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)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Medicare is a form of health coverage that’s available to anyone living in Illinois over the age of 65. It helps pay for hospital and health expenses and can cover additional items as well, depending on which Medicare Part coverage you have. When you enroll in the Medicare program in Illinois, you automatically are enrolled to receive Medicare Part A. This offers hospital coverage and is available without any sort of premium as long as you’ve worked for 10 years or 40 quarters throughout your lifetime. Medicare is made up of Parts A, B, C and D. Medicare Part B is optional medical coverage offered by an insurance company. It offers coverage for additional hospital and doctor services and for outpatient services but requires an added premium. Medicare Part C is known as Medicare Advantage which often includes extra benefits outside of traditional Medicare. You must have Parts A and B to qualify for C. Medicare Part D offers coverage for prescription drug costs and comes with an added premium. You must have Parts A and C to qualify for this as well.
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.
Every year, the cost of quality healthcare increases for Illinois residents. With new medical procedures, advanced equipment and new developments, high-quality care is only going to rise in the future which makes getting the coverage you need with just Medicare more and more difficult.
That’s why so many people are beginning to turn to Medicare supplemental health insurance. This special health insurance, also known as Medigap, is designed to help you cope with unexpected, expensive medical costs.
With a tool such as Medigap, filling your Medicare coverage gaps is simple to do. It works by helping to pay for the costs that traditional Medicare doesn’t. You’ll still enjoy the same services that you would receive with traditional Medicare, but you’ll enjoy increased coverage, so you don’t end up paying that $1,184 deductible for basic hospital services or get stuck with the $296 per day bill if you end up staying at the hospital for more than 60 days. With a supplemental insurance plan, you can make sure you’re protected while enjoying more predictable premium and deductible costs than what you might get from Medicare itself.
Taking action to supplement your current Illinois Medicare coverage is an excellent way to protect yourself from unexpected medical costs that you can’t afford. Two different supplemental options exist today for Illinois residents; Medigap and Medicare Advantage. Medigap is a tool that helps fill in the cost gap on services that Medicare is already providing, such as hospital stays, so you don’t get stuck with massive bills while using Medicare. Medicare Advantage offers many of the same benefits as Medigap, but can also offer some additional services that Medicare does not. It is a private health insurance that takes over all your health benefits. We break down the difference below to help you decide which is best for you.
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|
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:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$59||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$123||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$98||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$103||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$75||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$105||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$71||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$96||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$52||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$99||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
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.
Illinois Medigap vs. Illinois Medicare Advantage Policies
These two supplemental plans are very different from one another. To give you an idea of these differences, Medigap and Medicare Supplement is a service that helps pay for services that are already covered by Medicare. Medigap comes in and pays for the rest of the service that Medicare paid a portion of. Depending on the Medigap plan selected, it can help cover the costs of coinsurance and deductibles from standard Medicare. Medigap doesn’t offer any additional services not covered by Medicare though. That means Medigap won’t help pay for prescription drugs and instead you will have to rely on a product like Medicare Part D to cover those costs.
If you decide to purchase a Medigap plan, you must purchase it from a private insurance company. These companies sell different grades of Medigap that are all designated by letter. Medigap Plan E and Medigap Plan F are two different examples. These letters are standardized between companies and they have to meet specific regulations before offering plans. This makes it easy to compare Medigap plans between different insurance companies.
Medicare Advantage plans are different than Medigap because they can offer coverage that’s not included in Medicare at all. Medicare Advantage plans are provided by private insurance companies. These companies contract with Medicare to provide all of its services plus added benefits. Medicare Advantage plans can include benefits like prescription drug coverage and others as well. Most Medicare Advantage plans are restricted to specific doctors, hospitals and care networks.
Medicare Advantage plans have different rules for their out-of-pocket and co-pay fees than Medigap plans do. For that reason, some things might cost more with Medigap than they do with Medicare Advantage and vice versa.
Below is a list of common questions and answers about Medigap and Medicare Advantage. Read through it to learn the differences between the two or click here to get your free quote for a policy.
|Questions||Medicare Advantage||Medicare Supplement|
|How are these plans funded?||Medicare pays a set amount to your insurance company based on average medical costs in the area and you can be asked to pay a premium after, depending on your location and the company you’re using.||You pay one premium that covers all your Medicare-related expenses.|
|Am I required to pay for Medicare Part B?||Yes||Yes|
|What costs can I expect?||It depends. With some plans there is no added premium. Costs vary based on the government subsidies you qualify for and additional co-pays that your insurance company charges you.||Each Medigap plan comes with a premium cost. Many are very affordable though.|
|What coverage do these plans offer?||Every plan covers the basics provided by Medicare Parts A and B. Advantage plans can cover extras, such as prescription costs. But that added coverage comes with an added cost.||Medigap plans only cover the same items that basic Medicare covers. Medigap picks up the costs Medicare leaves behind. Going with a full-coverage plan like Medigap Plan F results in complete cost coverage.|
|Is this health plan good for budgeting my costs?||Budgeting can be difficult with Advantage plans because your costs fluctuate throughout the year.||Budgeting is easy with a Medigap plan because you will pay a consistent premium for the service.|
|Could this plan be cancelled on me?||Yes, it’s possible. Each year a Medicare Advantage provider can decide to keep or cancel your policy.||No, if you make all the premium payments and the company doesn’t go bankrupt, you cannot lose coverage.|
|Do I need pre-approvals or pre-certifications to use this plan?||Yes, you may be asked to go through a pre-approval process before being able to get a Medicare Advantage plan.||No, there is no pre-approval process for you to go through.|
|Do I have the option to go to any doctor or hospital I want?||No, you are limited to the specific network of providers offered by the insurer.||Yes, you are free to go anywhere that Medicare is accepted.|
|Who will generally benefit most from this plan?||This plan is optimal for healthier patients that live in more urban locations.||This plan is ideal for patients in rural locations with fewer providers to pick and choose from as well as those that need to budget.|
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:
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
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.