in your area.
  • Nutrition Project Centers - Illinois nutrition project centers provide congregate meals on weekdays at local senior centers, churches, and other community buildings. Some older adults may be eligible for home-delivered meals through this program.
  • OWL (Older Women’s League) - OWL exists to help older women grow, make important life decisions, and have access to financial assistance, quality health care, and legal support.
  • RSVP Senior Corps - Looking for more volunteer opportunities? From the same group that sponsors the Foster Grandparents program, RSVP finds and supports volunteer opportunities for those 55 and older. Those who are more physically active may enjoy home renovation and construction projects and helping natural disaster victims, while others may enjoy tutoring disadvantaged kids or organizing neighborhood watch programs.
  • Senior Companion Programs - The Senior Companion Program can set you up with help with anything from meal preparation to grocery shopping.

  • Senior Farmer’s Market Nutrition Program - Hand in hand with the Nutrition Project is the Illinois Senior Farmers Market Nutrition Program. Eligible seniors can receive a check which can be redeemed for fresh fruits and vegetables at local farmers markets from July 1 through October 31.

How do I Apply for Illinois Medicare?

If you are not automatically enrolled in Medicare, you’ll need to apply when you turn 65. You can start applying from three months before your 65 birthday up until three months after. If you are eligible due to a qualifying disease, you can apply once you have your diagnosis and begin treatment.

You can apply by visiting the Social Security website or calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). If you worked for a railroad, you should instead call the Railroad Retirement Board at 1-877-772-5772.

If you are interested in enrolling in a Medicare Advantage, Medicare Supplement, or Part D plan, Medicare Plan Finder is your number one source! We have licensed agents throughout the state of Illinois who can come to you to help you sort through your options. We do all the hard work for you. All you have to do is tell us how to reach you, or call us directly at 833-438-3676.

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