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Medicare Part D Prescription Drug Plans in Illinois


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Medicare Part D in Illinois offers prescription drug coverage to beneficiaries enrolled in Original Medicare or a Medicare Advantage Prescription Drug plan. Medicare Part A and Part B offer limited prescription drug coverage in inpatient and outpatient settings; however, Original Medicare beneficiaries can enroll in a stand-alone Medicare Prescription Drug Plan to get more comprehensive prescription drug benefits.

On the other hand, many Medicare Advantage plans include prescription drug coverage. Also known as Medicare Advantage Prescription Drug plans, these plans offer all-in-one coverage by including your Medicare Part A, Part B, and Part D coverage under a single plan. Medicare Advantage plans must offer at least the same level of coverage as Original Medicare (besides hospice care, which Part A still covers), but may also cover additional benefits, such as routine vision, dental, hearing, or prescription drugs.

Not every Medicare Advantage plan includes prescription drug coverage, so check with the individual plan before enrolling. Keep in mind that if you’re enrolled in a Medicare Advantage Prescription Drug plan, you shouldn’t also enroll in a stand-alone Medicare Prescription Drug Plan; doing so will automatically disenroll you from your Medicare Advantage plan and return you to Original Medicare.

Like the rest of the country, Medicare Part D coverage in Illinois is offered by individual insurance companies in the state contracted by Medicare, so availability and costs will vary by location.

Enrolling in Medicare Part D coverage in Illinois

You’re first eligible for Medicare Part D when you have Medicare Part A and/or Part B and live in the service area of a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan.

Like other types of Medicare coverage, beneficiaries can only sign up for this coverage during certain times. There are several different periods when a beneficiary may enroll in Medicare Part D in Illinois, including:

  • Initial Enrollment Period for Part D
  • Annual Election Period
  • Medicare Advantage Disenrollment Period
  • Special Election Period

The Initial Enrollment Period for Part D is when you’re first eligible for Medicare prescription drug coverage. For most people, it occurs at the same time as your Initial Enrollment Period for Part B, starting three months before your 65th birthday, including the month you turn 65, and ending three months afterward. If you’re eligible for Medicare due to a disability, the period starts three months before your 25th month of receiving disability benefits and lasts seven months. Note that you must be an American citizen or permanent legal resident of five continuous years or longer to qualify for Medicare.

If you don’t enroll in Medicare Part D when you’re first eligible, you can also enroll during the Annual Election Period that occurs each year from October 15 to December 7. During this time, beneficiaries may sign up for Medicare Part D by enrolling in a Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. They can also switch Medicare plans or disenroll from a Medicare plan.

Keep in mind that if you don’t enroll in Medicare Part D when you’re first eligible, you could owe a late-enrollment penalty if you don’t have Medicare Part D and go without creditable prescription drug coverage (insurance that is as good as Part D) for 63 consecutive days or more. Medicare prescription drug coverage is optional, so any penalty wouldn’t apply unless or until you sign up for this coverage.

If you use the Medicare Advantage Disenrollment Period (January 1 to February 14) to disenroll from your Medicare Advantage plan and return to Original Medicare, you can use this same period to enroll in a stand-alone Medicare Prescription Drug Plan.

In certain situations, you may qualify for a Special Election Period to make changes to your Medicare coverage, including Medicare Part D, outside of regular periods. Some examples of situations that may qualify include, but aren’t limited to, moving out of your Medicare plan’s service area or losing your Medicaid eligibility.

Choosing Medicare Part D coverage in Illinois

As mentioned, Medicare Part D coverage in Illinois can vary in terms of the coverage provided and the cost of the Medicare plan.

If you’re interested in Medicare prescription drug coverage, make sure to check the formulary (list of covered drugs) to see if your medications are covered by the plan. Keep in mind that Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans typically separate covered medications into cost tiers, with different copayment costs for the drugs on each tier. Formularies may change at any time; your plan will notify you when necessary.

It’s a good idea to carefully research the Medicare plan options in your area, since Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans can vary widely in costs, even to cover the same prescription drugs. If you have questions or need help finding Medicare plan options, contact eHealth today for personalized assistance with your Medicare needs.

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