Illinois has a large and competitive Medicare Advantage market in 2026, with 157 plans from 17 carriers available across all 102 counties. About 830,000 Illinoisans chose Medicare Advantage in 2026, representing roughly 34% of the state's 2.44 million Medicare-eligible residents. That penetration rate is below the national average of about 54%, leaving significant room for growth as more beneficiaries learn about the plan options available to them.
What makes Illinois distinct is the contrast between its large urban market and its rural downstate counties. Cook County (Chicago) offers 53 plans with a low average premium of $7/mo, while rural southern Illinois counties like Alexander County have 18 plans and somewhat higher averages. Humana, Aetna, and UnitedHealthcare dominate statewide. Blue Cross Blue Shield of Illinois covers 100 of 102 counties. Essence Healthcare, a regional carrier based in St. Louis, has the state's highest-rated HMO plans (4.5 stars) and focuses on the Chicago metro and downstate markets.
This guide covers the 2026 Illinois Medicare Advantage market: plan count, top carriers, what to look for when comparing plans, and the key enrollment windows. The Annual Election Period runs October 15 to December 7, 2026, with coverage starting January 1, 2027. The Medicare Advantage Open Enrollment Period for existing MA members runs January 1 to March 31, 2026.
2026 Medicare Advantage Market Overview in Illinois
In 2026, Illinois has 157 Medicare Advantage plans available, with 830,000 beneficiaries enrolled (34% MA penetration). The average monthly premium is $9 and the statewide average Star Rating is 3.6.
Top Medicare Advantage carriers in Illinois (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 32 | 3.8 | $13/mo |
| Aetna | 27 | 3.5 | $11/mo |
| UnitedHealthcare | 23 | 4.1 | $21/mo |
| Blue Cross Blue Shield of Illinois | 19 | 3.0 | $8/mo |
| Essence Healthcare | 8 | 4.5 | $10/mo |
| Anthem Blue Cross and Blue Shield | 14 | 3.5 | $12/mo |
| HealthSpring | 10 | 3.8 | $0/mo |
| WellCare | 6 | 3.0 | $0/mo |
Source: CMS 2026 MA-Part D Landscape State Fact Sheet; NerdWallet Illinois Medicare Advantage 2026; The Pocket Protector Illinois Medicare 2026; BCBSIL press release Oct 2025; Essence Healthcare press release 2025
Plan Types in Illinois: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Illinois| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| PPO | 69 | $14/mo | Flexibility to see out-of-network providers; no referral required |
| HMO | 28 | $7/mo | Lower premiums, primary care referrals for specialists |
| HMO-POS | 22 | $8/mo | HMO with limited out-of-network access at higher cost share |
| Special Needs Plan - Chronic (C-SNP) | 13 | $0/mo | Chronic conditions: diabetes, heart disease, COPD, ESRD |
| Special Needs Plan - Dual (D-SNP) | 8 | $0/mo | Dual-eligible (Medicaid + Medicare); coordinated coverage |
| PFFS / Other | 17 | $12/mo | Private Fee-for-Service and miscellaneous plan types; less common |
PPO plans are the most common in Illinois (44% of plans), reflecting demand for out-of-network flexibility in a state where downstate residents often need to travel to metro Chicago for specialty care.
Source: The Pocket Protector Illinois Medicare 2026; CMS Medicare Plan Finder Q4 2025
County-Level Variance in Illinois
Plan availability in Illinois varies significantly from Chicago-area counties to rural downstate. Cook County has the widest selection; some far-southern counties have fewer than 20 plans. Premiums also spread by geography, with suburban Chicago counties often having the most competitive pricing.
Plan count and average premium by county in Illinois| County | Plans Available | Avg Premium |
|---|
| Cook County (Chicago) | 53 | $7/mo |
| DuPage County | 50 | $7/mo |
| Peoria County | 23 | $16/mo |
| Alexander County | 18 | $11/mo |
Plan counts and average premiums are from MedicareAdvantage.com county pages and CMS Medicare Plan Finder Q4 2025 data. Run a ZIP-code search at medicare.gov for plans specific to your address.
Source: MedicareAdvantage.com county pages; CMS Medicare Plan Finder Q4 2025
What to Look For in a Medicare Advantage Plan in Illinois
Picking a Medicare Advantage plan in Illinois is not just about premium. Here is what matters for shopping in 2026:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital are in-network before enrolling. Networks vary by county and carrier. If you receive care at a Chicago academic medical center like Northwestern, Rush, or University of Illinois Hospital, verify that hospital is in your plan's network.
- Prescription drug coverage (formulary). Most Illinois MA plans include Part D drug coverage. Check that your specific medications are on the plan's formulary. The 2026 Part D out-of-pocket cap is $2,100, a major improvement from prior years thanks to the Inflation Reduction Act.
- Star Ratings. CMS rates every MA plan 1-5 stars annually. Plans rated 4 stars or higher receive CMS bonus payments that often fund richer benefits. In Illinois, Essence Healthcare HMO (4.5 stars) and UnitedHealthcare (4.1 stars) are the top-rated carriers. The statewide average is 3.6 stars.
- Extras (dental, vision, hearing, fitness, OTC). Most Illinois MA plans include supplemental benefits Original Medicare does not cover. Check the annual limits carefully: some plans offer only a cleaning and exam for dental while others cover crowns and partials. OTC allowances of $25-$100/month for health products are increasingly common.
- Maximum out-of-pocket (MOOP). All MA plans cap your annual in-network spending. The 2026 federal MOOP ceiling for in-network MA is $9,250 (down $100 from $9,350 in 2025). Cook County plans average around $4,833 in-network MOOP. Original Medicare has no annual cap on your costs.
- Prior authorization. MA plans can require prior authorization for procedures, advanced imaging, and specialty referrals. Ask about the plan's prior authorization burden before enrolling, especially if you have ongoing specialist relationships or expect surgery in 2026.
- Rural access considerations. If you live in downstate Illinois, verify that your nearest hospital is in-network. Some rural counties have limited local provider networks, which can mean driving further for in-network care. PPO plans offer more flexibility to see out-of-area providers at a higher cost share.
Key Medicare Dates in Illinois
Medicare and Medicare Advantage have several enrollment windows. Missing a window can mean waiting months or facing coverage gaps.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change your Part D standalone plan. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you are already in a Medicare Advantage plan, you can switch to a different MA plan or return to Original Medicare. One switch only during this period.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Begins 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original Medicare plus standalone Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for Medicaid (dual eligible), or a plan losing its CMS contract. Typically a 2-month window after the event.
Notable Extras in Illinois Plans
Illinois Medicare Advantage has a few state-specific features worth knowing:
- Illinois Medicaid (HFS) and dual-eligible D-SNPs: Illinois Department of Healthcare and Family Services (HFS) administers Medicaid. Residents who qualify for both Illinois Medicaid and Medicare are dual eligible and may enroll in a D-SNP plan. In 2026, Illinois has 8 D-SNP plans available with $0 premiums, $0 copays on primary care, and coordinated drug benefits. WellCare is launching an enhanced integrated duals model in Illinois for 2026. Check medicare.gov Plan Finder to see which D-SNPs are available in your county.
- Illinois TRAIL (Total Retiree Advantage Illinois): Illinois state retirees and their dependents have access to TRAIL, a state-sponsored Medicare Advantage program offered through CMS-contracted plans. TRAIL plans cover state retirees who are Medicare-eligible, typically at lower cost than individual market plans. If you are a former Illinois state employee, compare TRAIL plan options alongside individual market plans before AEP.
- Get Covered Illinois and Medicare: Illinois runs Get Covered Illinois as its state-based ACA marketplace, but this marketplace is for people under 65. If you are 65 or older and Medicare-eligible, you shop for Medicare Advantage directly through medicare.gov or with a licensed insurance agent. The Illinois Department on Aging's SHIP (State Health Insurance Assistance Program) provides free counseling to help you compare Medicare plans at no cost.
Medicare Advantage vs Original Medicare in Illinois
Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives you freedom to see any provider who accepts Medicare nationwide, with no prior authorization for most services. In Illinois, Medigap premiums plus Part D typically run $150-$350/month depending on your plan, age, and county. Medicare Advantage bundles hospital, medical, and usually drug coverage into one plan at an average of $9/month statewide, but you accept a defined provider network and prior authorization requirements.
For downstate Illinois residents who need to travel to Chicago for specialized care, Original Medicare plus Medigap is often the more predictable choice, since your coverage works the same anywhere in the country. For Chicago metro residents who have local access to large hospital networks and specialist groups, MA plans offer significantly lower out-of-pocket costs with the added benefits of dental, vision, and fitness programs.
One important caveat: if you switch from MA back to Original Medicare in Illinois, Medigap insurers are not required to sell you a policy without medical underwriting outside of your original 6-month Medigap open enrollment window (which starts when you first enroll in Part B at 65). There is no Illinois birthday rule like California's that would let you switch Medigap plans without underwriting each year. Plan accordingly before moving to MA if you may want Medigap access later.
How Star Ratings work and what they mean for Illinois
CMS rates every Medicare Advantage plan 1 to 5 stars each October based on roughly 40 quality measures: chronic disease management, customer service, member complaints, Part D drug safety, and preventive care rates. Plans rated 4 stars or higher receive bonus payments from CMS, which plan sponsors often use to fund richer benefits, lower premiums, or zero-cost supplemental services — including dental and vision benefits — for members.
Illinois's statewide average Star Rating of 3.6 is slightly below the national average of about 3.8. The standout carrier is Essence Healthcare, whose HMO plans have held 4.5 stars for multiple consecutive years and whose PPO line dropped to 3.0 stars for 2026 (was 4.0 in 2025). UnitedHealthcare's Illinois plans average 4.1 stars. One Illinois plan holds a 5-star rating for 2026, which triggers a Special Enrollment Period, Special Enrollment Period (5-Star SEP) allowing any Medicare beneficiary to switch into it once per calendar year between December 8, 2025, and November 30, 2026.
How Star Ratings work and what they mean for Illinois detail| Carrier | Plan Type | Star Rating | Avg Premium |
|---|
| Essence Healthcare | HMO | 4.5 | $10/mo |
| UnitedHealthcare | HMO-POS / PPO | 4.1 | $21/mo |
| Humana | HMO / PPO | 3.8 | $13/mo |
| HealthSpring | HMO / PPO | 3.8 | $0/mo |
| Aetna | HMO-POS / PPO | 3.5 | $11/mo |
| BCBS Illinois | HMO / PPO | 3.0 | $8/mo |
Star Ratings are CMS 2026 contract-level ratings. Individual plan ratings within a carrier may vary. Source: NerdWallet Illinois MA 2026; MoneyGeek Illinois MA 2026.
How to enroll in Medicare Advantage in Illinois
There are four ways to enroll in a Medicare Advantage plan in Illinois. First, go to medicare.gov Plan Finder and enter your ZIP code to see every plan available where you live, with full details on premiums, copays, drug coverage, and Star Ratings. Second, call 1-800-MEDICARE (1-800-633-4227) to enroll by phone with a CMS representative. Third, contact a licensed insurance agent or broker who is authorized to sell MA plans -- agents are paid by the carrier and their help is free to you. Fourth, contact the Illinois Department on Aging's SHIP (State Health Insurance Assistance Program) at 1-800-252-8966 for free one-on-one counseling with a trained volunteer who has no financial interest in which plan you pick.
Before you pick a plan, gather three things: a list of your current medications (name, dose, frequency), the names of every doctor and hospital you want to keep in-network, and your Medicare card with your Medicare Beneficiary Identifier (MBI). With those three items, any enrollment tool or agent can run a complete comparison that accounts for your real costs, not just the headline premium.
Frequently Asked Questions
How many Medicare Advantage plans are available in Illinois in 2026?
Illinois has 157 Medicare Advantage plans available statewide from 17 carriers in 2026, down from 165 plans in 2025. The number available in your specific ZIP code will be lower. Cook County (Chicago) has 53 plans; DuPage County has 50; rural downstate counties may have 16 to 23 plans. Run a search at medicare.gov using your ZIP code to see your exact options.
What is the average Medicare Advantage premium in Illinois for 2026?
The statewide weighted-average Medicare Advantage premium in Illinois is approximately $9 per month in 2026, below the national MA average of $14. More than half of all Illinois MA plans carry a $0 monthly premium beyond the standard Part B premium. Chicago-area plans average around $7-$8/month; downstate and rural counties average higher, around $11-$16/month.
Who are the top Medicare Advantage carriers in Illinois for 2026?
By plan count, Humana leads Illinois with 32 plans, followed by Aetna (27 plans), UnitedHealthcare (23 plans), Blue Cross Blue Shield of Illinois (covering 100 of 102 counties), and Anthem Blue Cross and Blue Shield (14 plans). Essence Healthcare has the highest Star Rating (4.5 stars for HMO plans) and serves Chicago and downstate markets. UnitedHealthcare has the highest Star Rating among the large national carriers at 4.1 stars.
When can I enroll in Medicare Advantage in Illinois?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage beginning January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by events like moving, losing employer coverage, or qualifying for Medicaid. Existing MA enrollees can switch plans during the MA Open Enrollment Period from January 1 to March 31, 2026.
Does Illinois have a free Medicare counseling service?
Yes. The Illinois Department on Aging runs the State Health Insurance Assistance Program (SHIP), which provides free, unbiased Medicare counseling by trained volunteers. SHIP counselors can help you compare Medicare Advantage, Medigap, and Part D plans with no financial interest in your choice. Call 1-800-252-8966 or visit ilaging.illinois.gov to find a local SHIP counselor.
What is the difference between HMO, PPO, and HMO-POS plans in Illinois?
HMO plans (28 plans in IL) require you to use in-network providers and get referrals to see specialists. They typically have the lowest premiums. PPO plans (69 plans, the largest group in IL) let you see out-of-network providers at higher cost share and don't require specialist referrals -- useful if you travel or need specialty care outside your local network. HMO-POS plans (22 plans) are a hybrid: they work like an HMO in-network but allow limited out-of-network access for a higher copay.
Can I get a Medicare Advantage plan if I qualify for both Medicare and Medicaid in Illinois?
Yes. If you qualify for both Illinois Medicaid (administered by the Department of Healthcare and Family Services, HFS) and Medicare, you are dual eligible and may enroll in a Dual Special Needs Plan (D-SNP). Illinois has 8 D-SNP plans available in 2026. D-SNPs typically have $0 premiums, $0 copays for primary care, and coordinated Medicaid-Medicare benefits. WellCare is launching an enhanced integrated duals model in Illinois for 2026. Use the Plan Finder at medicare.gov filtered by D-SNP to see your county's options.
Does Medicare Advantage cover dental, vision, and hearing in Illinois?
Most Illinois Medicare Advantage plans include some dental, vision, and hearing benefits, which Original Medicare does not cover. Coverage scope varies widely: basic plans may cover only a preventive dental exam and cleaning, while comprehensive plans cover fillings, crowns, and partial dentures. Essence Healthcare, UnitedHealthcare, and several Humana plans offer stronger supplemental benefit packages. Always read the Evidence of Coverage document for annual benefit limits before enrolling.
