Independent Insurance solutions

Medicare Insurance in Illinois

Get a Quote for Medicare Insurance in Illinois, Indiana, and Missouri

What is Medicare insurance?

Medicare insurance is a government-run program designed to provide health coverage to seniors and individuals with certain disabilities or medical conditions. It has different parts that cover various aspects of healthcare, including hospital care, outpatient services, and prescription drugs.

What is covered under Medicare insurance in Illinois?

Medicare insurance covers a range of healthcare services. The coverage is divided into several parts, each offering different benefits:

Medicare Part A (Hospital Insurance):
- Inpatient care: Covers hospital stays, including room, meals, and general nursing care.
- Skilled nursing facility care: Covers care in a skilled nursing facility (SNF) after a hospital stay, but not long-term care.
- Home health care: Covers part-time or intermittent care at home, including skilled nursing services and therapy.
- Hospice care: Covers care for terminally ill patients, including palliative care and services to manage pain and symptoms.
Medicare Part B (Medical Insurance):
- Doctor’s visits: Covers outpatient visits to physicians, specialists, and other healthcare providers.
- Outpatient hospital services: Includes services like outpatient surgery, lab tests, and diagnostic imaging.
- Preventive services: Covers preventive care such as screenings for cancer, heart disease, diabetes, vaccines, and annual wellness visits.
- Durable medical equipment (DME): Includes items like wheelchairs, oxygen tanks, and walkers.
- Mental health services: Covers outpatient mental health services, including therapy and counseling.
Medicare Part C (Medicare Advantage):
- Combination of Part A and Part B benefits: Includes the same services as Part A and Part B but is offered by private insurance companies approved by Medicare.
- Additional benefits: Medicare Advantage plans may offer extra services such as dental, vision, hearing, and wellness programs.
- Prescription drug coverage: Many Medicare Advantage plans include Part D prescription drug coverage.
Medicare Part D (Prescription Drug Coverage):
- Prescription medications: Covers prescription drugs, including both generic and brand-name medications.
- Vaccines and other medications: May also cover certain vaccines, insulin, and other medications as part of the plan’s formulary.

Get an insurance quote.

Provide us with your details, and we’ll create a personalized quote designed specifically for your needs.

How does Medicare work with employer-sponsored health insurance?

When you become eligible for Medicare, your employer-sponsored health insurance may still work alongside Medicare, but it depends on the size of your employer and whether you’re still working. If you work for a company with fewer than 20 employees, Medicare becomes your primary insurance, and your employer’s insurance becomes secondary. In this case, Medicare will pay first for your healthcare services, and your employer’s plan will cover additional costs. If your employer has 20 or more employees, your employer-sponsored plan is considered primary, and Medicare will act as secondary insurance, covering additional costs not paid by your employer’s health plan. It’s essential to inform both your employer and Medicare when you become eligible, to ensure proper coordination of benefits.

Does Medicare cover long-term care or nursing homes?

Medicare does not cover long-term care (also known as custodial care) or the costs of staying in a nursing home for an extended period. However, it may cover short-term stays in a skilled nursing facility (SNF) if you meet specific criteria. For example, Medicare will cover up to 100 days of skilled nursing care in a SNF after a qualifying hospital stay of at least three days. This coverage is for rehabilitation services or medically necessary care, but it doesn’t cover personal care like assistance with daily activities (bathing, dressing, eating) that are typical in long-term care situations. If you need long-term care, you may need to consider other options, such as Medicaid or private long-term care insurance.

What is the difference between a Medicare Special Enrollment Period and Open Enrollment?

A Medicare Special Enrollment Period (SEP) allows you to sign up for or make changes to your Medicare coverage if you experience certain life events, such as losing employer-sponsored health insurance or moving to a new area. The SEP is available to those who delayed enrolling in Medicare because they were covered under an employer’s plan, and they are now eligible to sign up without facing late enrollment penalties.

What factors affect the cost of Medicare insurance in Illinois?

The cost of Medicare insurance is influenced by several factors, including:

Type of Coverage: Medicare offers different plans, such as Original Medicare (Part A and Part B), Medicare Advantage (Part C), and Medicare Part D (prescription drug coverage). The cost will vary depending on which plan you choose, as Medicare Advantage plans and Part D may have additional premiums, copays, and deductibles.
Location: The cost of Medicare insurance can vary by county or region within Illinois due to differences in local healthcare providers, network coverage, and the cost of medical services.
Plan Choice: Medicare Advantage plans (Part C) often have different costs compared to Original Medicare. Advantage plans may include additional benefits, such as vision, dental, or hearing coverage, which can affect the premium.
Income: Individuals with higher income may pay an income-related monthly adjustment amount (IRMAA) for Medicare Part B and Part D, which increases their premiums. This surcharge is based on your income reported on your tax return from two years prior.
Health Status and Needs: People with chronic conditions or those requiring specialized care may choose plans with additional coverage or lower out-of-pocket costs, which could influence the overall cost.
Deductibles and Copayments: Different plans have varying deductibles and copayment structures, which can affect out-of-pocket costs. Higher deductibles or copayments usually result in lower premiums and vice versa.
Prescription Drug Coverage: If you opt for Part D or a Medicare Advantage plan with prescription drug coverage, the cost will depend on the drugs you need and the plan’s formulary (list of covered medications).

How can individuals in Illinois get Medicare insurance?

Reach out to the independent agents at Blanks Insurance for a fast quote on Medicare insurance in Illinois and get personalized assistance in finding the right plan for your healthcare needs. Our experienced agents will help you navigate the complexities of Medicare, ensuring you understand your options and select the coverage that best fits your budget and lifestyle. Whether you’re enrolling for the first time or looking to switch plans, Blanks Insurance offers expert guidance to make the process smooth and stress-free. Contact us today and take the first step toward securing the Medicare coverage you deserve.

Get in Touch

Feel free to contact our independent insurance agents with any questions or concerns you may have.

Send Us a Message!