Introduction to Medicare Part C in Illinois (Medicare Advantage)

Are you worried about how much you might end up paying in out-of-pocket medical bills if you don’t get your Medicare gaps covered? There are plenty of affordable Medicare supplement insurance policies which can help protect you from coverage gaps, and give you peace of mind. Medicare Part C (a.k.a. Medicare Advantage) is one such policy. In essence, it replaces your federal Medicare benefits with a private health insurance policy. It can also provide additional coverage to protect you from gaps, and help you acquire ancillary benefits under the same policy.

Federal Regulations for Medicare Advantage

Because a Medicare Advantage policy replaces your federal health benefits, there are regulations in place to protect you from private insurance companies who might otherwise take advantage of or exploit the process. By law, you must receive the basic health coverage offered by Medicare Parts A and B through Medicare Advantage. It is highly likely, however, that you will receive many more benefits beyond that.

Medicare Advantage Enrollment In Illinois

As far as Illinois goes, only 16% of Medicare-qualified seniors are signed up with a Medicare Advantage policy. There are a variety of reasons for this, which we will get into below. However, it should be noted that Medicare Advantage plans are not all the same. Below, you can see the most popular types of plans, in order of descending popularity:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Below, we have another chart which shows estimated costs for Medicare Advantage plans in your general area. Keep in mind, however, that these are only estimates. Additional factors, such as your age, zip code, and health status, will significantly influence your quoted rate.

Most Popular Medicare Advantage Plans in Illinois

In addition to the factors mentioned above, your rate will vary based on the type of Medicare Advantage plan you choose. There is a certain amount of trade-off between plans. More restrictive networks, such as those offered by an HMO plan, will give you limited access to medical care at an affordable rate. PPOs and PFFS plans, on the other hand, will expand your access to medical care – for a price.

Doctor/Provider Network Restrictions

One reason for the low number of Medicare Advantage enrollees in Illinois might have something to do with network restrictions. If you travel often, or if you don’t have access to a large city, it can be difficult to get access to the medical care that you need. Also, don’t forget that your insurance company could change the rules and regulations of your Network at any time. You’ll have to be prepared for unexpected rule changes.

Doctor/Providers List

Drug, Vision and Dental Coverage

Of those seniors who are a part of a Medicare Advantage plan in Illinois, convenience might be a favorable reason. Of all the available Medicare supplement insurance plans, Medicare Advantage has the unique ability to bundle all the coverage you need into a single plan. This includes basic Medicare benefits, benefits for coverage gaps, Prescription drug (Medicare Part D) benefits, and optional coverage, such as dental or vision.

Enrollment Options & Best Time To Enroll

Enrolling early in a Medicare Advantage plan while you are still in good health is the best way to get the most affordable rate. The longer you wait, and/or the worse your health is, the more difficult it will be for you to get covered. This is especially true if you have ESRD (End Stage Renal Disease), or a similarly devastating health condition. Finding coverage isn’t impossible, however; simply talk to your local insurance agent, or reach out to your state department of insurance to learn about your options.

  • Initial Enrollment Period: For best results, try to enroll in a Medicare Advantage plan within your first 6 months of Medicare enrollment.
  • Annual Enrollment Period (AEP): You have the option of changing or cancelling your Medicare Advantage and Part D drug plan between October 15th and December 7th every year.
  • Special Enrollment Period (SEP): If you lose your employer plan coverage, move out of your coverage area, or lose coverage from your provider, you could qualify for an SEP.

What Medicare Advantage Plan Is Best For Me?

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