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Medicare Health Plans in Illinois

Medicare is a health insurance program managed by the Centers for Medicare and Medicaid Services (CMS), part of the U.S. Department of Health and Human Services. The CMS administers other programs like Medicaid and the State Children's Health Insurance Program as well. Medicare is generally offered to citizens aged 65 years or older who meet certain criteria, although exceptions may be made. Traditional Medicare coverage is generally the same throughout the country, but residents of Illinois have their choice of Medicare supplement plans, often called Medigap, from different private companies.

  1. Traditional Medicare

    • Traditional Medicare is often referred to as Medicare Part A or hospital Medicare. This kind of Medicare generally covers only in-patient care in hospitals, skilled nursing facilities or nursing homes. Hospice or home health care coverage is also part of traditional Medicare. Many recipients of Part A do not have to pay premiums. However, there are many things that Part A does not cover, which is the reason a large number of individuals who qualify for Medicare purchase Medigap coverage.

    Medicare HMO

    • Medicare Advantage, Medigap insurance, comes in several forms. One of the least expensive in Illinois is HMO Medicare. This allows customers to have access to more services, with certain restrictions. Those who use HMO Medicare must get all their services from within a network of providers. Customers make co-payments as well as pay regularly-scheduled premiums. In Illinois, you can find HMO Medicare plans that cover prescriptions, hearing, vision, routine physicals and transportation. Illinois's Medicare HMO is offered by private companies such as Aetna Health of Illinois, Group Health Plan, Inc., HealthSpring, Humana, WellCare and United Healthcare of the Midwest. Which company you use may depend on county in which you live. For example, Human Health Plan's HMO, which covers hearing, vision, routine physical exams and prescriptions, is only offered in Kendall County and parts of Cook and Kane counties.

    Medicare PPO

    • Another kind of Medicare Advantage offered in Illinois is Medicare PPO, preferred provider organization. Patients can go outside the network with PPO coverage, but they will make lower co-payments if they stay within the network. Group Health Plan, Inc., Health Alliance Medical Plans, OSF HealthPlans and United Healthcare all offer PPO Medicare in Illinois.

    Private Fee-For-Service

    • Medicare Private fee-for-service (PFFS) has no network of providers. Clients can use any doctor or hospital that agrees to the PFFS plan's conditions. Customers and the insurance plan then both pay a set fee to the provider. Humana, Sterling Life Insurance, Unicare Life and Health and United Healthcare all offer PFFS plans in Illinois, with Unicare and Sterling being offered in the largest number of counties.

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