Keeping Networks Is a Good Thing

Sometimes, the more things change, the more they remain the same. This seems especially true when talking about Illinois health insurance.

It wasn’t too long ago that Blue Cross and Blue Shield of Illinois told their members that one of their hospitals, St. John’s, was making the decision to discontinue its status as a Medicare Select contracting network hospital. That decision, which caused a lot of pandemonium, was supposed to kick-in on the 17th of June, 2009.

Of course the implications for a decision like this that affected Illinois health insurance echoed far and wide, with the major complaint, aside from what people would do to replace the service they were getting, was having to change to another type of plan that was more expensive. An agreement was ironed out where Blue Cross Blue Shield helped people who’d lost their original Illinois health insurance plans to get reinstated and credited for premium increases that arose due to changing plans.

This kind of thing raises the very specter of changes coming to the health care system over the next few years. And along with the changes come the questions of whether or not the changes will be beneficial. This is one of the toughest questions to answer with any degree of certainty.

It would involve having a crystal ball and a system that would address everyone’s medical needs; a system that would be affordable and accessible to all. Comprehensive health care reform is supposedly coming, and likely won’t come any too soon given the current state of the health system. In the meantime we muddle along with what works the best at any given time, and that includes Medicare Select.

Medicare Select is basically an Illinois health insurance Medicare supplemental insurance plan that provides you with choices. They also have the advantage of being priced at an even more reasonable level than the usual versions of Medigap insurance policies. The one major difference that you might want to be aware of is that Medicare Select acts like a managed care plan. That simply means that you’d have to use doctors and hospitals that are in an Illinois health insurance network. In addition, your insurance company will only pay full benefits if you got your medical care from a preferred health provider who is, once again, a part of the insurance company’s designated network.

Let’s take a quick look at an example. If you go to see a preferred provider physician, Medicare pays the approved charges. Your supplemental insurer pays the full benefits under your policy. However, if you choose to use services outside the plan network, the plan may deny the claim entirely or only pick up a very limited portion.

So really, there are three things you need to know and remember about a Medicare Select plan. The first thing is that it is considered to be an Illinois health insurance supplemental product, just about the same as Medigap insurance. In other words, when you buy a Medicare Select policy, you’re getting a standard Medigap plan. And, as we already pointed out (but it’s worth mentioning again) pretty much the only difference between a standard Medigap policy and a Medicare Select policy is that the Select policies are managed care plans. To get full benefits from the Select plans, you will need to use designated hospitals, clinics and even certain doctors. This will explain why these plans are priced lower than similar Medigap policies.

Something else you also need to know about Medicare Select plans is that they are typically only offered in larger cities in Illinois. If you live outside a large city, you may have other options. To find out what those options are, contact an expert Illinois insurance agent in your area.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit

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