Medicare Advantage in Illinois
When you become eligible for Medicare, you can enroll in Original Medicare through the federal government or enroll in a Medicare Advantage plan through a private insurer.
With a Medicare Advantage plan (also known as Medicare Part C), you’ll receive coverage for everything Original Medicare covers and usually more. Plus, all of your health-care benefits—including medical, prescription, vision, etc.—will be handled by a single insurance company.
Thirteen insurance companies offer a total of 98 Medicare Advantage plans in Illinois.1 Of the 2.2 million Illinois residents enrolled in Medicare, just over 600,000, or 25%, are enrolled in Medicare Advantage plans.2
Medicare Advantage plan benefits
Medicare Advantage plans are required to cover inpatient (Medicare Part A) and outpatient (Part B) treatment like Original Medicare does. But most Medicare Advantage plans include additional benefits. Most commonly, Medicare Advantage plans also cover the following: 2
- Prescription drug coverage
- Eye exams and glasses
- Dental coverage
- Fitness programs
- Hearing aids
- Over-the-counter allowances
Illinois residents who have chronic illnesses may also have the option to purchase a Medicare Advantage plan that covers certain nonmedical benefits that would help improve their condition. Such benefits could include meal assistance, transportation coverage, and pest control.3
Medicare Advantage plan costs in Illinois
The chart below shows that the average cost of a Medicare Advantage plan in Illinois is $5,860 annually. Monthly premiums average about $60 in Illinois but could be higher or lower, depending on which county you reside in. The average prescription drug deductible in Illinois is only $76, which is quite a bit lower than other states.
|Average annual cost||$5,859.88|
|Average monthly premium||$60.25|
|Average drug deductible||$75.75|
|Annual max out-of-pocket||$5,061.12|
Table created from data at https://www.healthmarkets.com/content/medicare-advantage-costs-index. Data as of 6/2/2020.
Medicare Advantage insurers in Illinois
Here are insurance providers that offer Medicare Advantage plans in Illinois:
- Ascension Complete
- Blue Cross Blue Shield (BCBS)
- Bright Health
- Lasso Healthcare
- Sunrise Advantage Plan
- Zing Health
Top-rated Medicare Advantage providers
Each year, the Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans to help beneficiaries decide on which plan might be best for them. CMS takes into account 45 quality and performance factors—including how quickly plan participants receive care and customer complaints—and rates each plan on a scale of 1 to 5.3
More than half of all Medicare Advantage plans that include prescription drug coverage (210 plans in total) have received at least 4-star ratings for 2020 by CMS. Ninety-two received ratings of 4.5 or above. One Illinois plan, the Quartz Health Plan, which is available in Winnebago County, received a 5-star rating.
Overall, the Medicare Advantage plans available in Illinois average 3.5 to 4 stars, although not all counties have rating data available.4
Find the Medicare Advantage plan that fits you best
When it comes to selecting a Medicare Advantage plan, Illinoisans have choices. Most plans are either health maintenance organization (HMO) or preferred provider organization (PPO) plans.5
|Must stay in-network|
|Must choose a primary care physician|
|Referrals required to see a specialist|
|More expensive premiums|
|Can go out-of-network at a higher cost|
|May or may not choose a primary care physician|
|No referrals needed to see specialists|
|May or may not have a network|
|In-network expenses lower than out-of-network|
|Plan is accepted by any doctor who agrees to the plan’s terms|
|Need written acceptance for coverage before each service|
|Similar to a health savings account (HSA)|
|Accompanied by high-deductible health plan (HDHP)|
|Money accumulated in savings rolls over each year|
|Cannot deposit personal funds into an MSA|
Medicare Cost Plan
|Hybrid between HMO and PPO|
|Enrollees not restricted to plan’s network|
|Some plans offer prescription drug coverage|
|Enrollees can return to Original Medicare at any time|
Illinois residents can choose from 27 PPO plans and 64 HMO plans. Illinois also has two private fee-for-service (PFFS) plans, three medical savings accounts (MSA), and two Medicare Cost Plans.5 Which plans are available to you depends on where in Illinois you live.
Local resources in Illinois
- Senior Health Insurance Program: A free health insurance counseling service that provides Medicare beneficiaries information on health insurance and assistance applying for coverage.
- Illinois Department of Insurance: This state government agency handles questions and complaints about all types of insurance, including Medicare Advantage.
1. Medicare, “Find a Medicare Plan”
2. Meredith Freed, Anthony Damico, and Tricia Neuman, Kaiser Family Foundation, “A Dozen Facts about Medicare Advantage in 2020,” April 2020. Accessed July 13, 2020.
3. Joanna Young, Sean Creighton, Thomas Kornfield, Shruthi Donthi, Avalere, “Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020,” November 19, 2020. Accessed July 13, 2020.
4. CMS.gov, “2019 Star Ratings Fact Sheet,” October 9, 2020. Accessed July 13, 2020.
5. Kaiser Family Foundation, “Medicare Advantage Plans, by Plan Type.” Accessed July 13, 2020.
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