Health & Benefits

"Dual-eligibles" are people receiving both Medicare and Medicaid. If this applies to you, you need to apply to enroll in a Prescription Drug Plan (PDP), also known as Medicare Part D. Medicare covers your prescription drugs. 

You will be randomly assigned to a plan covering your drug costs if you do not pick your preferred PDP. The plan should have a monthly premium at the average premium or less for available Illinois plans.

If you do not receive Medicaid, you may still be able to apply and enroll in a PDP. You must receive Supplemental Security Income (SSI) or help from the State paying your Medicare expenses through the Qualified Medicare Beneficiary Program (QMB) or one of the other Medicare savings programs. You can apply when your SSI or QMB becomes effective. Otherwise, when your SSI or QMB becomes effective, you will be given a random plan. This plan's monthly premium will be average or below average for plans available in Illinois.

You would also qualify for the Extra Help program to lower or cut Part D costs. 

Your coverage will begin on the first day of the month after the month you join.

Switching your Medicare Drug Plan

If, after being randomly enrolled in a Medicare prescription plan, and you would like to switch plans, you may do so during the annual Open Enrollment Period. The Open Enrollment Period is from October 15-December 7. Changes made during this time will take effect January 1 of the following year.

Beginning January 2025, “Dual-Eligibles” and those with Extra Help, will be eligible to make changes to their prescription drug plans once per month.  

If you have other prescription drug coverage

If you already have prescription drug coverage through an employer or union, check with your plan administrator. Your plan administrator can help you learn how your plan works with Part D. You need to learn whether your drug coverage is at least as good as Medicare’s standard drug coverage. This is called creditable coverage.

If you continue to have employee or retiree prescription drug coverage, you have 3 choices:

• If your plan covers as much as or more than Medicare’s standard drug plan, you can keep it. Here, you don't have to buy Medicare drug coverage. You can later enroll in a Medicare Part D plan without paying a penalty. This is as long as you enroll within 63 days of losing or dropping your coverage.
• If your plan covers less than Medicare’s standard drug plan, you can drop it and buy Medicare drug coverage. Be sure to find out if you can drop your current drug coverage without losing needed health benefits. Also know that if you drop your employer or union-based coverage, you may not be able to get it back. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents.
• If your plan works with Medicare’s drug coverage, you can keep it and buy Medicare drug coverage, as well.

If you have creditable coverage, do not sign up for Medicare Part D. Sign up only if you have received one-on-one, trustworthy counseling. Counseling can be from the Senior Health Insurance Program (SHIP) or another reliable source. Enrolling in Medicare Part D may end your current prescription drug coverage. You may risk losing your retiree or supplemental general health coverage as well.

Costs for dual-eligibles in long-term care

If you are dual-eligible, you will not pay any cost sharing in your Medicare PDP, even if you live in a Long-Term Care (LTC) Facility. This means that in addition to not having to pay a premium or a deductible, you will not have to pay any co-payments, either. Medicare pays for it all.

For purposes of Medicare drug coverage, LTC facilities include:

• Skilled or unskilled nursing facilities,
• Inpatient psychiatric hospitals, and
• Intermediate care facilities that are residential facilities for developmentally disabled adults (ICF/MR).