Getting Medicare Advantage in Illinois When Turning 65: Everything You Need to Know

Turning 65 in Illinois
By James O'Neal

Will you celebrate your 65th birthday this year? If so, congratulations! Turning 65 is a milestone for many reasons. One of the most important ones? You are now eligible for Medicare Advantage coverage! If you are an Illinois resident considering this option over original, government-supplied Medicare this article covers everything you need to know before you begin your coverage. 

What is Medicare Advantage?

Before we dive into how to apply for Medicare at 65, let’s quickly review what Medicare Advantage includes. In short, this is a type of Medicare health plan (Medicare Part C) offered by a private company that’s contracted with Medicare to provide you with all of the Part A and Part B benefits you expect, along with Medicare Prescription Drug coverage (Medicare Part D), available on most plans. 

Most Medicare Advantage plans are designed to cover the same Medicare services as a government plan would provide. 

The most common types of Medicare Advantage plans include:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Special Needs Plans (SNPs)
  • Private Fee-For-Service (PFFS) plans

Though they aren’t as common, other types of Medicare Advantage plans include HMO Point-of-Service (HMOPOS) plans, as well as Medicare Medical Savings Account (MSA) plans. 

With most Medicare Advantage plans, you won’t have to pay an additional premium beyond your Medicare Part B premium. If the plan you select does have a monthly premium, it won’t be calculated based on your age, gender, or current health condition. 

How to Apply for a Medicare Advantage Plan in Illinois

Before you being the steps for applying for Medicare in Illinois, you must first make sure you’re eligible to receive Medicare Part A coverage. Then, once you’re enrolled in a plan, you’ll still be required to pay your Part B premium. The only caveat? Some services, including Medicaid, might pay that premium on your behalf.

Steps for Apply for Medicare Advantage in Illinois

1. Check Your Zip Code

There are more than 1,000 different Medicare Advantage plans offered in the state of Illinois. How can you know which one is the best fit for you? To begin, you can start narrowing your search by geographic location. Not every plan will be available in every county throughout the state, so it’s important to understand which ones are viable options where you live.

When you partner with an independent insurance broker agency like O’Neal Insurance Group, our team can help you search your zip code to see a comprehensive list of Medicare Advantage plans offered in your area. You’ll be able to see all of the available plans with a few clicks, as well as compare their availability, benefits, and associated costs. This way, you won’t waste time and spin your wheels looking at plans that aren’t even available where you live.

2. Enroll in Medicare Part A and Part B

Before you sign up for Medicare Advantage, you’ll need to enroll in Medicare Part A and B. Grouped together, these two plans are normally referred to as Original Medicare.

To be eligible to enroll in Original Medicare at age 65, you’ll need to meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident.
  • You must have lived in the U.S. for a continuous, five-year period.
  • You (or your spouse) must have worked long enough to receive Social Security benefits (or Railroad Retirement benefits).
  • You (or your spouse) must be government employees or retirees who have not paid into Social Security yet but have already paid Medicare payroll taxes.
  • Not quite 65? Even if you’re a little younger, you might meet Original Medicare enrollment requirements if the following conditions apply:
  • You’ve received Social Security benefits for 24 months or more (or some disability benefits from the Railroad Retirement Board).
  • You’ve been diagnosed with Amyotrophic Lateral Sclerosis‎ (ALS or Lou Gehrig’s disease).
  • You’ve been diagnosed with End-Stage Renal Disease (ESRD) and you (or your spouse) have paid Social Security taxes for a set period of time.

If the last bullet (ESRD) applies to you, keep in mind that you might not be eligible to qualify for most Medicare Advantage plans. However, you may be eligible to apply for an Illinois Medicare SNP. This type of health care plan is strategically designed to support your ongoing medical needs.

3. Choose a Medicare Advantage Plan 

Our team of experts can help you browse the Medicare Advantage plans that are available in your Illinois county. As you review your different options, the following distinguishing features can you make your decision:

  • Medicare Star Ratings (reflect overall quality)
  • Third-party information on each plan’s credit rating and financial standing (available through Standard & Poor’s)
  • Online reviews and testimonials from current plan participants

4. Enroll During an Appropriate Enrollment Period

Did you find the perfect plan for your situation and future goals? Next, you’ll need to understand the appropriate time to apply for Medicare Advantage. Let’s take a look at your health insurance options.

Medicare Initial Enrollment Period

Your Medicare Initial Enrollment Period (IEP) is a span of seven months that includes:

  • The three months leading up to your 65th birthday month
  • Your 65th birthday month
  • The three months following your 65th birthday month

This means if you’ll turn 65 in July, your IEP will span from April to October. 

Many Illinois residents will sign up for Medicare Advantage during their IEP. If you miss the window, there are other times you can apply. 

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period lasts from January 1 to March 31 every year. While it’s open, you’re free to switch Medicare Part C plans or apply to one for the first time.

You can also choose to drop your Medicare Advantage plan and return to Original Medicare. If you go this route, you’ll still be able to join a standalone Medicare Prescription Drug Plan (Medicare Part D).

Medicare Annual Enrollment Period

If you miss both the IEP and Open Enrollment period, you can also sign up for a Medicare Advantage plan during the Medicare Annual Enrollment Period (or Annual Election Period, also called AEP), which begins on October 15 and ends on December 7 every year.

During AEP, you can sign up for a new Medicare Advantage plan, as well as join, drop or switch your Medicare Part D plan. You can also switch from one Medicare Advantage plan to another or cancel your coverage altogether, opting instead to install in Original Medicare.

Medicare Special Enrollment Periods

The above enrollment periods are designed to allow eligible individuals in Illinois to enroll in Medicare Advantage. If you’re unable to enroll during any of these times, you may be able to sign up during a Special Enrollment Period (SEP). These can occur at any time during the year, though they’re only available to individuals with extenuating circumstances or limited situations. 

Not sure if you qualify to enroll for Medicare Advantage during an SEP? Your insurance broker can counsel you on the timeline that is the best fit for your needs.

Why Partner with an Independent Insurance Broker?

When you’re first researching Medicare Advantage, it can be overwhelming to sort through all of the myriad options. Not only are there different types of plans, but each one has its own set of features, advantages, drawbacks, and limitations. How can you decide between an HMO, PPO, PFFS, or any other type of plan? More importantly, how can you be confident that you’re making the right decision? 

As an independent insurance broker, we don’t work for a massive corporation. This frees us up to offer unbiased advice on which plan is right for you. For more than 25 years, we’ve helped clients just like you find the best plans to help protect themselves and their families. You’ll work one-on-one with an agent broker who will provide dedicated service every step of the way.

Turning 65? Give Us a Call.

Are you looking forward to turning 65 this year? If so, we’d love to connect. There are Medicare Advantage plans across the state of Illinois designed to provide you with the level of health care you require, both now and into the future. Our skilled team of agent brokers is ready to take your call, so get in touch today. We’ll help you take control of your health and prepare for the journey ahead, one step at a time.