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Medicare Plans in Illinois – Coverage and Benefits

For Illinois residents who are at least 65 years of age and have an employment history here in the US, there exists a form of health care coverage provided by the government called Medicare. There are four total parts that you can sign up for: Parts A, B, C, and D. When you enroll, the bare minimum level of coverage you will start with comes from Parts A and B. Look at the table below to see what sort of benefits they provide. Parts A and B are also commonly referred to as “Original” or “Traditional” Medicare. The good news is that Parts A and B alone provide for the vast majority of health care services you will need during your golden years. Unfortunately, there are potentially expensive gaps in this coverage, and we will discuss them in this article.

The Medicare program is designed to be affordable enough for retired citizens to easily afford. The base cost for Original Medicare requires you to pay monthly premiums and a yearly deductible. Additionally, your employment history will determine whether or not you will have to pay a premium for Part A coverage. Those who have worked at least 40 quarters (or 10 full years) need not worry; your Part A coverage is free. Those with a shorter history, however, may need to budget for the additional expense.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Illinois Medicare Beneficiaries: Who Gets What?

There are nearly 2 million people in Illinois age 65+ who are enrolled in the Medicare system. Of those, a meager 16% have decided to replace their Traditional Medicare benefits with a Medicare Advantage policy (we’ll talk more about Medicare Advantage later). Based on the numbers, Medigap supplement policies are much more popular in Illinois – just under 32% of beneficiaries have one. The other 48% have neither Medigap nor Medicare Advantage. Odds are that they are either taking advantage of some sort of employer health benefits, or simply relying upon Original Medicare to cover everything.

For qualified seniors, obtaining a Medicare supplement is easy. However, you must first make sure you are enrolled in Medicare and receiving Part A & B benefits. If not, click that link and find out how.

Why isn’t Medicare Enough for Illinois Residents?

Parts A and B of Medicare by themselves may be enough – or even more than enough – to take care of your medical needs and expenses. Most people with Medicare plans in Illinois might not require supplemental coverage at all. However, unexpected medical emergencies can happen at any time. And if they sneak up on you, these are just a few of the expenses you can expect:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Fortunately, there are Medicare supplement policies out there which will protect you financially and help you secure the medical services you need to live a long, healthy life. The two major forms of supplement coverage out there are Medicare Advantage, and Medigap. Keep reading to learn more about them.

Illinois Medigap Policies

In Illinois, you have the option to add a small, supplemental health insurance policy to your existing Medicare benefits. This policy will be underwritten by a private company, while the federal government will still be in charge of your Traditional Medicare benefits. Plans E, H, I, and J are no longer available as of 2010, but plans A, B, C, D, F, G, K, L, M, and N are available for you to choose from based on your individual needs.  Each plan is the same in all 50 states, meaning that Plan K offers you the same coverage whether you live in Illinois or Ohio. They will likely differ by price and provider from state to state, though. Each plan provides the following benefits:

[chart category=”supplement” name=”planTypes” state=”IL” zipcode=”60629″]

Illinois Medicare Advantage Options

Medicare Advantage (sometimes called Medicare “Part C”) effectively replaces your government Medicare benefits with a private health insurance policy managed by a private company. No matter what sort of Part C policy you choose, your benefits will be at least equal to that of Traditional Medicare. This is required by federal law. You may also be eligible for additional benefits (dental or prescription drugs, to name a few) for low additional costs.

So why is Medicare Advantage the least popular form of supplement insurance available in Illinois? Well, it’s hard to say for sure. It might have something to do with the fact that most Advantage plans have limited PPO and HMO networks. For some, losing their doctor might not be worth the switch, despite the promised savings. However, you should carefully explore all of your health care needs before making a final decision.

If you decide to go with a Medicare Advantage plan, your PPO (Preferred Provider Organization) or your HMO (Health Maintenance Organization) will determine what doctors you see, and where you receive your medical care. Here are some leads on affordable providers:

[chart category=”advantage” name=”topHMOPlans” zipcode=”60629″ state=”IL”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”60629″ state=”IL”]

Illinois Medigap vs. Illinois Medicare Advantage Policies

For a clearer picture on the differences between these two supplemental policies, consult the table below:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Illinois Medicare Offices & Contact Information

Still have questions? We’re glad you do – that’s the first step to making sure you make the wisest decision about your future health care needs. We hope this article helped, but it can only give you so much information. By contacting the Medicare insurance experts in Illinois using the directory below, you can ask more specific questions related to your personal needs and circumstances:

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

 

 

 

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