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2021 Medicare Advantage Plans In Decatur, IL

2021 Medicare Advantage Plans In Decatur, IL

From October 15-December 7, you have the opportunity to enroll in Medicare health and drug plans for 2021. If you enroll in a plan during this Annual Open Enrollment Period, that plan will begin on January 1, 2021.

Medicare Advantage is expanding rapidly across the country, and we’re also seeing it here in Decatur. Last year, there were only four Medicare Advantage HMOs and PPOs. This year, there are a total of 17 Medicare Advantage plans:

  • Five PPO plans
  • Two MSA plans
  • Nine HMO plans
  • One Cost plan

Here’s everything you need to know about the 2021 Medicare Advantage plan options in Decatur, IL.

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Reminder! The Medical Annual Enrollment Periods ends December 7 – make changes to your health and drug plans before it's over. Call our office at 217-423-8000 to get started!

Should I Switch to Medicare Advantage?

Before we get into the available Medicare Advantage options in Decatur, IL for 2021, you might be wondering if you should consider switching from your Medicare Supplement plan.

Consider Plan Choices

We have 17 Medicare Advantage plans in Decatur – the national average is 47 (CMS). So, while we do have more plans here than ever before, it’s still nothing compared to the national average.

Smaller cities and rural areas have fewer plan choices, making it difficult to find a competitive plan. In other words, less competition means less attractive plans.

As an example, one of the most competitive plans in Chicago offers a $0 premium and a $2,650 out-of-pocket maximum (Humana Gold Plus HMO). One of the most competitive plans in Decatur offers a $0 premium and a $6,700 out-of-pocket maximum (Health Alliance Medicare HMO Basic).

While the out-of-pocket maximum is vastly different, there is one thing both plans have in common: strict network restrictions.

Consider the Network

And that’s the second concern individuals have with Medicare Advantage. It’s also one of the most common reasons people decide to switch back to Original Medicare with a supplement.

Medicare Advantage plans are network-based, meaning you need to see physicians that accept the plan. HMOs are the most strict, PPOs offer more flexibility, and the MSA technically does not have a network.

As with any medical insurance product you have, always make sure your provider accepts it.

You Still Pay the Part B Premium

If you choose a Medicare Advantage plan, you should know you are still required to pay the Medicare Part B premium of $144.60 per month in 2020. 

Some clients see the $0 premium feature and get excited, and while the Medicare Advantage plan may be $0 premium, you still have to pay your Medicare Part B premium.

Even though you are forfeiting your Original Medicare benefits in favor of a private Medicare Advantage plan, you still must pay that premium.

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PPO Medicare Plans In Decatur, IL for 2021

There are five PPO (Preferred Provider Organization) plan options in Macon County for 2021. PPOs are generally much more flexible when it comes to the network of approved providers. However, always check with your physicians before enrolling in a plan to ensure they’ll accept it.

What’s a PPO?

These plans have a network of doctors and other providers, but you can use providers outside the network. You’ll usually pay less if you get services from in-network providers. If you want drug coverage, the PPO Plan you join must include drug coverage.

Which Insurance Companies Offer an PPO In Decatur?

Aetna Medicare, Humana, and Blue Cross Blue Shield of IL, NM offer PPO Medicare Advantage plans in Macon County for 2021.

Aetna Medicare Value Advantra (PPO)

This is one of the two plans we are recommending in the Medicare Advantage world for 2021. In our opinion, it is one of the most competitive options in Macon County.

This plan has a $0 monthly premium, a $0 health and drug deductible, and a $5,500 in-network out-of-pocket maximum. The in and out-of-network maximum is $7,000.

Some brief plan highlights:

  • $5 copay for in-network primary doctor visits
  • $40 copay for in-network specialist visits
  • $40 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, over-the-counter drugs, home and bathroom safety devices, telehealth, worldwide emergency coverage, and meals for a short duration.

One attractive part of this plan’s drug component is preferred generics and generics have a $0 copay. If you take a generic drug (and it’s in this plan’s formulary), you may pay nothing for your prescriptions. However, the best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison.

Based on our research, 112 family practice, 34 general practice, 22 geriatric medicine, and 109 internal medicine doctors in Decatur, IL accept this plan. 

Aetna also has the benefit of being a national organization, which means they have in-network doctors all over the country. This could be a great solution for those who travel often or who are snowbirds. However, always check with your physicians to ensure they accept the plan. That’s a step you never want to skip when it comes to Medicare Advantage plans.

HumanaChoice R5361-001 (Regional PPO)

This plan has a $0 monthly premium, a $0 health deductible, and a $6,700 in-network out-of-pocket maximum. The in and out-of-network maximum is $10,000.

This plan does not include drug coverage.

Some brief plan highlights:

  • $20 copay for in-network primary doctor visits
  • $50 copay for in-network specialist visits
  • $20-50 copay or 50% coinsurance for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, over-the-counter drugs, telehealth, worldwide emergency coverage, and meals for a short duration.

Humana doesn’t offer a full list of accepted doctors on their website. You have to enter your doctor’s name to see if they’re in-network. However, based on some preliminary research, it appears Humana has a vast network in Decatur, IL. 

Always check with your physicians to ensure they accept the plan.

Aetna Medicare Premier Advantra (PPO)

This plan has a $25 monthly premium, a $0 health and drug deductible, and a $6,500 in-network out-of-pocket maximum. The in and out-of-network maximum is $11,300.

Some brief plan highlights:

  • $0 copay for in-network primary doctor visits
  • $35 copay for in-network specialist visits
  • $35 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, over-the-counter drugs, telehealth, worldwide emergency coverage, and meals for a short duration.

One attractive part of this plan’s drug component is preferred generics and generics have a $0 copay. If you take a generic drug (and it’s in this plan’s formulary), you may pay nothing for your prescriptions. However, the best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison.

Based on our research, 112 family practice, 34 general practice, 22 geriatric medicine, and 109 internal medicine doctors in Decatur, IL accept this plan. 

Aetna also has the benefit of being a national organization, which means they have in-network doctors all over the country. This could be a great solution for those who travel often or who are snowbirds. However, always check with your physicians to ensure they accept the plan. That’s a step you never want to skip when it comes to Medicare Advantage plans.

Blue Cross Medicare Advantage Choice Plus (PPO)

This plan has a $50 premium and a $0 health and drug deductible. The in-network maximum out-of-pocket is $7,550, and the in and out-of-network maximum is $11,300.

Some brief plan highlights:

  • $5 copay for in-network primary doctor visits
  • $40 copay for in-network specialist visits
  • $40 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, over-the-counter drugs, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears no doctors in Decatur, IL accept this plan. The closest general primary care physicians listed are in Kankakee, IL.

This plan is brand new to Macon County, which could explain why no doctors are currently listed in the provider directory. Always check with your physician to find out if they accept the plan.

HumanaChoice R5361-002 (Regional PPO)

This plan has a $120 monthly premium, a $198 health deductible, and a $420 drug deductible. The in-network out-of-pocket maximum is $6,700, and the in and out-of-network maximum is $10,000.

Some brief plan highlights:

  • 20% coinsurance for primary doctor visits
  • 20% coinsurance for specialist visits
  • 20% coinsurance for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, a health essentials kit, over-the-counter drugs, telehealth, travel coverage, and meals for a short duration.

Humana doesn’t offer a full list of accepted doctors on their website. You have to enter your doctor’s name to see if they’re in-network. However, based on some preliminary research, it appears Humana has a vast network in Decatur, IL. Always check with your physicians to ensure they accept the plan.

Note: This particular plan has inaccurate and incomplete information on Medicare.gov’s Plan Finder. We accessed the plan’s Benefit Summary to provide the accurate information in this article.

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MSA Medicare Plans In Decatur, IL for 2021

There are two MSA (Medical Savings Account) plan options in Macon County for 2021. 

What’s an MSA?

A Medicare MSA is a high-deductible plan that deposits money into a savings account that you can use to pay healthcare costs before you meet the deductible. You can see any doctor or provider as long as they agree to accept the plan.

Once you’ve used the amount of money in the account, you’ll pay all costs until you meet the deductible. These plans don’t include drug coverage, but you can also join a separate Drug Plan.

Which Insurance Companies Offer an MSA In Decatur?

Lasso Healthcare is the only company offering MSA Medicare Advantage plans in Macon County for 2021. In fact, this is the first company to sell an MSA in Decatur, IL – ever!

The MSA is the only Medicare Advantage plan that actually gives money to the member to use for qualified medical expenses. It’s an exciting option gaining a lot of traction as it goes into its third year here.

Alongside the Aetna Medicare Value Advantra (PPO), this is one of our recommended plans for 2021. Both options offered by Lasso Healthcare are competitive – it’s just a matter of preference.

Lasso Healthcare Growth (MSA)

This plan is $0 premium and has a $5,000 annual deductible. You receive a $2,000 deposit at the beginning of the year that you can use to pay for qualified medical expenses. If you don’t use all of that money, it rolls over to the following year.

This plan doesn’t include drug coverage, but you are allowed to purchase a separate Medicare Part D drug plan. This plan also does not include many “extra” benefits.

Unlike other Medicare Advantage plans, the MSA has no provider network and is currently accepted by thousands of providers across the U.S. However, physicians can choose to reject the plan if they wish, so as always, be sure to check with your providers before you enroll in the plan.

Lasso Healthcare Growth Plus (MSA)

This plan is $0 premium and has an $8,000 annual deductible. You receive a $3,000 deposit at the beginning of the year that you can use to pay for qualified medical expenses. If you don’t use all of that money, it rolls over to the following year.

This plan doesn’t include drug coverage, but you are allowed to purchase a separate Medicare Part D drug plan. This plan also does not include many “extra” benefits.

Unlike other Medicare Advantage plans, the MSA has no provider network and is currently accepted by thousands of providers across the U.S. However, physicians can choose to reject the plan if they wish, so as always, be sure to check with your providers before you enroll in the plan.

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HMO Medicare Plans In Decatur, IL for 2021

There are nine HMO (Health Maintenance Organization) plan options in Macon County for 2021. Four of them are HMO-POS plans, or HMO with a point-of-service option.

What’s an HMO?

With an HMO plan, you usually have to use the doctors and other providers in the plan’s network. In an HMO-POS (HMO with point-of-service option), you may be able to go out-of-network for certain services. If you want drug coverage, the HMO Plan you join must include drug coverage.

Which Insurance Companies Offer an HMO In Decatur?

Blue Cross of Blue Shield of IL, NM and Health Alliance offer HMO Medicare Advantage plans in Macon County for 2021.

Blue Cross Medicare Advantage Basic (HMO)

This plan has a $20 premium and a $0 health and drug deductible. The in-network maximum out-of-pocket is $5,500.

Some brief plan highlights:

  • $0 copay for primary doctor visits
  • $40 copay for specialist visits
  • $40 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, fitness benefits, over-the-counter drugs, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears no doctors in Decatur, IL accept this plan. The closest general primary care physician listed is in Kankakee, IL.

This plan is brand new to Macon County, which could explain why no doctors are currently listed in the provider directory. Always check with your physician to find out if they accept the plan.

Health Alliance Medicare HMO Basic (HMO)

This plan is $0 premium, has a $0 health deductible, and comes with $6,700 in-network out-of-pocket maximum. The plan does not come with drug coverage, so if you don’t have some other form of prescription drug coverage, this plan won’t work for you.

Some brief plan highlights:

  • $25 copay for primary doctor visits
  • $50 copay for specialist visits
  • $65 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. 

This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare HMO Basic Rx (HMO)

This plan has a $32 monthly premium, a $0 health and drug deductible, and a $6,700 in-network out-of-pocket maximum.

Some brief plan highlights:

  • $15 copay for doctor visits
  • $50 copay for specialist visits
  • $65 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare POS Basic Rx (HMO-POS)

This plan has a $51 monthly premium, a $0 health and drug deductible, a $6,700 in-network out-of-pocket maximum, and an $11,300 in and out-of-network maximum.

Some brief plan highlights:

  • $15 copay for in-network doctor visits
  • $50 copay for in-network specialist visits
  • $65 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare POS Basic (HMO-POS)

This plan has a $23 monthly premium, a $0 health deductible, and a $6,700 in-network out-of-pocket maximum. The in and out-of-network maximum is $11,300.

This plan does not include drug coverage.

Some brief plan highlights:

  • $35 copay for in-network primary doctor visits
  • $50 copay for in-network specialist visits
  • $65 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare HMO 40 Rx (HMO)

This plan has a $73 monthly premium, a $0 health and drug deductible, and a $4,700 in-network out-of-pocket maximum.

Some brief plan highlights:

  • $10 copay for doctor visits
  • $45 copay for specialist visits
  • $40 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare POS 30 Rx (HMO-POS)

This plan has a $105 monthly premium, a $0 health and drug deductible, a $5,500 in-network out-of-pocket maximum, and an $11,300 in and out-of-network maximum.

Some brief plan highlights:

  • $15 copay for in-network doctor visits
  • $45 copay for in-network specialist visits
  • $40 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare HMO 20 Rx (HMO)

This plan has a $125 monthly premium, a $0 health and drug deductible, and a $4,000 in-network out-of-pocket maximum.

Some brief plan highlights:

  • $20 copay for doctor visits
  • $40 copay for specialist visits
  • $25 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

Health Alliance Medicare POS 10 Rx (HMO-POS)

This plan has a $165 monthly premium, a $0 health and drug deductible, a $4,500 in-network out-of-pocket maximum, and an $5,750 in and out-of-network maximum.

Some brief plan highlights:

  • $20 copay for in-network doctor visits
  • $30 copay for in-network specialist visits
  • $30 copay for urgent care
  • $90 copay for ER
  • Extra benefits included (plan limits apply): hearing, dental, vision, acupuncture, fitness benefits, telehealth, worldwide emergency coverage, and meals for a short duration.

The best way to find out if your prescriptions are affordable under this plan is to have your agent run a plan comparison. Every Medicare Advantage Prescription Drug plan has a different formulary, and they put different drugs in different pricing tiers.

Based on our research, it appears only one doctor in Decatur, IL accepts this plan. This is fairly typical for Health Alliance, and it’s why we don’t currently sell Health Alliance Medicare Advantage plans.

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Cost Medicare Plans In Decatur, IL for 2021

There is one Cost plan available in Macon County for 2021. 

What’s a Cost Plan?

These plans are only available in some states. You can see any doctor or other provider that works with Medicare. If you go to a provider outside the network, Original Medicare covers those services. You'll pay the Hospital (Part A) and Medical (Part B) deductibles and coinsurance, usually 20% of the Medicare-approved amount, for those services.

You can join a Cost Plan without drug coverage anytime the plan's accepting new members. You can also join a separate Drug Plan when you enroll.

Which Insurance Companies Offer a Cost Plan In Decatur?

Medical Associates Health Plan, Inc. is the only company offering a Cost plan in Macon County for 2021.

Live360 Health Plan (Cost)

This plan has a $147 monthly premium and a $0 health deductible.

This plan doesn’t include drug coverage, but you are allowed to purchase a separate Medicare Part D drug plan.

Some brief plan highlights:

  • No out of pocket costs on Medicare eligible services
  • No deductibles, no copays, no coinsurance when using a network provider
  • Nationally ranked health plan
  • Worldwide emergency coverage

Live360 Health Plan features providers from HSHS Medical Group, Prairie Cardiovascular, Springfield Clinic, SIU Medicine, and many other primary care and specialty providers in the area. Click here to view the provider directory.

If you use providers that are not in the network, the plan may not pay for Medicare-eligible services and Original Medicare cost sharing would apply.

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Which Medicare Advantage Plans Do We Recommend?

The most competitive plans in Macon County, in our opinion, are the Aetna Medicare Value Advantra and the Lasso Healthcare MSA (either of the two MSA plan options).

These plans are $0 premium and have flexible networks. Aetna has the benefit of having a national network, so you have more flexibility to travel or go to another state for part of the year. Lasso Healthcare has the benefit of having no provider network.

In both cases, we still recommended checking with your preferred providers to make sure they accept the plan. We recommend this before enrolling in any Medicare Advantage plan.

In addition, the Lasso Healthcare MSA is very unique and arguably offers the most attractive “extra” – money! Each year, the member is given a deposit to use towards qualified medical expenses. That money rolls over to the next year if you don’t use it.

While we highly recommend a Medicare Supplement to many of our clients, these are the two options worth considering on the Medicare Advantage side for 2021 (in our opinion).

For more information, give us a call at 217-423-8000 today!

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