Medicare & Medicaid in Illinois (IL)
2026 healthcare costs, coverage, and spending data for Illinois.
$8,095
Spending/Capita
2,379,954
Medicare Enrollees
3,206,605
Medicaid Enrollees
6.8%
Uninsured Rate
Medicare Premiums in Illinois
Part B Premium
$185/mo
Part D Premium (Avg)
$66/mo
Medigap Premium (Avg)
$341/mo
Medicaid Expansion: Yes - Illinois expanded Medicaid under the ACA
Procedure Costs in Illinois
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Liver Transplant | $143,064 | $114,451 | $28,613 |
| Kidney Transplant | $98,213 | $78,570 | $19,643 |
| Heart Valve Replacement | $98,147 | $78,517 | $19,629 |
| Coronary Artery Bypass Graft (CABG) | $90,852 | $72,682 | $18,170 |
| Defibrillator Implantation (ICD) | $48,722 | $38,978 | $9,744 |
| Spinal Fusion | $44,125 | $35,300 | $8,825 |
| Total Knee Replacement | $41,485 | $33,188 | $8,297 |
| Total Hip Replacement | $28,352 | $22,682 | $5,670 |
| Sepsis Treatment | $27,799 | $22,239 | $5,560 |
| Pacemaker Implantation | $25,257 | $20,206 | $5,051 |
| Hip Fracture Repair | $24,544 | $19,635 | $4,909 |
| Carotid Endarterectomy | $24,022 | $19,218 | $4,804 |
| Laminectomy | $23,698 | $18,958 | $4,740 |
| Prostatectomy | $21,493 | $17,195 | $4,299 |
| Colectomy | $20,819 | $16,655 | $4,164 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Lithotripsy (Kidney Stones) | $8,132 | $6,506 | $1,626 |
| Arthroscopic Knee Surgery | $7,890 | $6,312 | $1,578 |
| Dialysis Access Surgery | $6,900 | $5,520 | $1,380 |
| TURP (Prostate) | $6,146 | $4,917 | $1,229 |
| Endoscopic Sinus Surgery | $5,579 | $4,463 | $1,116 |
| Hemorrhoid Surgery | $5,524 | $4,419 | $1,105 |
| Bunionectomy | $5,336 | $4,268 | $1,067 |
| Nasal Polyp Removal | $5,214 | $4,171 | $1,043 |
| Carpal Tunnel Release | $4,923 | $3,939 | $985 |
| Septoplasty | $4,220 | $3,376 | $844 |
| Tonsillectomy | $4,210 | $3,368 | $842 |
| Bronchoscopy | $4,073 | $3,258 | $815 |
| Varicose Vein Treatment | $3,648 | $2,919 | $730 |
| Adenoidectomy | $3,316 | $2,653 | $663 |
| Cataract Surgery (Outpatient) | $3,208 | $2,566 | $642 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $2,688 | $2,151 | $538 |
| CT Angiography | $1,824 | $1,459 | $365 |
| Nuclear Stress Test | $1,813 | $1,451 | $363 |
| MRI Brain | $1,473 | $1,178 | $295 |
| CT Scan Abdomen/Pelvis | $1,417 | $1,133 | $283 |
| MRI Spine (Cervical) | $1,364 | $1,091 | $273 |
| MRI Knee | $1,314 | $1,051 | $263 |
| MRI Shoulder | $1,313 | $1,051 | $263 |
| MRI Spine (Lumbar) | $1,272 | $1,018 | $254 |
| MRI Hip | $1,261 | $1,008 | $252 |
| Bone Scan | $1,151 | $921 | $230 |
| CT Colonography (Virtual) | $985 | $788 | $197 |
| CT Scan Chest | $858 | $687 | $172 |
| CT Scan Head | $697 | $558 | $139 |
| Fluoroscopy | $693 | $554 | $139 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $404 | $323 | $81 |
| Annual Wellness Visit | $299 | $299 | $0 |
| Psychiatry Visit | $295 | $236 | $59 |
| Mammogram (Screening) | $285 | $285 | $0 |
| Allergy Testing | $265 | $212 | $53 |
| Office Visit (New Patient) | $248 | $198 | $50 |
| Bone Density Test (DEXA Scan) | $218 | $175 | $44 |
| Mental Health Counseling | $207 | $165 | $41 |
| Shingles Vaccination | $169 | $169 | $0 |
| Wound Care Visit | $160 | $128 | $32 |
| Occupational Therapy Session | $152 | $121 | $30 |
| Office Visit (Established Patient) | $150 | $120 | $30 |
| Vision Exam (Diabetic) | $149 | $119 | $30 |
| Speech Therapy Session | $147 | $117 | $29 |
| EKG (Electrocardiogram) | $145 | $116 | $29 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| BNP (Heart Failure Marker) | $62 | $50 | $12 |
| Vitamin D Level | $62 | $49 | $12 |
| Blood Type and Crossmatch | $62 | $49 | $12 |
| Blood Culture | $54 | $43 | $11 |
| PSA (Prostate-Specific Antigen) | $50 | $40 | $10 |
| Troponin Level | $46 | $37 | $9 |
| Glucose Tolerance Test | $40 | $32 | $8 |
| Thyroid Panel (TSH) | $39 | $31 | $8 |
| Iron Studies (Ferritin) | $37 | $30 | $7 |
| B12 Level | $36 | $29 | $7 |
| Comprehensive Metabolic Panel | $33 | $26 | $7 |
| Hemoglobin A1C | $31 | $25 | $6 |
| Basic Metabolic Panel | $29 | $23 | $6 |
| Pap Smear Lab Processing | $27 | $21 | $5 |
| Lipid Panel | $27 | $21 | $5 |
Compare Illinois With Other States
Frequently Asked Questions
How much does Medicare spend per person in Illinois?
In 2026, the average Medicare spending per beneficiary in Illinois is $8,095.
How many people are enrolled in Medicare in Illinois?
Illinois has approximately 2,379,954 Medicare beneficiaries.
Did Illinois expand Medicaid?
Yes, Illinois expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in Illinois?
The uninsured rate in Illinois is 6.8%.
What is the average Medigap premium in Illinois?
The average Medigap (Medicare Supplement) premium in Illinois is $341 per month.