Clear Guidance for Medicare and Health Coverage
To Speak with Rhonda
Medicare & Health Insurance Education Center
Health insurance decisions become easier when you understand the terminology, timelines, and choices involved.
The Healthy Choices IL Education Center provides straightforward information about Medicare, Medicare Advantage, Medicare Supplement insurance, prescription drug coverage, Medicaid, Marketplace health insurance, provider networks, enrollment periods, and other common coverage topics.
Use this page as a starting point. Read the sections that apply to your situation, follow the links to official government resources for additional details, and contact Rhonda Torossian when you are ready to discuss your individual questions.
Find the Information You Need
Use the topics below to move directly to the information most relevant to you.
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Medicare Basics
Medicare is federal health insurance primarily for people age 65 and older. Certain younger people may qualify because of disability, End-Stage Renal Disease, or ALS. Some people are enrolled automatically, while others need to actively sign up.
Understanding Medicare begins with learning how the different parts work together.
Official Resources
Understanding Medicare Parts A, B, C and D
Medicare is commonly described using four letters, but each one serves a different purpose.
Medicare Part A - Hospital Insurance
Medicare Part A generally helps cover:
Inpatient hospital care
Skilled nursing facility care under qualifying circumstances
Hospice care
Certain home health services
Part A is one half of Original Medicare.
Medicare Part B - Medical Insurance
Medicare Part B generally helps cover:
Physician services
Outpatient care
Preventive services
Certain medical equipment
Other medically necessary services
Part B works with Part A to form Original Medicare.
Medicare Part C - Medicare Advantage
Medicare Part C is another name for Medicare Advantage.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans provide Part A and Part B benefits and usually include prescription drug coverage. Depending on the plan, provider networks and prior authorization requirements may apply.
Medicare Part D - Prescription Drug Coverage
Medicare Part D helps pay for eligible prescription medications.
Part D coverage is offered through private insurance companies approved by Medicare. People with Original Medicare can purchase a standalone Part D plan, while many Medicare Advantage plans include prescription drug coverage.
Original Medicare
Medicare Advantage plans provide another way to receive Medicare benefits.
These plans are offered by private insurance companies approved by Medicare and include Part A and Part B benefits. Many plans also include prescription drug coverage and may offer additional benefits that Original Medicare does not routinely provide.
Depending on the plan, beneficiaries may need to use certain provider networks or obtain authorization before receiving some services.
Factors Worth Reviewing
Primary care physician
Specialists
Hospital network
Prescription medications
Pharmacy network
Monthly premium
Deductibles
Copayments
Coinsurance
Annual out-of-pocket maximum
Travel coverage
Referral requirements
Additional benefits
Official Resources
Medicare Advantage
Medicare Advantage plans provide another way to receive Medicare benefits.
These plans are offered by private insurance companies approved by Medicare and include Part A and Part B benefits. Many plans also include prescription drug coverage and may offer additional benefits that Original Medicare does not routinely provide.
Depending on the plan, beneficiaries may need to use certain provider networks or obtain authorization before receiving some services.
Questions to Consider
Do my doctors accept Medicare?
Do I travel frequently?
Do I want broad provider access?
Will I purchase Medicare Supplement insurance?
How will I obtain prescription drug coverage?
What out-of-pocket costs should I expect?
Official Resources
Medicare Supplement Insurance
Medicare Supplement insurance is also called Medigap.
Medigap policies work alongside Original Medicare and may help pay certain costs that Original Medicare does not pay, such as eligible deductibles, copayments, and coinsurance.
In most states, Medigap policies are standardized by plan letter. Policies with the same plan letter provide the same basic benefits even when sold by different insurance companies, although premiums can differ.
Medigap does not work with Medicare Advantage.
Important Questions
When does my Medigap Open Enrollment Period begin?
What plan letters are available to me?
How are premiums calculated?
Can premiums increase?
Does medical underwriting apply?
Am I eligible for guaranteed issue protections?
Official Resources
Prescription Drug Coverage and Formularies
Prescription drug coverage deserves careful attention when comparing Medicare plans.
Each Part D or Medicare Advantage prescription drug plan uses a formulary, which is the plan's list of covered medications.
A medication may fall into a particular tier or be subject to:
Prior authorization
Quantity limits
Step therapy
Preferred pharmacy requirements
Mail-order rules
Drug formularies and pharmacy networks can differ between plans.
Before Choosing a Plan
Consider writing down:
Medication name
Dosage
Frequency
Preferred pharmacy
Whether you use mail-order prescriptions
You can then compare how available plans treat those medications.
Official Resources
Turning 65 and Preparing for Medicare
Your 65th birthday is an important Medicare milestone.
Some people are automatically enrolled, while others must actively sign up. Social Security administers enrollment in Medicare Part A and Part B.
Your employment status matters.
A person who is:
Already retired
Retiring at age 65
Continuing to work
Covered through a spouse's employer
may face different decisions regarding Medicare enrollment.
Start Early
Do not wait until your birthday month to begin learning about Medicare.
Review:
Current employer coverage
Social Security status
Medicare eligibility
Part B enrollment timing
Prescription drug coverage
Medicare Advantage
Medicare Supplement insurance
Official Resources
Medicare Enrollment Periods
Medicare enrollment does not happen whenever you choose.
Different enrollment periods apply depending on your situation.
Initial Enrollment Period
For many people becoming eligible for Medicare, the Initial Enrollment Period surrounds the time they first become eligible.
Medicare explains that the Initial Enrollment Period for joining a Medicare health or drug plan generally begins three months before you first get Medicare and ends three months afterward.
General Enrollment Period
If you miss certain enrollment opportunities for Part B, the General Enrollment Period may provide another opportunity.
Social Security states that the General Enrollment Period for Part B runs from January 1 through March 31.
Special Enrollment Periods
Certain circumstances may allow enrollment outside the standard periods.
Employment-based health insurance is one common situation that can affect Medicare enrollment timing.
Official Resources
Working After Age 65
Turning 65 does not necessarily mean you must retire.
Many people continue working and remain covered through employer-sponsored health insurance.
Whether you should enroll in Medicare immediately can depend on:
Employer size
Type of health plan
Whether coverage is based on current employment
Whether you contribute to a Health Savings Account
Your spouse's coverage
Prescription coverage
Social Security notes that people covered through an employer group health plan may sometimes choose to delay Part B without the same consequences that can apply when no qualifying employer coverage exists.
This is an area where individual circumstances matter considerably.
Official Resources
Provider Networks
Provider access can be one of the most important differences between health plans.
Before enrolling, consider checking:
Primary care physician
Cardiologist
Oncologist
Orthopedic specialist
Preferred hospital
Rehabilitation provider
Laboratory
Pharmacy
Other regularly used providers
Medicare Advantage plans may use provider networks, while Original Medicare generally allows beneficiaries to use participating Medicare providers throughout the United States.
Provider directories can change.
Always verify important providers directly with the plan and provider office before making a final coverage decision.
Understanding Medicare Costs
A monthly premium is only one part of healthcare expenses.
Depending on the coverage, you may encounter:
Premiums
Deductibles
Copayments
Coinsurance
Prescription drug costs
Out-of-pocket maximums
Non-covered services
A plan with a low premium may still have higher costs when services are used.
Medicare maintains current information about Medicare costs and available financial assistance programs.
Official Resources
Medicare and Medicaid Are Different
Medicare and Medicaid are separate programs.
Medicare is federal health insurance associated primarily with age or qualifying disability.
Medicaid is a joint federal and state healthcare program for eligible individuals who meet applicable financial and other requirements.
Some people qualify for both programs.
These individuals are often called dual eligible beneficiaries.
Illinois Medicaid is administered through the Illinois Department of Healthcare and Family Services.
Illinois Resources
Medicare Savings Programs
Some Medicare beneficiaries with limited income and resources may qualify for assistance with Medicare-related expenses.
Medicare Savings Programs may help eligible individuals with costs such as:
Medicare premiums
Deductibles
Coinsurance
Other eligible expenses
Income and resource limits can change, so avoid relying on an old brochure or income table.
Illinois publishes current information through the Department of Healthcare and Family Services.
Official Resources
Marketplace Health Insurance
The Health Insurance Marketplace provides individual and family health coverage for eligible consumers.
Marketplace coverage may be relevant for:
Self-employed individuals
People between jobs
Early retirees
People who recently lost employer coverage
Individuals who do not have access to qualifying employer coverage
Families purchasing their own insurance
The Marketplace also determines whether eligible applicants qualify for financial assistance based on applicable household and income information.
Official Resources
Marketplace Open Enrollment
Marketplace coverage generally has an annual Open Enrollment Period.
HealthCare.gov currently identifies the federal Marketplace Open Enrollment period as November 1 through January 15, although applicable dates and rules should always be verified for the current coverage year.
Outside Open Enrollment, a qualifying life event may allow enrollment through a Special Enrollment Period.
Special Enrollment Periods
A Special Enrollment Period may allow someone to enroll in Marketplace coverage outside the annual Open Enrollment Period.
Qualifying circumstances may include events such as:
Losing qualifying health coverage
Getting married
Having a baby
Adopting a child
Certain moves
Other eligible life changes
Eligibility depends on the specific circumstances.
Official Resources
Losing Employer-Sponsored Health Coverage
Losing employer-sponsored insurance can create important enrollment deadlines.
Depending on your age and circumstances, options may include:
Medicare
Marketplace insurance
COBRA
Coverage through a spouse
Medicaid
Another eligible group plan
People eligible for Medicare should pay particular attention to Part B and Part D enrollment requirements after losing qualifying employer coverage.
Medicare provides specific forms for people enrolling in Part B after employment or job-based coverage ends.
Official Resources
Choosing Coverage Based on Your Situation
There is no single plan that automatically makes sense for every person.
A meaningful comparison should consider your individual circumstances.
Doctors
Are the physicians and specialists you rely on available?
Hospitals
Are your preferred hospitals included?
Perscriptions
How does the plan cover your current medications?
Costs
What could you pay in premiums, deductibles, copayments, coinsurance, and prescriptions?
Travel
How does the plan work when you are away from home?
Healthcare Usage
Do you see specialists frequently or receive ongoing treatment?
Convenience
Do you value broader provider choice, predictable expenses, additional plan benefits, or another feature?
The answer may be different for your neighbor, spouse, friend, or sibling.
Coverage should be considered based on your circumstances.
Questions to Ask Before Enrolling
Before choosing Medicare or health insurance coverage, consider asking:
Important Questions
Are my doctors in the network?
Is my preferred hospital included?
Are my prescriptions covered?
What pharmacies can I use?
What is the monthly premium?
What is the deductible?
What will I pay to see my primary doctor?
What will I pay to see a specialist?
What will an emergency room visit cost?
Is there an annual out-of-pocket maximum?
Does the plan require referrals?
Does it require prior authorization?
How does coverage work when traveling?
What happens if my healthcare needs change?
When can I change coverage again?
Bring these questions to your conversation with Rhonda.
Illinois Senior Health Insurance Program - SHIP
Illinois residents also have access to the Senior Health Insurance Program, commonly called SHIP.
Illinois SHIP is a free statewide counseling service for Medicare beneficiaries and caregivers. It provides Medicare education and assistance without selling insurance products.
SHIP can be particularly useful for people who want independent government-sponsored Medicare counseling.
Official Resources
Trusted Government Resources
Bookmark these resources if you are researching Medicare or health insurance.
Medicare.gov
The official federal Medicare website.
Use it to:
Learn about Medicare
Compare Medicare plans
Review Medicare costs
Learn about Medigap
Research prescription drug plans
Find providers
Review enrollment information
Medicare Plan Compare
Use Medicare's official comparison tool to review Medicare Advantage and Part D plans available in your area.
Social Security Administration
Social Security handles enrollment in Medicare Part A and Part B.
HealthCare.gov
The official federal Health Insurance Marketplace website.
Use it for Marketplace eligibility, enrollment, Special Enrollment Period information, and coverage applications.
Illinois Department of Healthcare and Family Services
Illinois HFS administers Medicaid and other healthcare assistance programs in Illinois.
Illinois Department on Aging
The Illinois Department on Aging provides resources for seniors, caregivers, and Medicare beneficiaries.
Illinois SHIP
SHIP provides free Medicare counseling to Illinois Medicare beneficiaries and caregivers.
When Should You Speak With an Insurance Professional?
Online resources are helpful, but your situation may involve details that a general article cannot evaluate.
Consider speaking with Rhonda if:
You are approaching age 65.
You are retiring.
You are continuing to work after 65.
You are losing employer insurance.
Your doctors have changed.
Your prescriptions have changed.
You recently moved.
You want to review Medicare Advantage.
You are considering Medicare Supplement insurance.
You need Marketplace health insurance.
You simply want someone to explain your choices.
Am I eligible for guaranteed issue protections?
You do not need to know which plan you want before calling.
Start with your questions.
Clear Guidance for Medicare and Health Coverage
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Important Insurance Information
Healthy Choices IL is an independent insurance resource operated by a licensed insurance professional.
Healthy Choices IL is not connected with or endorsed by the United States government, the federal Medicare program, the Illinois Department of Insurance, the Social Security Administration, or the Health Insurance Marketplace.
This website provides general educational information and is not a substitute for professional medical, legal, tax, or financial advice.
Rhonda Torossian may not represent every insurance company or plan available in your area. Information provided may be limited to insurance companies and plans she is licensed, certified, contracted, appointed, and authorized to offer.
Plan availability, benefits, provider networks, formularies, premiums, deductibles, copayments, coinsurance, service areas, eligibility requirements, and enrollment periods may change.
Provider directories and prescription formularies should be verified directly with the applicable insurance company before enrollment.
Enrollment depends on eligibility, applicable enrollment periods, plan availability, receipt of a completed application, and approval by the insurance company or appropriate program administrator.
Submitting a website form, making a phone call, scheduling a meeting, or discussing coverage does not create insurance coverage or guarantee enrollment.
For information about all available Medicare options, visit Medicare.gov or call 1-800-MEDICARE.
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