As a Medicare beneficiary in Illinois, you may want to think about joining a Medicare Supplement (Medigap) plan to get help paying for health-care costs associated with Original Medicare, Part A and Part B, such as copayments, coinsurance, and deductibles. There are various Medicare Supplement plan options in Illinois, depending on the zip code in which you live. Understand what Medigap in Illinois covers, and find out how to get help choosing a plan that may fit your individual needs.
How Medigap plans work in Illinois
There are 10 standardized Medicare Supplement plans available in 47 states, each of which is identified by one of 10 letters (A, B, C, D, F, G, K, L, M, and N), with plans of the same letter offering the same benefits (for example, Plan N has the same benefits no matter where you buy it). Three states – Massachusetts, Minnesota, and Wisconsin – offer different kinds of standardized Medigap plans.
If you decide to enroll in Medigap in Illinois, you must be enrolled in Original Medicare, Part A and Part B. The best time to sign up is during your Medigap Open Enrollment Period, which is a six-month period that starts the first day you are age 65 or older and enrolled in Medicare Part B. During this time frame, you have special Medigap protections known as “guaranteed issue rights.” This means that you can join any Medigap plan available in your area, with the insurance company of your choosing, without being required to undergo medical underwriting. If you enroll during this period, you can’t be denied coverage altogether due to health, although the Medigap plan is still allowed to make you wait up to six months before covering pre-existing conditions. If you decide to join Medigap in Illinois after this period has passed, you may be denied coverage or charged more for your insurance plan. You may have trouble switching Medicare Supplement plans if you have health problems.
Keep in mind that Medigap plans in Illinois and the rest of the United States are meant to supplement, not replace, Original Medicare. You have to remain enrolled in Original Medicare, Part A and Part B, and continue paying your Medicare Part B premium, in order to keep your health insurance coverage. If you need prescription drug coverage, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan. Medigap plans in Illinois, like those in the rest of the United States, don’t offer coverage for prescription drugs.
In addition, please note that Medicare Supplement insurance can only be used to pay for costs in Original Medicare. If you enroll in a Medicare Advantage plan, your Medigap coverage can’t be used to pay for costs you may have with Medicare Part C.
Types of Medigap plans in Illinois
Before you enroll in a Medigap plan in Illinois, take a look at the 10 standardized Medicare Supplement plans available in your state. This will help you understand what each plan covers, and make an educated decision when choosing a Medigap plan. Keep in mind that not every plan type may be offered in every service area, and Plans E, H, I, and J are no longer offered. In this chart, X indicates that the service (or item) is 100% covered; a percentage indicates what percent of the service/item is covered; and a blank cell indicates it is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B excess charges||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Out-of-pocket limits apply.**|
*Medicare Supplement Plan F offers a high-deductible version in which beneficiaries pay a certain deductible amount before the plan begins coverage. This amount may change from year to year.
**Once you reach the out-of-pocket limits (including the Part B deductible), both Medicare Supplement Plans K and L pay 100% of covered services in the above chart for the remainder of the calendar year.
***Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, except for a copayment of up to $20 on doctor visits and up to $50 on emergency room visits that don’t result in an inpatient admission.
Choosing a Medigap plan in Illinois
As stated earlier, Medicare Supplement plans in Illinois with the same letter designation don’t vary in coverage or benefits. However, because these plans are offered through independent insurance companies, costs may vary, and each insurance company has the freedom to set its own monthly premium structure. This means that if you live in Chicago, in Cook County, you may pay more or less than a resident of Springfield in Sangamon County for an identical Medicare Supplement plan. Knowing about the possible difference in costs, it may be smart to compare all Medicare Supplement plan options available in your area, and then select a Medigap plan in Illinois based on your individual health and budget needs.
For more information on other types of Medicare coverage in Illinois, see:
To get help choosing a Medigap plan in Illinois that may suit your needs, you can start browsing plan options in your area now using the plan finder tool on this page. Or, for more immediate assistance, call the phone number on this page to speak with a licensed insurance agent.