Medicare in Illinois, Parts A, B, C, D & Medigap
What Medicare does and doesn't cover, and how Illinois SHIP counselors help, free.
Medicare is the foundation of health coverage for Americans 65+. It is not long-term care insurance, a fact families discover the hard way. This guide explains what Medicare actually covers, what it doesn't, and the free help available to every Illinois senior through SHIP (Senior Health Insurance Program).
The four parts, in one paragraph
- Part A, Inpatient hospital, skilled nursing (up to 100 days after a qualifying hospital stay), hospice.
- Part B, Doctor visits, outpatient care, durable medical equipment.
- Part C (Medicare Advantage), A private plan that bundles A + B and usually D, often with dental/vision. Blue Cross, Humana, Aetna, and UnitedHealthcare dominate the Illinois market.
- Part D, Prescription drugs. Sold as a stand-alone plan (with Original Medicare) or built into Advantage.
Medigap (Medicare Supplement) is separate insurance that pays deductibles and coinsurance under Original Medicare. You cannot have both Medigap and a Medicare Advantage plan.
The big thing Medicare doesn't cover: long-term care
Medicare pays for short-term skilled care, usually rehab after a hospital stay. It does not pay for:
- Long-term nursing home stays
- Assisted living
- Non-medical home care (bathing, meals, transport)
- Adult day care (in most cases)
For that, families rely on personal savings, long-term care insurance, VA benefits, or Medicaid.
Enrollment windows, don't miss these
- Initial Enrollment Period, 7 months around your 65th birthday.
- General Enrollment, Jan 1 to Mar 31 each year (penalties possible).
- Annual Open Enrollment, Oct 15 to Dec 7 each year. Change your Part D or Advantage plan.
- Medigap Open Enrollment, The 6 months after you first enroll in Part B. This is the only guaranteed-issue window in Illinois for most Medigap plans. After it closes, insurers can reject you or charge more for preexisting conditions.
Illinois SHIP, free help, no sales pitch
Illinois SHIP is a federally-funded, state-run counseling program. Trained volunteers help you:
- Compare Part D and Advantage plans annually
- Understand hospital and doctor bills
- Apply for Medicare Savings Programs or Extra Help (LIS)
SHIP counselors do not sell insurance. Call 1-800-252-8966 or find a local site through the Illinois Department on Aging.
Frequently asked in Illinois
My mom's Advantage plan changed and now her doctor is out of network. Can we switch?
Yes, during Annual Open Enrollment (Oct 15 to Dec 7) or if she qualifies for a Special Enrollment Period. But switching from Advantage back to Original Medicare + Medigap can be difficult, insurers may medically underwrite. A SHIP counselor can walk through options.
Does Medicare pay for a nursing home?
Only short-term (up to 100 days) after a qualifying 3-day inpatient hospital stay, and only if care is skilled and progressing. After that, families pay privately or use Illinois Medicaid.
What are the Medicare Savings Programs?
Illinois programs (QMB, SLMB, QI) that pay Part B premiums (and sometimes deductibles) for lower-income seniors. Apply through ABE.Illinois.gov.
Next steps for your family
Popular Medicare questions in Illinois
- Senior Benefits in Chicago, IL: VA, Medicaid & Medicare Guide
- Senior Benefits in Naperville, IL: VA, Medicaid & Medicare Guide
- Senior Benefits in Aurora, IL: VA, Medicaid & Medicare Guide