Medicare Advantage in Cook County (2026): What You Need to Know
Fast facts for 2026 (Cook County)
When you can shop: The Medicare Plan Finder posts 2026 plan data October 1, 2025, and Open Enrollment runs October 15–December 7, 2025 (for coverage that starts January 1, 2026).
Overall outlook: CMS says the MA and Part D programs are expected to remain stable in 2026; 2026 Star Ratings post on or around October 9, 2025.
Where to see plans: Click Here to view Cook County options and filter by doctors, drugs, and costs. Medicare
Statewide context: CMS’s 2026 state fact sheet shows 157 MA plans available in Illinois; Cook County typically has one of the most expansive selections in the state. Use our services here for the exact Cook County count.
What’s new or different in 2026
Stable environment, modest payment increase. CMS finalized policies projecting a 5.06% increase in MA payments year-over-year for 2026, which generally supports plan participation and can help keep choices stable. “Stable” doesn’t mean no changes—some carriers adjust lineups by county—but it signals a steady market.
MedicareCenter upgrades. For 2026, adds:
In-tool provider directory information for MA plans (helps you confirm your doctors and hospitals).
Expanded supplemental-benefit displays (clearer dental/vision/hearing/OTC detail and cost-sharing).
A new AI-powered drug search tool to speed up formulary checks.
Part D redesign continues. If you choose an MA-PD (an MA plan that includes Part D), remember the Part D benefit is redesigned under the Inflation Reduction Act. For 2026, the annual out-of-pocket maximum for Part D drugs is $2,100—once you hit it, you don’t pay copays/coinsurance for covered Part D drugs for the rest of the year.
Choosing between HMO, PPO, HMO-POS, and SNPs
HMO (Health Maintenance Organization). Typically offers the lowest premiums (often $0). You pick a primary care provider (PCP) and usually need referrals for specialists. Out-of-network care is generally not covered except for emergencies. Good if your doctors/hospitals are in the network and you like coordinated care.
PPO (Preferred Provider Organization). You usually pay a higher premium than HMO, but you can see out-of-network providers (at higher cost). Referrals often not required. Good if you want more flexibility with specialists and travel.
HMO-POS (HMO with Point-of-Service). An HMO with limited out-of-network allowances at preset copays. Useful if one key provider is occasionally out-of-network but you still want a lower-premium HMO structure.
SNPs (Special Needs Plans). Tailored MA plans for people who:
D-SNP: Qualify for Medicaid/Extra Help (dual-eligible).
C-SNP: Live with certain chronic conditions (e.g., diabetes, COPD, heart failure).
Eligibility comes first—you must meet the SNP criteria to enroll. In Cook County, multiple D-SNP and C-SNP options are typically available; check your eligibility on Plan Finder.
Key costs to compare (no hype, just the essentials)
When you compare plans in Cook County, focus on these six cost buckets (Plan Finder shows all of them for 2026):
Monthly premium (many $0 options exist).
MOOP (maximum out-of-pocket) for medical care—your annual safety cap for in-network spending.
Primary/specialist copays and urgent care copays.
Inpatient hospital cost structure (per day vs. per stay).
Drug costs (Tier 1–3 copays, deductible, preferred pharmacies).
Supplemental benefits that you actually use (e.g., dental/vision/hearing, OTC allowance, transportation), noting that 2026 Plan Finder will show more detailed cost-sharing for these extras.
For MA-PDs, remember the 2026 Part D OOP cap is $2,100—but you still need to compare monthly drug costs, tiers, and pharmacy networks to estimate your total year-ahead spending.
Enrollment windows & switching rules
AEP (Annual Enrollment Period): Oct 15–Dec 7, 2025 — Enroll in, switch, or drop an MA or Part D plan for Jan 1, 2026 start.
OEP (MA Open Enrollment Period): Jan 1–Mar 31, 2026 — If you’re already in an MA plan, you may switch to a different MA plan or go back to Original Medicare once.
Special Enrollment Periods (SEPs): Move, loss of Medicaid/LIS, 5-Star plan access (if available), and qualifying C-SNP diagnoses can trigger SEPs. Check Medicare & You 2026 for rules and proof you’ll need.
Free, unbiased help: The Illinois Senior Health Insurance Program (SHIP) provides no-cost counseling. Call 1-800-252-8966 (711 TRS) or visit the Illinois Department on Aging site for assistance. Illinois Department on Aging
Cook County checklist (save or print)
Confirm your doctors/hospitals are in-network (use the 2026 Plan Finder’s built-in provider directory).
Check every prescription against the plan’s formulary and pharmacy network.
Compare MOOP and any prior authorization requirements for services you use often.
If you qualify for Extra Help or Medicaid, apply before you pick a plan; D-SNPs may fit if you’re dual-eligible.
Re-check during AEP even if you’re happy now—costs, networks, and extras can change each year.
How to read the numbers (quick guide)
Start with counts: In the plan comparisons in MedicareCenter, tally MA-only vs MA-PD (drug-included) plans to see what share includes Part D.
Scan plan types: Count HMO/HMO-POS vs PPO, and list SNP categories (D-SNP, C-SNP).
Look for $0 premiums: The CMS fact sheet shows widespread $0 premium access statewide; confirm Cook County options in Plan Finder.
Check 2026 Stars: After Oct 9, 2025, note the share of plans with ≥ 4★ and use that to prioritize a shortlist.
Validate your network and drugs before you enroll (Plan Finder’s 2026 enhancements help here).
FAQs
When can I change my MA plan if I pick wrong during AEP?
If you’re enrolled in an MA plan on Jan 1, you can use MA OEP (Jan 1–Mar 31, 2026) to switch once (MA→MA or MA→Original Medicare). Drug coverage rules apply if you drop MA-PD.
Do $0 premium plans mean $0 costs?
No. Premiums can be $0, but you’ll still have copays/coinsurance and an annual MOOP for medical services. Compare copays and MOOP, not just the premium.
What’s different about drug costs in 2026?
The Part D annual out-of-pocket maximum is $2,100. After you hit it, you pay $0 for covered Part D drugs for the rest of 2026. MA-PDs use the same Part D rules.
Are premiums going up or down?
CMS projects a stable market and finalized a 5.06% payment increase to plans for 2026. Your premium can still vary by plan; always compare on Plan Finder.
Where can I get neutral help in Cook County?
Illinois SHIP counselors offer free, unbiased guidance: 1-800-252-8966 (711 TRS). They can help you read the Landscape counts, check networks, and compare drug costs. Illinois Department on Aging
Compliance & disclaimers
Use official sources: CMS, Medicare.gov, and IL SHIP are cited throughout. No carrier marketing claims are made here.
Things can change: Plan availability, premiums, benefits, networks, and Star Ratings can change each year. Always verify your doctors, drugs, and total costs on Medicare.gov before enrolling.
