Medicare in Illinois: Plans, Costs and Coverage (2026)

Medicare in Illinois follows the federal rules, but the state adds two things: free counseling through Illinois SHIP and a 45-day yearly window to change Medigap plans without a health screening. This guide covers how to take Medicare here, what it costs in 2026, and how to get help paying.1,2

This guide covers every part of Medicare in Illinois for 2026, what each part costs, the plan choices specific to this state, and the programs that help Illinois residents pay for it.

In This Guide

• Key Takeaways
• Original Medicare in Illinois: Parts A and B
• Medicare Advantage in Illinois (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Illinois and the Birthday Rule
• Help Paying for Medicare in Illinois
• Medicare Enrollment Periods
• Free Medicare Help: Illinois SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, so check that CMS fact sheet or medicare.gov for the figures in force when you read this.3 To reach a person, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), which takes calls 24 hours a day, 7 days a week except some federal holidays.8 For free help sorting out what applies to you, call the Illinois SHIP at 1-800-252-8966.7,1

Original Medicare in Illinois: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Illinois and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends after 60 days in a row with no inpatient hospital or skilled nursing care. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Original Medicare doesn't cover routine dental, vision, or hearing.3,9

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B. Creditable drug coverage does not protect you here; that is the Part D test, not the Part B one.10

Medicare Advantage in Illinois (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.9

Illinois residents in the Chicago metro area generally see the widest choice of plans, while rural downstate counties tend to have fewer. The plan options, networks, and prices change every year and differ by county, so compare what's actually available at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra. CMS also notes that some plans may help pay all or part of your Part B premium itself.3,9
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll.
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.9
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.9

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If you want help with the results, Illinois SHIP offers free education on your Medicare Advantage choices.1

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).11
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. The projected average standalone Part D premium for 2026 runs roughly $34.50 a month, though actual plan premiums vary widely.3 Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Illinois and the Birthday Rule

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.9

Illinois offers the federally standardized plans, labeled A-D, F, G, and K-N, including high-deductible Plan F and Plan G, and they're regulated by the Illinois Department of Insurance (IDOI).2 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.2,3

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health.2

The Illinois Birthday Rule

Illinois law adds a second yearly window that federal law doesn't provide. If you're at least 65 but no older than 75 and you already hold a Medicare Supplement policy, you get a 45-day open-enrollment period each year that begins on your birthday. During it you can buy any Medigap policy that offers benefits equal to or less than your current coverage, from the same insurer or from any affiliate authorized to do business in Illinois, with no medical underwriting.2

Two limits are worth knowing. First, the switch stays with your current insurer or one of its affiliates authorized in Illinois (a 2026 change widened it beyond same-company-only), so you can move to a leaner, cheaper plan within that corporate family but not freely shop every carrier. Second, the new plan must carry equal or lesser benefits, so you can trim coverage but not add to it. Illinois caps the window at 45 days, shorter than California's 60-day version, so the date matters: count from your birthday.

Separately, the Illinois Department on Aging's 2026 Medicare Choices guide says Illinois has one Medicare Supplement insurer that sells to anyone over 65 in any health condition, year-round, at the same premium rate as anyone else in that policy class: Blue Cross Blue Shield of Illinois, listed as a guarantee issue company for 2026. The same guide notes that BCBSIL also sells some plans that do use underwriting, so year-round guaranteed issue doesn't cover its whole lineup, and the designation can change from year to year. Confirm the current guaranteed-issue company, and which of its plans qualify, with IDOI or the Illinois SHIP before you rely on it.2

Medigap or Medicare Advantage?

A Medigap policy can't be used to pay a Medicare Advantage plan's copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you Medigap unless you're switching back to Original Medicare. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. That first choice isn't a permanent lock-out: join an Advantage plan for the first time and federal law gives you a trial right to buy a Medigap policy and a separate drug plan if you return to Original Medicare within 12 months.9 For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Illinois

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Illinois runs its Medicare Savings Programs through the Illinois Department of Human Services and Healthcare and Family Services (DHS and HFS), the same agencies that handle Medicaid. They pay some or all of your Medicare premiums and cost-sharing based on income. Illinois keeps a resource test: the DHS manual's resources table carries a Medicare Savings Programs row. The operative 2026 income standards are the ones DHS publishes in its own manual, at WAG 25-03-02, and the state's SHIP chart names that manual as its main reference. They are set out below.5

QMB is the most generous, covering the Part A and Part B premiums plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.5 Illinois keeps a resource test for all three programs, and the state's 2026 asset limits are $9,950 for one person and $14,910 for a couple, and the chart states that those "Asset Limits do not include an additional $1,500/$3000 burial allowance deduction."5

Do not measure your gross pay or your gross savings against any of these numbers and rule yourself out. DHS decides what income counts, and it automatically disregards $25; on the resource side, no Illinois source states which of your assets are excluded from those totals, so the figures are not a bank-balance test. Social Security's own instruction to its staff is to encourage people to apply even when income or resources look somewhat higher than the state limits.5 QI also has to be reapplied for every year, and the standards are tied to the Federal Poverty Level and update each April, so confirm the current numbers with Illinois DHS. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help.5

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.12 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii limits run higher)12
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses12
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically5
• QDWI, the Medicare Savings Program for people who lost premium-free Part A after returning to work, pays the Part A premium but does not carry Extra Help with it, so a QDWI enrollee has to apply to Social Security for Extra Help separately5,12

Apply through Social Security at ssa.gov or call 1-800-772-1213.12

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Illinois as everywhere else.13

The dates in the table above are federal, so they run the same in Illinois as everywhere else. Changes you make during Annual Open Enrollment take effect the following January 1. If you're already getting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security.13

Free Medicare Help: Illinois SHIP

You don't have to figure this out alone. The Illinois Senior Health Insurance Program (SHIP) is located within the Illinois Department on Aging and provides free, confidential, and objective insurance counseling to people on Medicare and their families.1 It is Illinois's State Health Insurance Assistance Program. Counselors must complete SHIP training and pass a certification exam, and they counsel you in confidential one-on-one sessions. SHIP is not affiliated with any insurance company, its counselors don't sell or solicit any type of insurance, and they can't recommend a specific insurance company, agency, or policy.6

An Illinois SHIP counselor can help you:

• Understand your choices for Medicare Parts A and B, Medicare Supplements, and Medicare Advantage plans1
• Work through questions about Medicare supplement insurance and long-term care insurance1
• Get information on Medicare Savings Programs and Extra Help6
• Get help with Medicare claims and appeals6

Call 1-800-252-8966 (711 TRS), the number the Illinois Department on Aging lists for the Senior Health Insurance Program.7 Ask for the nearest SHIP office, then call that office and request a meeting, at no charge, with a trained SHIP counselor.1 The Department's SHIP section also points you to sites in your area where you can get assistance applying for Medicare.1

Key Illinois Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in Illinois at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.