Medicare Supplement Plans In Illinois

If you’re concerned about the amount of money you’re liable to pay for medical care under Medicare, you may want to consider adding a Medicare Supplement plan. In this article, we’ll review the basics of these plans and some of the details so that you can understand how Medicare Supplement plans in Illinois work.

What Are Medicare Supplement Plans?

Medicare Supplement Plans, which are popularly referred to as Medigap Plans, are an insurance coverage that are designed to be used with Original Medicare. As the name “supplemental” suggests, they only supplement your basic Medicare benefits; they don’t provide any benefits on their own. Instead, they are designed to pay for some of the expenses that you’d normally have to pay out of pocket when you use your Medicare benefits. Original Medicare, Parts A and B, cover most of the costs for your Medicare care, but not all of them. Medicare was designed in such a way that you’re expected to share a portion of the cost for most treatments and services you receive. The costs, which are often called gaps, include:

• Part A deductible ($1,556 for 2022)
• Part A co-insurance (paid after you’ve met the deductible; applies to longer term hospital and skilled nursing home stays, and hospice care)
• Part B deductible ($233 for 2022)
• Part B co-insurance (20% of the cost for all Part B services during the year after you’ve paid the deductible)
• Part B excess charges (up to 15% of the cost, in addition to the 20% co-insurance, charged by certain providers in limited circumstances)
• Emergency care received outside of the United States

As you can see, Medicare will pay most of the costs for the treatments you receive throughout the year. However, the costs that you do pay, while relatively small, can add up during the year. In fact, they keep adding up all year; there is no cap or limit on your out of pocket spending. While in most years your expected payments are likely to be mild, the possibility exists that you might need extensive treatments, surgeries, or hospitalization; paying for these can be a crippling financial burden. This is what Medicare Supplement plans are designed to help prevent.

How Do Medicare Supplement Plans Work?

Medigap coverage is issued by private insurance companies. As stated before, they are designed only to fill in the gaps in Medicare. To accomplish this goal, Medigap insurance is regulated by the federal government as well as the state of Illinois. CMS - the Centers for Medicare and Medicaid Services - is the primary regulator of all aspects of Medicare. However, a combination of federal and state legislation has standardized Medigap plans throughout 47 of the states (including Illinois). This means that the number of Medigap plans available, and the benefits they provide, are the same in all 47 states. In these standardized states, there are 11 standardized Medigap plans. They’re known by letter (A, B, C, D, F, G, K, L, M, N, High Deductible F, and High Deductible G), and each one of them offers a different coverage mixture. The standardized plans each cover a different number and combination of the gaps in Medicare. Since the plans are standardized, the plans and benefits are the same in each of the standardized states; they’re also standardized across all insurance companies. This standardization feature makes comparing coverage and choosing a plan much easier. As mentioned earlier, Medigap works together with Original Medicare. When you go to the doctor or a facility for services and procedures, you’ll pay with both your Medicare card and your Medicare Supplement plan card. The provider will bill both programs in this manner:

• Original Medicare, as the primary, or first payor, will pay the bulk of the cost (the first 80% for Part B services)
• Your Medigap plan in accordance with the terms of your plan (in most cases, a Medigap plan will pay the remaining 20% of approved costs for Part B services)

Since your Medicare Supplement plan will be picking up the tab for many of the costs you’re supposed to pay, you can tailor your coverage to your needs by picking the standardized Medigap plan that will cover the expenses you care most about, while also fitting your budget.

Who Is Eligible For Medicare Supplement Plans In Illinois?

For people who are age 65 and older when they become eligible to enter Medicare, the eligibility requirements are simple. You have to be enrolled in both Part A and Part B of Medicare. You have to keep paying your Part B premium. As long as you meet those requirements, you’re eligible for Medicare Supplement coverage, no matter which state you live in. The picture is less clear for people who enter Medicare before their 65th birthday. There are three qualifications for entering Medicare early:

• Receiving federal disability benefits for 24 consecutive months
• Being diagnosed with ALS (Lou Gehrig’s Disease)
• Being diagnosed with End Stage Renal Disease

In these cases, your coverage will start right away, even if you are years or decades younger than 65 years old. While you’ll qualify for Parts A and B, each individual state has its own rules about Medigap eligibility for people under 65. In Illinois, insurance companies are required to offer Medigap coverage to people who enter Medicare before age 65. Not only this, but they also require insurance companies to limit the premiums for people under 65. 

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