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Medicare Advantage, also known as Medicare Part C, is an another way to get your Original Medicare, Part A and Part B, coverage through a Medicare health plan. Available through Medicare-approved private insurance companies, Medicare Advantage plans are required to cover all benefits under Original Medicare, except for hospice coverage (which is still covered through Part A of the government program).
Here’s how it works: You must be enrolled in Medicare Part A and Part B to be eligible for a Medicare Advantage plan. In addition, you must also live in the service area of a plan and, with a few exceptions, not have end-stage renal disease. Even after you enroll in a Medicare Advantage plan, you must continue to pay your Part B premium, in addition to any premium required for your plan.
If you are looking to enroll in a Medicare Advantage plan in Illinois, there are several times throughout the year when you can do so, known as “election periods.” These are the same times of the year that you can enroll in any state in the country, although the types of changes you can make will depend on the specific time frame.
Initial Enrollment Period (IEP): The first time you can sign up for Medicare Part A and Part B. This seven-month period begins three months before the month you turn 65, carries through your birth month, and runs for three months after it. If you qualify for Medicare because of disability, your IEP starts three months before your 25th month of disability benefits, includes the 25th month, and ends three months later.
Medicare enrolls most beneficiaries in Original Medicare during this time if they’re already receiving Social Security or Railroad Retirement Board retirement benefits when they turn 65. If you’re not automatically enrolled, the IEP could be the best time for you to manually sign up.
Initial Coverage Election Period (ICEP): The initial eligibility period for enrolling in a Medicare Advantage plan.
Annual Election Period (AEP): Also known as the Fall Open Enrollment, this period runs from October 15 through December 7 each year. During this time, you can switch from Original Medicare to a Medicare Advantage plan or move from one Medicare Advantage plan to another. If you stay with Original Medicare, you can also add or drop prescription drug coverage, which is available through a stand-alone Medicare Prescription Drug Plan.
Medicare Advantage Disenrollment Period (MADP): Goes from January 1 to February 14 annually. This is a time when you can leave Medicare Advantage and return to Original Medicare, Part A and Part B. You can also sign up for Medicare Part D (prescription drug coverage) during this time with a Medicare Prescription Drug Plan if you return to Original Medicare. This is not a time when you can change from one Medicare Advantage plan to another; you can do that during the AEP (above).
Special Election Period (SEP): This period exists for extenuating circumstances that would have prevented you from enrolling in or making changes to your Medicare Part C coverage during one of the established election periods. For example, if you move outside of your current Medicare Advantage plan’s coverage network, you may be eligible for an SEP to enroll in another. Or, if Medicare ends its contract with your Medicare Advantage plan, you may be able to switch to a different plan with an SEP.
Below is a description of the numerous types of Medicare Advantage plans that may be available in Illinois. Familiarize yourself with the differences so that you can find a plan that works best for your situation when it comes time to enroll.
MAPD (Medicare Advantage Prescription Drug) plans: When a Medicare Advantage plan includes coverage for medications, it’s called a Medicare Advantage Prescription Drug plan. Any of the plan types listed below can be MAPD plans; most, but not all, Medicare Advantage plans cover prescription drugs. But when you’re shopping for a plan, it’s a good idea to make sure it covers medications if you want prescription drug coverage now or in the future. (If you’re a Medicare beneficiary without prescription drug coverage, and you later decide to add that benefit, you might pay a late-enrollment penalty if you go without Part D or other creditable prescription coverage for 63 days in a row or more.)
HMO (Health Maintenance Organization) plan: These plans require you to choose a primary care physician up front. This physician will then refer you to any specialists that you need to see as necessary for your treatment. A typical HMO has a network of doctors and health-care providers, and seeking treatment outside of that network may mean that you pay the full cost for care (with the exception of medical emergencies). To save money, it’s generally best to find a network that has your physician and use in-network providers and hospitals.
HMO-POS (Health Maintenance Organization – Point of Service) plan: A variation of the HMO plan, this one covers both in-network and certain out-of-network health services (although usually for a higher cost). As with standard HMOs, visiting doctors and health providers inside of the plan’s network is cheaper; however, you have the option to go out of network for some services and have at least a portion of the care covered by your plan.
PPO* (Preferred Provider Organization) plan: PPOs don’t require you to choose a primary care provider up front in many cases, and you don’t need referrals for specialist care. These plans offer a bit more freedom in where you go to receive coverage: You can stay in-network or go outside of it. Your costs might be higher if you go to an out-of-network doctor.
PFFS (Private Fee-for-Service) plan: Many of these plans have no network limitations, meaning that you are free to seek medical treatment with the doctor of your choosing. However, your doctor must accept the plan’s payment terms and conditions on a case-by-case basis, and you’re responsible for the cost sharing set by the plan at the time you receive the service. Some PFFS plans do have networks of providers that always agree to treat you.
SNP (Special Needs Plan): This type of plan limits enrollment to beneficiaries who meet certain eligibility criteria. There are three types of SNPs, and each type targets a different group of beneficiaries with unique health needs. These include people with certain chronic or disabling conditions like end-stage renal disease, diabetes, or HIV/AIDs; Medicare beneficiaries living in institutions; and those who are dual eligible, meaning they qualify for both Medicaid and Medicare. SNPs tailor plan benefits to meet the needs of its members, including provider networks, covered medications, or specialized services.
MSA (Medical Savings Account) plan: This high-deductible plan establishes a bank account to use for out-of-pocket medical costs. The amount deposited into the bank account can vary by plan, and the money is tax free, provided that it is used on IRS-qualified medical expenses. You can use the money in your savings account to pay for eligible health costs before you reach your plan’s deductible.
When shopping for a Medicare Advantage plan in Illinois, there are numerous things to consider. Not every plan may be available in your area, and pricing and plan coverage details can vary from one plan to another.
For example, some Medicare Advantage plans may have premiums as low as $0. While it’s easy to assume this would be the cheapest option, there could be higher deductible and copayment amounts in place to offset the cost. Consider this while you browse. Also, think about whether you need prescription drug coverage; if you do or think you might want this coverage later, you might want to enroll in a Medicare Advantage Prescription Drug plan and get all your Medicare coverage through one plan. Remember, you would continue paying your Part B premium, regardless of what you pay for your Medicare Advantage premium.
You can shop for Medicare Advantage plan options in Illinois by using the plan finder tool on this page; just enter your zip code into the census to get started. Or, if you’d like help figuring out plan options that may work for your needs, call the phone number on this page to speak with a licensed insurance agent.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.