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Medicare in Illinois

October 6, 2016

In Illinois, Medicare beneficiaries may enroll in Original Medicare, Part A and Part B. This is the federally administered Medicare program that provides coverage for inpatient hospital care (Part A) and outpatient and doctor’s services (Part B). Individuals may also elect to enroll in a Medicare Advantage plan, which provides the same benefits as Original Medicare (except hospice care, which remains a service covered by Part A). Medicare Advantage plans are offered by private insurance companies contracted with Medicare. Medicare Advantage plans are available in many different types, although not all may be available in every county in Illinois.

Original Medicare Part A and Part B cover medication only in limited situations, such as during an inpatient hospital stay or administered by a physician in an outpatient facility. For people who want Medicare Part D prescription drug coverage, two options are available: (1) enroll in a Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage in one plan; or (2) enroll in a stand-alone Medicare Part D Prescription Drug Plan, which works alongside Original Medicare.

The Medicare plan options that may be available in your part of Illinois are described below.

Original Medicare for Illinois beneficiaries

Original Medicare, Part A and Part B, refers to the health insurance program created and administered by the federal government. It works the same in Illinois as it does in every other state in the country. U.S. citizens and legal permanent residents of at least five continuous years age 65 or older, along with people under 65 year of age who have qualifying disabilities, may be automatically enrolled in Medicare if they receive federal benefits.

Those who reach the Medicare-eligible age of 65 are automatically enrolled if they receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). If disabled individuals receive SSA disability benefits, or certain RRB disability benefits, for 24 consecutive months, then they, too, may be enrolled in Medicare automatically at the beginning of their 25th month of receiving disability benefits.

Beneficiaries in Illinois may also enroll manually in Medicare. There are several ways to do this. You can apply by visiting your local SSA office or by registering online. Enrollment can also be performed over the phone:

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. SSA representatives are available Monday through Friday, from 7AM to 7PM.
  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. TTY users can call 1-312-751-4701. RRB representatives are available Monday through Friday, from 9AM to 3:30PM.

Medicare plan options in Illinois

There are Medicare insurance plans offered by private insurance companies that enable Medicare beneficiaries to obtain additional coverage and/or an alternative means of receiving their Medicare Part A and Part B benefits.

Medicare Part C, also called Medicare Advantage, is an alternative way to receive your Medicare Part A and Part B benefits. Enrolling in a Medicare Advantage plan means you remain enrolled in Part A and Part B (and must continue paying your Part B premium), but your coverage comes from a private Medicare-approved insurance company that offers the Medicare Advantage plan you selected. Medicare Advantage is required to cover everything that Original Medicare does (save for hospice care, which is still covered by Part A); however, many Medicare Advantage plans include additional benefits, like routine dental, vision, hearing, and prescription drug coverage. Plans that include prescription drug coverage are called Medicare Advantage Prescription Drug (MA-PD) plans.

Medicare Part D refers to prescription drug coverage. If you are enrolled in Medicare Part A and/or Part B, you can receive prescription drug coverage by enrolling in  a stand-alone Medicare Part D Prescription Drug Plan to complement your Medicare coverage. All Medicare Part D Prescription Drug Plans are offered by Medicare-approved private insurance companies, and each one has a formulary, which is a list of prescription medications covered by the plan. Formularies can vary by plan, and the formulary may change at any time, although if you are a member you will receive notice from your plan when necessary. You may wish to compare all offerings in your area to find the prescription drug coverage that best suits your needs.

Medicare Supplement plans (Medigap) are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B. Different

Illinois resources for Medicare beneficiaries

Medicare.gov offers a list of available resources for all of your health-care needs. For example, you can contact the State Health Insurance Assistance Program (SHIP), or the agency below.

  • National Institute on Aging Information Center: Toll-free number 1800-222-2225. TTY users please call 1-800-222-4225. Hours: 8:30AM – 5PM Monday-Friday. Website.

Learn more about how Medicare plans work in Illinois, including: