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Medicare in Illinois

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By the numbers

Illinois is home to well over two million Medicare beneficiaries. Here are some 2018 statistics from the Centers for Medicare & Medicaid Services (CMS)*:

  • Number of beneficiaries enrolled in stand-alone Medicare Part D Prescription Drug Plans: 1,127,414
  • Number of beneficiaries in Illinois enrolled in Medicare Advantage Prescription Drug plans: 498,776
  • Total number of beneficiaries in Illinois enrolled in Medicare: 2,209,787

Original Medicare refers to the government-run health insurance program that includes Part A (hospital insurance) and Part B (medical insurance). You typically pay a monthly premium for Part B, but many beneficiaries qualify for premium-free Part A. If you’ve worked at least 10 years while paying Medicare taxes, you don’t pay a monthly premium for Medicare Part A.

There are other costs involved when you have Original Medicare, such as deductibles, copayments, and coinsurance. And it’s important to know that Original Medicare doesn’t include prescription drug coverage beyond certain situations such as when you’re a hospital inpatient; when you need to have medications administered to you as an outpatient; and other limited instances.

American citizens and legal permanent residents of at least five continuous years are commonly enrolled in Original Medicare automatically when they reach age 65 or if they’re already receiving Social Security or Railroad Retirement Board (RRB) benefits. You’re also automatically enrolled if you’ve been receiving disability benefits from Social Security or the RRB for 24 months in a row, prior to age 65. You may also be eligible for Medicare at any age if you have amyotrophic lateral sclerosis (Lou Gehrig’s disease) or end-stage renal disease.

You may have several choices when it comes to changing or adding to your Medicare coverage, depending on where in Illinois you live. If you stay with Original Medicare, you can add a Medicare Prescription Drug Plan and/or a Medicare Supplement insurance (Medigap) plan. With Medicare Prescription Drug Plans, costs and coverage details vary among the private, Medicare-approved insurance companies that offer these plans. Medigap plans are also offered by private insurance companies, but their purpose is to help with your Part A and Part B out-of-pocket costs, such as deductibles and copayments.

Another choice you may have is to receive your Medicare benefits through Medicare Advantage (Medicare Part C). Available through private, Medicare-approved insurance companies, Medicare Advantage plans are required to include at least the same coverage as Medicare Part A and Part B benefits (except for hospice care, which Medicare Part A still covers). Many Medicare Advantage plans offer more benefits, such as prescription drug coverage and routine hearing services. You must still pay your Part B premium along with any premium your Medicare Advantage plan may charge.

Medicare resources in Illinois

Residents may take advantage of state Medicare resources that provide information about Medicare and may advise you about how to get help with health-care costs.

Medicare Savings Programs: These programs help eligible beneficiaries who are unable to pay the out-of-pocket expenses that Medicare doesn’t cover. Anyone in Illinois (or any state) can apply for these Medicare Savings Programs, but most programs are for beneficiaries whose income is below a certain limit or have certain disabilities.

Illinois State Health Insurance Counseling and Assistance Program (SHIP): The Senior Health Insurance Program (SHIP) offers free assistance for Medicare beneficiaries and their caregivers. SHIP tries to help Illinois seniors maintain their health and independence by providing health insurance counseling and resources.

*Statistical data from the Centers for Medicare & Medicaid Services (CMS), “Medicare Enrollment Dashboard,” from the CMS Office of Enterprise Data & Analytics, February 2019.

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