Medicare

Medicare

All Memorial Health affiliates accept Medicare coverage. If you are covered by Medicare, we will submit your claims to Medicare on your behalf.  If you have a policy secondary to Medicare, we will bill your supplemental insurance carrier for you as well.  

We understand that Medicare terms can be confusing. Let us help you break down some the terms used within Medicare: 

  • “Part A” refers to the inpatient component of your Medicare coverage.
  • “Part A deductible” is the amount you would pay before your Medicare coverage would apply to your hospitalization event. The Part A deductible applies from the initial day of hospitalization to day 60.
  • “Part A daily coinsurance” is the additional per-day amount you would pay for hospitalization from day 61 to day 90.
  • “Part A Lifetime Reserve” is the additional per-day amount you would pay for hospitalizations from day 90 to day 150.
  • “Part B deductible” is the amount you would have to pay before your Medicare Part B coinsurance would apply.
  • “SNF daily coinsurance days” is the amount you would pay per day for a skilled nursing facility (SNF) stay.

To help summarize, please see the table below, which breaks out these amounts for you. For ease, we have included the current and prior year amounts for reference. These amounts are determined at the national level by the Centers for Medicare and Medicaid Services (CMS).

Deductible/CoInsurance Rates

The deductible and daily coinsurance rates for (traditional) Medicare are:

Medicare Benefit Year Part A Deductible Part A
Daily Co-Insurance
Days 61-90
Lifetime Reserve
Days 91-150
Part B Deductible SNF Daily
Co-Insurance days
Days 21-100
2021 $1484 $371 $742 $203 $185.50
2020 $1408 $352 $704 $198 $176

Additional information about Medicare premiums, deductibles and coinsurance rates is available on Medicare.gov.

We understand life gets busy!

To help you keep up to date on the re-enrollment cycle, please create a calendar notification by clicking the link below.

Calendar Notification

Medicare Advantage

Medicare Advantage Plans are offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits.  Alongside Medicare Advantage, you may hear these plans referred to as “Part C” plans. In many cases, these plans will also offer prescription (or “Part D”) plans as well.  Note that Medicare Advantage plans are administered by insurance companies and have different kinds of benefit designs. Medicare Advantage plans can be purchased either on an individual basis or through your employer. 

For State of Illinois retirees within our service area, Medicare Advantage plans are offered on a group basis through the Total Retiree Advantage Illinois (“TRAIL”) program. We encourage you review the State of Illinois website for more information on benefit plans offered. Memorial Health cannot answer any specific benefit questions and we encourage you to review the state’s website for additional plan details. Finally, we encourage you review our Insurance page for information on plans accepted through the TRAIL program. 

For non-State of Illinois retirees within our service area, Memorial Health accepts a number of Medicare Advantage plans. Plans we accept are found on our Insurance page.

Enrollment timelines for those wishing to choose a traditional Medicare or Medicare Advantage plan are set by CMS. Information on switching plans and enrollment periods is included below from Medicare.gov:

  • To switch to a new Medicare Advantage plan: Simply sign up with the plan you choose during one of the enrollment periods. Doing so will disenroll you from your current plan when the new plan coverage begins.
  • To switch to traditional Medicare: Contact your current plan or call 1-800-MEDICARE.

There are three windows in which you can gain coverage:

  • Initial Enrollment Period: When you first become eligible for Medicare, you can join a plan.
  • Open Enrollment Period: From Oct. 15 to Dec. 7 each year, you can join, switch or drop a plan. Coverage selected will begin on Jan. 1. 
  • Medicare Advantage Open Enrollment Period: From Jan. 1 to March 31 each year, individuals enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan OR switch to traditional Medicare once during this time.

Unfortunately, we are unable to discuss benefit and coverage options with you. This is to ensure that you and your family make an independent decision about which plan best meets your needs. We encourage you to consult each plan’s website to educate yourself on the variety of options available, or consult with an independent Medicare broker to assist you in the decision-making process. 

Medicare Advantage 

Memorial Health will routinely provide information here on updated insurance coverage options. This is intended to give our patients and their families the most up-to-date coverage information to aid you in the decision-making process. While Memorial Health System cannot discuss plan-specific benefit and covered options, we are can communicate changes in the plans we accept.

Please check this section for the latest news regarding Medicare Advantage plans accepted at Memorial Health. If you have question about which plans Memorial Health accepts, please feel free to contact our Managed Care Department at 217-788-4448 during normal business hours. We will be happy to assist you.

We understand that life is busy!

To help you keep up to date on the Medicare Managed Care re-enrollment cycle, please create a calendar notification by clicking the link below.

Calendar Notification

Other Important Information

If you already receive benefits from Social Security

If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about three months before your 65th birthday. For example, if your 65th birthday is Feb. 20, 2004, your Medicare effective date would be Feb. 1, 2004. (Note: If your birthday is on the first day of any month, Medicare Part A and Part B will be effective the first day of the prior month. For example, if your 65th birthday is Feb. 1, 2004, your Medicare effective date would be Jan. 1, 2004.)

If you are not getting Social Security benefits

If you are not getting Social Security benefits, you can apply for retirement benefits and Medicare online. If you would like to file for Medicare only, you can apply by calling 800-772-1213

If you are under 65 and disabled

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement.

You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about three months before your Medicare entitlement date.

Note: If you are under age 65 and have Lou Gehrig's disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.

For more information about enrollment, call the Social Security Administration at 800-772-1213, 877-279-9504 for the Springfield office or visit their website at SocialSecurity.gov.

Should I sign up for Medicare Part A and B if I am still working?

Even if you keep working after you turn 65, you should sign up for Medicare Part A.

If you have health coverage through your employer or union, Part A may still help pay some of the costs not covered by your group health plan. Call the Social Security Administration at 800-772-1213, 877-279-9504 for the Springfield office to sign up.

However, you may want to wait to sign up for Medicare Part B if you or your spouse are working and have group health coverage through you or your spouse's employer or union. (See note below if you work for a small company.) You would have to pay the monthly Medicare Part B premium, and the Medicare Part B benefits may be of limited value to you as long as the group health plan is the primary payer of your medical bills.

Note: If you are age 65 or older and working for a small company (fewer than 20 employees), you should talk to your employee health benefits administrator before making any decision not to take Medicare Part B. If your employer has fewer than 20 employees, Medicare is the primary payer and your group health insurance would be the secondary payer.


Advance Beneficiary Notice

An Advanced Beneficiary Notice (ABN) is a form designed by Medicare that is presented to you before receiving certain services. It is intended to notify you that:

  • Medicare may deny the procedure or service.
  • You will be responsible for the full payment if Medicare denies payment.

You have the option to receive or refuse the services.

If you sign the ABN and choose to have the services, you will be responsible for the charges. An estimate of the cost of the service will be printed on the ABN.

  • If you chose to have the services but refuse to sign the ABN, two witnesses will sign the ABN form and you will most likely be held responsible for those charges.
  • If you chose to not sign and refuse services, you should notify your physician of your decision.

Contact us