One Size Does Not Fit All in Medicare

Bren Sheriff, CSA
Bren Sheriff, CSA

One Size Does Not Fit All in Medicare

If you are reading this article, you probably live in Illinois.  If so, I hope that the following information will help those enrolling or re-enrolling in Medicare to make an informed decision on the plan that best fits their healthcare needs.

During the upcoming Medicare open enrollment period (October 15 to December 7, 2025, is the time to assess what your healthcare needs are.  When considering what plan is best for you depends on your health, your prescriptions, and how much flexibility you have in your monthly budget.  Walk with me through some of the most common options available in Illinois.

First up: Original Medicare (Part A+Part B).  In most cases. Part A is premium-free if you or your spouse paid Medicare taxes for 40 or more quarters (approx. 10 years). But Part B is rising; the standard premium in 2026 is projected to climb to $206.50/month, about a 11.6% increase from 2025.  There will also be a deductible increase: many sources expect the Part B deductible to go from $257 to about $288.

Original Medicare gives you the broadest access to providers statewide and beyond Illinois borders, but by itself it leaves yuexposed to coinsurance, copays, and deductibles – costs that can balloon if your health care needs increase.

That’s where Medigap (Medicare Supplement) policies help bridge coverage gaps.  In people with healthcare needs for multiple specialist visits, recurring tests, or hospital stays often select plans like Part G.  Premiums vary (city, age, insurer matter), and in 2026 premiums for this coverage is expected to increase by 8-12% or more.  The trade-off: steady, predictable costs for people needing a lot of healthcare services.

Then there is Medicare Advantage- MA(Part C)-the bungled option. Many Illinois Advantage plans charge modest or even $0 extra premiums beyond the Part B payment.  The Illinois average MA premiums have remained low: 2025, the average was around $10.29/month.  Some sources suggest that Illinois Advantage plan costs may show an increase in 2026, due to a projected decrease in federal payments to MA plans in Illinois.  But remember, advantages come with conditions-you must stay in network, get prior authorization for some services, and your prescription coverage is tied to your plan’s pharmacy service.

Speaking of pharmacy (prescription drugs) service, Part D (PDP), major changes are coming in 2026.  The base Part D premium is projected to rise to $33.99/month.  Additionally, deductibles may also climb to a maximu, of $615, and the out-of-pocket cap (highest amount you will have to pay) for prescription costs will increase to $2,100.  If you rely on multiple prescriptions, your choice of plan (or MA-PD combo) can heavily influence your total costs.

So, what fits whom here in Illinois?

  • If you are relatively healthy, take few meds, and need to tightly manage your monthly budget: a MA plan with low or no extra premium may be your best bet – providing both your doctor and prescriptions are covered.
  • If you expect high medical usage – frequent specialists, labs, hospital stays – then Original Medicare + a Medigap Plan + a strong Part D option is usually best suited to meet your healthcare needs. You’ll pay more upfront in premiums, but your financial exposure in declining health years decreases.
  • If prescriptions dominate your health costs, compare MA-PD options vs. Original Medicare + standalone (PDP) – select a plan what covers your meds best.
  • If you split time between Illinois and another state (snowbird or extensive domestic travel), Original + Medigap likely offers more nationwide flexibility than network-bound MA.

When you talk with your agent, keep in mind income surcharges (IRMAA) also apply to Part B and D for higher income individuals, so have your past tax returns available.

The bottom line: make sure that your Medicare choices match your health, location, and budget.  As the open enrollment window approaches, total up expected premiums + copays + drug costs, check doctor & drug coverage, and see what best fits your needs. Because when it comes to health coverage, truly “One Size Does Not Fit All” – especially if you are eligible for Medicare coverage in Illinois.

Bren Sheriff, CSA


THIS WEEK’S QUIZ: Does Social Security have a death benefit?

Answer to the last quiz: Generally, U S citizens over 65 years old that have contributed to social security for 40 quarters and generally those with certain disabilities of any age after receiving Social Security Disability Insurance payments for 25 months.  ALS is automatic, no waiting period

Questions: 773-817-0601 or basheriff1@gmail.com

Disclaimer: The illustrations presented in this column are not, nor are they intended to be, legal, financial, or any other licensed professional advice, you should contact the licensed professional of your choice for advice on your individual situation.


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