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Medicare Prescription Drug Plans in Illinois

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If you’re a Medicare beneficiary living in Illinois who needs prescription drug coverage, you have two options: (1) you can enroll in a stand-alone Medicare Part D Prescription Drug Plan, or (2) you can sign up for a Medicare Advantage Prescription Drug plan.

Costs for each stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage plan vary depending on your location and prescription drug benefit, but most plans will require Illinois beneficiaries to a pay a monthly premium, annual deductible, and copayment or coinsurance.

How Medicare prescription drug coverage works in Illinois

Stand-alone Medicare Part D Prescription Drug Plans are offered by Medicare-approved private health insurance companies and are designed to help Medicare beneficiaries cover prescription drug costs. In Illinois, as in other states, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan in addition to your Original Medicare (Part A and Part B) coverage.

You can also obtain Medicare prescription drug coverage by enrolling in a Medicare Advantage Prescription Drug plan, which combines health benefits and prescription drug benefits into a single plan.

Formularies

Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans share some common prescription drug benefit features.  Each has its own list of covered prescription drugs. This list is called a formulary, and the covered prescription drugs are placed in different categories, called tiers. Prescription drugs in the lowest tier will generally cost the least, while medications in the higher tier will be priced higher. If your doctor or prescribing health provider believes that a drug in a higher tier is medically necessary to treat your health condition, and you can’t afford that prescription drug, you may be able to ask your plan for a tiering exception to let you pay a lower copayment. The formulary may change at any time. You will receive notice from your plan when necessary.

In Illinois, most Medicare plans providing prescription drug coverage will let you choose between brand-name and generic drugs when filling prescriptions. A generic drug is a substitute for a brand-name drug that uses similar active ingredients and offers similar results. Generic drugs typically cost less than brand-name medications. In certain cases, the generic version of your brand-name prescription drug may not be available, but there may be a similar generic drug that could work just as well for your particular condition. Be sure to discuss all such generic drug options with your doctor or other prescribing health care provider.

Eligibility and enrollment

  • To enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must have Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance).
  • You must reside in the Medicare Part D Prescription Drug Plan’s service area. In Illinois, as in other states, you can enroll in a Medicare Part D Prescription Drug Plan during the three months before you turn 65, your birthday month, and three months following your birthday month. This is the seven-month Medicare Initial Enrollment Period.
  • If you’re enrolled in Medicare due to a disability, you can usually enroll in a stand-alone Medicare Part D Prescription Drug Plan from three months before until three months after your 25th month of collecting disability benefits from the Social Security Administration or the Railroad Retirement Board.
  • You can also enroll during the Annual Election Period, which runs from October 15 to December 7 each year, and you can switch Medicare Part D Prescription Drug Plans during that same period.
  • If you’re enrolled in a Medicare Advantage plan and decide to switch to Original Medicare, you can do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. You can add a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage during that time.

In Illinois as in other states, you may be faced with a lifetime Medicare Part D late-enrollment penalty if you don’t enroll in a Medicare plan offering Part D prescription drug coverage when you’re first eligible (during your Initial Enrollment Period), and you remain without creditable drug coverage for 63 consecutive days or more. Creditable drug coverage is prescription drug coverage that is at least as good as Medicare Part D.

The late enrollment penalty is 1% of the national base beneficiary premium ($32.74 in 2020) times the number of months you were eligible for a Medicare plan providing prescription drug coverage but didn’t enroll. This amount is then added to your Part D monthly premium. The national base beneficiary premium may increase each year, which means your late enrollment penalty may also increase.

It’s important to note that if you sign up for an Illinois  stand-alone Medicare Part D Prescription Drug Plan, you have to stay enrolled in Part A and/or Part B and continue paying your Medicare Part A and/or Part B premiums, as applicable, to keep your health coverage.

Types of Medicare plans providing prescription drug coverage in Illinois

It’s important for you to understand the difference between a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Prescription Drug plan:

  • Stand-alone Medicare Part D Prescription Drug Plans are a good option for Medicare beneficiaries who have Medicare Part A and/or Part B coverage. By enrolling in a stand-alone Medicare Part D Prescription Drug Plan, you have prescription drug coverage. The plan operates as a complement to the health coverage you receive from Original Medicare. When you’re enrolled in a stand-alone Medicare Part D Prescription Drug Plan, you probably have to pay the plan’s premium in addition to your Original Medicare premiums.
  • A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into a single plan offered by a Medicare-approved private insurance company. Medicare Advantage Prescription Drug Plans must offer at least the same coverage as Original Medicare (except hospice care, which continues to be covered by Part A), and often additional benefits such as routine vision, hearing, and dental, all in one plan. To enroll in a Medicare Advantage Prescription Drug plan, you must have Medicare Part A and Part B, live in  the plan’s service area, and continue to pay your Medicare Part B premium in addition to the plan’ premium, if any.

Some things you may want to think about when choosing a Medicare plan that provides prescription drug coverage:

  • Make a list of your medications so you can see if a plan you’re looking at covers them. Try to think about future medication needs, if that’s possible.
  • Look at the costs of various drug plans, such as premiums and deductibles.
  • Ask about their coverage gap benefits.
  • If you’re already enrolled in a Medicare plan providing prescription drug coverage, it’s always a good idea to review your plan offerings toward the end of the year and learn of any important changes. In Illinois, as in other states, Medicare plans offering prescription drug coverage are allowed to change their premiums, copayments, deductibles, and drug formularies every year, so the plan you’re currently enrolled in may not be the one best suited for your current and future needs. Review the Annual Notice of Changes and Evidence of Coverage your current plan mails you in the fall and compare it with the other plan choices you have where you live. To get started, you may enter your zip code in the plan finder located on this page.

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