Illinois & Medicare

Most Medicare plans are standardized and offer the same benefits nationwide, with the exception of Medicare Advantage. Medigap plans can also change according to region. In Illinois, the Medicare programs are overseen by the state's Department of Insurance. The Illinois Department on Aging also helps Medicare recipients by providing up-to-date information regarding Medicare and any changes to its benefits.

Original Medicare

• Original Medicare is made up of Parts A and B. Most Medicare recipients get this coverage straight from the federal government, which sets the annual deductibles and monthly premium costs. If you or your spouse have paid Medicare taxes for 40 quarters, or ten years, you qualify for premium-free Part A. Everyone enrolled in Part B must pay a monthly premium, however. Part A medical benefits include inpatient hospitalizations, hospice care and home health care. Part B benefits are mostly preventive and include doctor's visits, outpatient hospital services and health screenings. Illinois participates in Medicare Savings Programs (MSP) that help low-income seniors with the costs of original Medicare. Illinois Medicare beneficiaries who qualify may receive help with premiums, deductibles and coinsurance.

Medicare Advantage

• Medicare Advantage (MA), Part C Medicare, allows beneficiaries to combine their Part A and B benefits with additional benefits such as dental, vision or prescription drug coverage. Medicare Advantage plans are sold by private insurance companies according to service area. These insurance companies decide the premiums, copays and deductibles for their MA plans, but they must offer all the same benefits as original Medicare. Most MA plans sold in Illinois are by health-maintenance organizations (HMO), preferred-provider organizations (PPO) or private fee-for-service (PFFS) plans. PFFS policies allow the user to go to any medical provider who agrees to its payment terms, but PPO and HMO plans require you to use their own network of medical professionals. You can go outside the network with a PPO plan, but you will pay higher costs. Insurance companies that offer MA policies in Illinois as of 2011 include Humana, Health Alliance, United Healthcare, Essence and Wellcare.

Part D

• Part D Medicare offers prescription-drug benefits only. You can gain Part D benefits either through a Medicare Advantage plan or by buying a standalone plan. Part D coverage also requires a monthly premium and copays. Part D also has a "doughnut hole" in coverage after you meet the initial coverage limit. Illinois Cares Rx helps Medicare beneficiaries who make less than $26,917 per year to afford prescription drugs. In 2010, the program offers benefits for basic drugs to treat conditions such as Alzheimer's Disease, arthritis, heart disease and Parkinson's with only a $2.50 copay for generic drugs and a $6.30 copay for name-brand medications..

Illinois Medicare Supplements

• Medicare supplement plans, also called Medigap, offer additional health-care benefits to Medicare users as well as helping to cover the costs of original Medicare's deductibles, copays and premiums. In Illinois, a Medigap company must sell you any policy you like, regardless of previous health conditions, if you are 65 or over and apply within six months of enrolling in Part B. Illinois also guarantees a 30-day "open look" period, where buyers can get their money back for a policy with no questions as long as they return it within 30 days of purchase. Illinois Medigap plans are also guaranteed to be renewable.