Medicare Advantage Plans in Illinois

The Balanced Budget Act of 1997 included legislation that created Medicare Advantage plans for Medicare recipients. Medicare Advantage plans in Illinois give beneficiaries the opportunity to choose Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Private Fee-For-Service Plan (PFFS) plan options. Private health insurance providers administer the plans and recipients must enroll in Parts A and B of of the traditional Medicare program. Illinois residents interested in applying for Medicare can submit an application over the phone, online or at any Social Security Administration office in the state.

Advantage Plans

• Medicare pays plan administrators a predetermined fee each month for each enrollee. Medicare Advantage plans often offer services not provided by traditional Medicare, including dental care, vision services and prescription medication benefits. The plans require recipients to make co-payments for services and each plan has individually established rules intended to minimize participant costs. All Medicare Advantage plans include coverage for emergency services. Select plans require participants to use approved plan providers within a service area, but will cover costs when emergency services are needed by a beneficiary outside of the service area. Premiums for Medicare Advantage plans can increase or benefits can decrease on an annual basis. Specialist services can require the approval of a participant's primary physician and can require increased co-payment, depending on the plan. Medicare Advantage plans available in Illinois vary, depending on the county. The amount Medicare pays toward monthly premiums varies, depending on participant income.

Golden Medicare Plan

• Residents of Cook County can select the Golden Medicare Plan, an HMO plan administered by Aetna Health of Illinois. Medicare Advantage HMO plans require participants to choose services within an established network of health care providers. Participants must pay an established co-payment fee for each service. In addition to Medicare services covered in Parts A and B, the Golden Medicare Plan also covers routine medical examinations, prescription medications, vision services and hearing services. As of October 2010, coverage premiums range in cost from free to $66 per month.

Advantra PPO

• Group Health Plan, Inc. offers the Advantra PPO plan for Medicare participants living in Madison and St. Clair Counties. Medicare Advantage PPO plans allow participants to use health care providers outside established networks, but with higher co-payments. Advantra PPO offers the same benefits and services as Medicare Parts A and B, along with hearing services, physical examinations and vision care. Monthly premiums cost approximately $46.

Gold Choice

• The Gold Choice plan, administered by Humana Insurance Company, offers PFFS coverage for Medicare participants in Henry Mercer, Whiteside and Rock Island Counties. The plan includes all services offered by traditional Medicare Parts A and B, along with coverage for prescription medications, medical examinations, hearing services and vision care. PFFS plans do not require participants to use services within a network of providers, allowing beneficiaries to use the hospitals and doctors they choose. PFFS plans and participants both pay established fees to providers. Humana Insurance Company offers basic and standard Gold Choice plans, with premium rates ranging from free to $119 per month. Gold Choice covers all services provided by traditional Medicare coverage, along with prescription drugs, physical examinations, hearing services and vision care.