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 switch Medigap without a health screening. About 2.3 million Illinois residents are on Medicare, and this guide covers how to take it here, what it costs in 2026, and how to get help paying.
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: 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. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or the Illinois SHIP at 1-800-252-8966.
Original Medicare: 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.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. 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. It doesn't cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage 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.
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.
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.
- 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.
- 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.
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 reading the results, an Illinois SHIP counselor will go through them with you for free.
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. Part D now moves through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
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 average standalone Part D premium for 2026 is about $46.50 a month, though actual plan premiums vary widely. 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. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
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 only with Original Medicare, never with Medicare Advantage.
Illinois offers the federally standardized plans, labeled A through N, including high-deductible Plan F and Plan G, and they're regulated by the Illinois Department of Insurance (IDOI). 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.
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.
The Illinois Birthday Rule
Illinois law adds a second yearly window that most states don't have. 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 from the same insurer that offers benefits equal to or less than your current coverage, with no medical underwriting.
Two limits are worth knowing. First, the switch has to stay with your current insurer, so it lets you move to a leaner, cheaper plan with the company you already have rather than shop carriers. 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, for 2026 Illinois designates at least one insurer that must sell a Medigap policy to applicants 65 and older year-round, regardless of health. The Illinois Department on Aging's 2026 premium guide lists Blue Cross Blue Shield of Illinois as a guaranteed-issue company, but this designation can change, so confirm the current year's guaranteed-issue insurer with IDOI or the Illinois SHIP before you rely on it.
Medigap or Medicare Advantage?
You can't hold both. 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. 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. Unlike California, Illinois uses the standard federal income tiers and resource limits, not higher state-set ones.
| Program | Individual | Couple | What it pays |
|---|---|---|---|
| QMB | Up to about $1,350 | Up to about $1,824 | Part A and B premiums, deductibles, coinsurance |
| SLMB | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. The income figures are tied to the Federal Poverty Level and update each April, so the Illinois Department on Aging republishes its state MSP chart every year. Confirm the current numbers with Illinois DHS before you rule yourself in or out, and note that enrolling in any of these programs automatically qualifies you for Extra Help.
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. 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
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically
Apply through Social Security at ssa.gov or call 1-800-772-1213.
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.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
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.
Free Medicare Help: Illinois SHIP
You don't have to figure this out alone, and you don't have to pay a broker. Illinois runs the Senior Health Insurance Program, or SHIP, through the Illinois Department on Aging. It's the state's version of the federal State Health Insurance Assistance Program, and Illinois named its own program SHIP too. Counselors are trained, give free and unbiased help, and do not sell insurance.
An Illinois SHIP counselor can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans side by side
- Apply for Medicare Savings Programs and Extra Help
- Sort out claims, denials, and appeals
Call the statewide line at 1-800-252-8966, based in Springfield, and you'll be referred to your nearest local SHIP site for a free appointment.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the 2026 average is about $46.50), and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you pick and the care you use.
It's a state protection. If you're 65 to 75 and already have a Medicare Supplement policy, Illinois gives you 45 days each year, starting on your birthday, to switch to an equal-or-lesser policy with your current insurer without any health screening. It's narrower than the better-known California rule, which lasts 60 days and lets you change carriers, so the same-insurer and 45-day limits matter.
Apply for a Medicare Savings Program through Illinois DHS, and apply for Extra Help with Part D through Social Security at 1-800-772-1213. QMB covers all your Medicare premiums and cost-sharing if your income and resources are under the 2026 limits. An Illinois SHIP counselor (1-800-252-8966) can walk you through both applications for free.
The Illinois Department on Aging runs the Senior Health Insurance Program (SHIP), which gives free, one-on-one Medicare counseling statewide through trained counselors who don't sell insurance. Reach the statewide helpline at 1-800-252-8966 to be matched with a local site.
Learn More
- Illinois Medicare Supplement (Medigap) and the birthday rule
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Savings Programs
- Medicare Enrollment Periods
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.