About a quarter of Medicare enrollees choose Medicare Advantage coverage in the state of Illinois. A Medicare Advantage plan offers you another way to get your Original Medicare (Part A and Part B) benefits.
There are also extra benefits for Medicare Advantage plans in Illinois including routine vision and dental care. Many Medicare Advantage plans also have prescription drug benefits. This applies for every state regarding Medicare Advantage plans.
How many people have Medicare Advantage plans in Illinois?
Do you live or are soon moving to Illinois. Then you may want to know more about how Medicare Advantage plans work in Illinois. Read on to learn more.
Many people in Illinois are likely to choose a Medicare Advantage plan as their choice of Medicare. The Centers for Medicare & Medicaid Services (CMS) reported about 619,000 people have a Medicare Advantage plan in Illinois in 2019. While there are 2.4 million Medicare beneficiaries in Illinois. A Medicare Advantage plan with prescription drugs is also popular as well. 30% of the people who live in Illinois receive their prescription drugs from a Medicare Advantage prescription drug plan.
What you get with a Medicare Advantage plan in Illinois
If you don’t want to get your Medicare benefits directly from a government run program, Medicare Advantage (Medicare Part C) is the way to go. You will get your coverage from a private insurance company that Medicare approves with a Medicare Advantage plan.
If you are a Medicare Advantage enrollee, you must have at least the same level of coverage as Original Medicare (Part A and Part B). The only exception is Part A which will still cover hospice care. Most Medicare Advantage plans will offer extra benefits beyond Original Medicare. These benefits can include routine dental, vision, and hearing services. You can also get prescription drug coverage along with your Medicare Advantage plan. This will allow you to receive health care and prescription drug coverage under one plan.
You can choose from different types of Medicare Advantage plans. The following are some examples of the Medicare Advantage plans you can choose from in Illinois (not every plan option is available in your area):
- HMO (Health Maintenance Organization) plans: This is a less expensive plan with a network of providers. It covers a network of providers and does not cover providers outside the network (unless in a medical emergency). You will need a primary doctor as well as referrals from your primary doctor to get specialty care.
- PPO (Preferred Provider Organization) plans: PPO’s also have a provider network but offer more flexibility. The plan will cover out-of-network providers too, unlike HMOs. As a general rule, providers in the network will be cheaper. You don’t need a primary care doctor or referrals for specialist care.
- Private Fee-for-Service (PFFS) plans: These plans do not have provider networks. In fact, You will be able to see any provider. These plans will have their own rates by how much you will pay for each service and how much providers get paid. The provider must accept the plan’s terms and conditions on a case-by-case basis.
Medicare Advantage plans with prescription drug benefits in Illinois
If you need prescription drugs, you can get a Medicare Advantage plan that includes prescription drug coverage. These plans are called Medicare Advantage prescription drug plans. One advantage of these plans is that you can get your health care and prescription drug coverage all under one plan.
Each Medicare Advantage Prescription Drug plan carries a formulary which is a list of the drugs covered by the plan. If you need prescription medications, then look up the plan’s formulary and compare it to the prescription drugs you need. This way you can choose a plan that best fits your needs. Be aware that formularies are subject to change every year and your plan will notify you if it does.
Comparing Medicare Advantage plans in Illinois that best fit your needs
Where you live in Illinois determines what Medicare Advantage plans are available. Research each plan thoroughly to choose the best option that fits your needs.
Medicare Advantage plans will vary in costs and in benefits. Some plans may include routine hearing or wellness programs, other plans may not. Some plans may include prescription drugs, others may not. Although with Original Medicare, you need to sign up to a stand-alone prescription drug plan (Medicare Part D) to get your medications. It may be a benefit to have your prescription drugs in one plan like a Medicare Advantage prescription drug plan. This is so you don’t need to keep track of two.
Costs for each Medicare Advantage plan in Illinois will also vary depending on where you live.
- Medicare Advantage plan premiums can vary, some offer free premiums. The costs differ on the plan, the location, and the coverage offered in the plan. Please note that you still must pay your monthly Medicare Part B premium.
- You should also research each plan’s out-of-pocket costs like copayments, co-insurance, and deductible. Every Medicare Advantage plan in Illinois has different cost-sharing rates and out-of-pocket limits.
Researching the Medicare Advantage plan is important especially if you want an HMO or PPO plan. Make sure that the plan’s network includes the doctors and hospitals that you want. When you use the provider network, your costs will generally be lower. Also, your prescription drug costs will be lower if you use the plan’s formulary (or list of covered drugs). Make sure the drugs you need match the plan’s formulary.
If you want to compare Medicare Advantage plans in Illinois, you can by entering your zip code on the page. You can also narrow your search by the prescription drugs you need.