Table of Contents:
- Medicare Advantage Plans in Illinois: The Basics
- The Benefits Medicare Advantage Plans Provide in Illinois
- Types of Medicare Advantage Plans Available in Illinois: HMOs vs. PPOs
- Medicare Advantage Prescription Drug Plans in Illinois
- How Much Do Medicare Advantage Plans Cost in Illinois?
- Finding the Right Medicare Advantage Plan for you in Illinois
- When to Enroll in a Medicare Advantage Plan in Illinois
Medicare Advantage Plans in Illinois: The Basics
Private insurance companies that have a contract with the Centers for Medicare & Medicaid Services (CMS) can offer Medicare Advantage plans, also known as Medicare Part C. In 2020, according to the Kaiser Family Foundation, more than 27% of Medicare-eligibles in Illinois were enrolled in a Medicare Advantage plan.
Medicare Advantage Eligibility
To qualify for a Medicare Advantage (MA) plan, you must be eligible for Medicare Part A and enrolled in Medicare Part B, plus live in the plan’s service area you wish to enroll. MA plans are local—down to the county level—and numerous options are available.
Medicare Advantage Plan Popularity in Illinois
Curious where people enroll in Medicare Advantage plans the most? The 10 Illinois counties with the largest MA enrollment are Jo Daviess County (49%), Champaign County (46%), Stephenson County (45%), Rock Island County (43%), Monroe County (41%), Piatt County (41%), Madison County (40%), Sangamon County (40%), St. Clair County (40%), and Winnebago County (40%).
In Illinois, in 2021, 147 Medicare Advantage plans are available compared to 126 plans in 2020. That’s a nearly 17% percent increase in Medicare Advantage plan options—many more options for you to choose from.
Four of those plans offer innovative benefits to Medicare Advantage enrollees. These benefits often include dental, vision, & hearing aids; wellness & health care planning; reduced cost-sharing; plus rewards and incentives programs. These are benefits that are not provided by Original Medicare Parts A & B.
The Benefits Medicare Advantage Plans Provide in Illinois
Are you looking for extra benefits, like dental, along with a way to reduce your Medicare costs? A Medicare Advantage plan could be an option for more affordable premiums, doctor visits, and prescription drugs.
Extra Benefits: Dental, Vision, Hearing (Aids)
Do you want routine benefits such as dental, vision, or hearing (hearing aids)? Many Medicare Advantage plans offer these additional benefits, plus prescription drug coverage. With a Medicare Advantage plan, you can expect the same level of coverage as Original Medicare, plus extra benefits you won’t receive with Original Medicare.
Lower Monthly Premiums
Are you looking for a $0 monthly premium? Many Medicare Advantage (MA) plans offer that. For MA plans that charge a premium, you’ll pay the MA plan premium plus the monthly Medicare Part B premium. Read more about how much Medicare Advantage plans cost in Illinois.
Lower Out-of-Pocket Costs
Did you know that Original Medicare doesn’t have a maximum spending limit and that there’s no cap on annual out-of-pocket expenses? A Medicare Advantage plan can limit your out-of-pocket costs for covered services by Medicare Part A and B. That’s because MA plans set their deductibles, coinsurance, and copays—within the maximum out-of-pocket limits set by the federal government.
When you’ve reached your out-of-pocket maximum, including your deductible, your Medicare Advantage plan pays 100% of covered healthcare expenses for the remainder of the year. Suppose you’d like to keep your Original Medicare (Parts A & B) but are searching for more predictable monthly premiums. In that case, a Medicare Supplement (Medigap) plan is an alternative to Medicare Advantage.
Unsure whether a Medicare Advantage or Medicare Supplement plan is best for you? Let a local licensed agent guide you to your optimal plan for your health and budget. Call (623) 223-8884.
Types of Medicare Advantage Plans Available in Illinois: HMOs vs. PPOs
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the two most common types of Medicare Advantage plans. HMOs and PPOs have hospitals, doctors, and other healthcare professionals that participate in their networks.
Are Medicare Advantage HMOs and PPOs similar?
Yes. There are several ways that they are similar:
- Medicare Advantage HMOs and PPOs are available through private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS).
- Both typically use provider networks.
- They both have preferred pharmacy networks, and there’s usually prescription drug coverage included.
- Medicare Advantage HMOs and PPOs require that you have Medicare Part A and B and that you live within the plan’s service area.
Medicare Advantage HMO
If you’re enrolled in a Medicare Advantage HMO, your costs will traditionally be lower than an MA PPO plan. Once you enroll in the HMO, you’ll choose a primary care physician who will coordinate your care through referrals to participating in-network providers. If you need to see a specialist, your primary care physician will provide a referral. Outside of emergencies, an out-of-network provider’s services are not covered unless approved in advance by the Medicare Advantage HMO plan.
Medicare Advantage PPO
A Medicare Advantage PPO provides more flexibility than an HMO but at a slightly higher cost. Monthly premiums will generally be higher than an HMO, but you can see doctors outside the PPO plan network. If you see a provider outside of the plan network, you’ll likely pay more for that care.
With an HMO, the network will have thorough recordkeeping of all your care. With a PPO, you’ll need to play a more active role in coordinating your care, including record keeping of your medical care and prescription drugs. If you’d prefer not to share records between providers, an HMO might be a better option.
If maintaining existing relationships with doctors, hospitals, and other care providers is vital to you, check the HMOs’ or PPOs’ plan network before making a plan change. You’ll need to ensure that your preferred healthcare providers participate in the Medicare Advantage plan’s network.
Aside from HMOs and PPOs, you may come across the following plan types: Point of Service (POS) plans, Private Fee-for-Service (PFFS) plans, and Special Needs (SNPs) plans.
Need help ensuring that you pick a plan that includes the doctors and prescriptions you need? Call Connie Health to find an MA plan that maintains your current care: (623) 223-8884.
Medicare Advantage Prescription Drug Plans in Illinois
Want prescription drug benefits with your MA plan? Those Medicare Advantage plans are called Medicare Advantage Prescription Drug (MAPD) plans. MAPD plans provide the convenience of having Medicare medical and prescription drug benefits all through one plan. In 2020, 90% of Medicare Advantage plans in the United States offered MAPDs, and 89% of all Medicare Advantage plan enrollees were in MAPD plans.
How Much Do Medicare Advantage Plans Cost in Illinois?
The lowest monthly premium for a Medicare Advantage plan is $0. If you are enrolled in Medicare Part A and B, you have access to a Medicare Advantage plan with a $0 monthly premium. The average monthly Medicare Advantage plan premium in Illinois, for those with a premium, is $14.76.
Medicare Advantage Prescription Drug Plan Costs
Medicare Advantage Prescription Drug (MAPD) plan costs vary by county, and the premiums vary by plan type (e.g., HMO vs. PPO). According to the Kaiser Family Foundation, in 2020, premiums ranged from $20 to $47 per month throughout the US.
Premiums were on average $20 per month for HMOs, $32 per month for local PPOs, and $47 per month for regional PPOs. The majority of Medicare Advantage beneficiaries enrolled in an HMO (61%), followed by local PPOs (33%) and regional PPO plans (5%).
Because MA and MAPD plans are through private insurance companies contracted with CMS, these premiums are paid directly to the plan provider. They are paid separately from the Medicare Part B premium paid to Medicare, which is traditionally paid by a monthly withdrawal from your Social Security benefit.
If you are on insulin, it’s important to note that in Illinois 50 MAPD plans offer lower out-of-pocket insulin costs through the Part D Senior Savings Model.
Are you wondering if you qualify for a $0 premium Medicare Advantage plan in your county? Schedule a call with a local Connie Health agent.
Finding the Right Medicare Advantage Plan for you in IllinoisThe number of Medicare Advantage plans available to you will depend on the county you reside. You may have a few or numerous options available to you—and their networks and benefits will vary. Your Medicare Advantage plan choice will come down to a combination of coverage and cost. From extra benefits, prescription drug coverage, plan network, to premium and out-of-pocket costs—there’s a lot to consider. Have a local licensed agent guide you through your Medicare journey to ensure you get the health care coverage you need at a price that you can afford. Call (623) 223-8884.
When to Enroll in a Medicare Advantage Plan in Illinois
It’s vital that you know when you can switch, enroll, or unenroll from a Medicare Advantage plan—in fact, knowing when could save you a lot of money. The best time to join a Medicare health plan or drug plan is during your Initial Enrollment Period. Continue reading to learn about that, and the other three times, you can make a MA plan change.
Initial Enrollment Period (IEP)
Three months before you turn 65, the month you turn 65, and three months after you turn 65 is your Initial Enrollment Period. In total, it’s a seven-month period. That’s when most Illinoisans enroll in Medicare Part A & Part B. If you reach your Initial Enrollment Period and you’re not yet collecting Social Security benefits; you’ll need to sign up for Medicare online or contact the Social Security Administration.
Important to note: If you don’t enroll in Medicare Part B during your seven-month Initial Enrollment Period, you could face a lifetime late enrollment penalty. The penalty would be added to your monthly Medicare Part B premium for your lifetime. The longer you wait to sign-up for Part B after your Initial Enrollment Period, the larger the monthly premium penalty becomes.
If you miss your IEP, you might be eligible during the Annual Enrollment Period (AEP) or the Medicare Advantage Special Election Period (MA SEP). If an election was made during AEP, you could make changes during the Medicare Advantage Open Enrollment Period. Continue reading to learn more.
Annual Enrollment Period (AEP)
The Annual Enrollment Period is annually between October 15 and December 7. That’s the time to join a Medicare Advantage plan, but you can also do the following:
- Switch from Original Medicare, to a Medicare Advantage plan with or without a stand-alone prescription drug plan.
- Switch from a MA plan back to Original Medicare, with or without a Medicare prescription drug plan.
- Switch from one MA plan to another MA plan.
- Switch from a MA plan that doesn’t offer drug coverage to an MAPD—or vice versa.
- Join an MAPD or switch from one MAPD to another.
- Drop your MAPD coverage entirely.
Medicare Advantage Open Enrollment Period (OEP)
Between January 1 and March 31, annually, you can change your Medicare Advantage plan. Some changes you can make include:
- Switch from an MA plan, with or without prescription drug coverage, to another MA plan with or without prescription drug coverage.
- Unenroll from your MA plan and enroll in Original Medicare. If you decide to make this change, you’ll need to join a Medicare stand-alone prescription drug plan to ensure you continue to have creditable coverage.
- Suppose you enrolled in a MA plan during your Initial Enrollment Period. In that case, you can change to another MA plan or go back to Original Medicare—with or without a prescription drug plan—within the first three months you have Medicare.
You cannot switch from Original Medicare to a MA plan during the Medicare Advantage Open Enrollment Period. Neither can you join a Medicare prescription drug plan if you’re in Original Medicare or switch your Medicare Prescription drug plan to another if you’re enrolled in Original Medicare.
Medicare Advantage Special Election Period (MA SEP)
There are times when you qualify for an MA SEP. These include if you move, lose your coverage, have the opportunity to get other coverage, your plan changes its contract with Medicare or other special circumstances. During an MA SEP, you can sign up for or make Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan changes.
Not sure when you should enroll or change your Medicare Advantage plan? Call (623) 223-8884 to speak with a local licensed agent. We’re here to guide you through your Medicare journey.
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