Understanding Your Medicare Michigan Options

Updated for November, 2021

Key Takeaways:
  • Almost half of all Michigan Medicare beneficiaries are enrolled in Medicare Advantage
  • Every Michigan Medicare enrollee has access to a zero-premium Medicare Advantage plan
  • You can only sign up for Medicare Advantage during certain times of the year
  • You may be able to buy a Medicare SELECT plan and lower your Medicare Supplement premium

If you are signing up for Medicare in Michigan, you have more options than just Part A and Part B. In fact, there are over 150 Medicare Advantage plans and 30 Part D prescription drug plans available in the state.

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With so many options, it’s important to learn about your choices so you can find the right Medicare plan for your specific health care needs.

Medicare Plans in Michigan

There are currently just over 2 million Medicare beneficiaries residing in Michigan. Before Medicare Advantage was created in 2003, Original Medicare (Part A and Part B) was the only option for most Michigan seniors.

Now, however, there are 14 insurance companies offering a variety of Medicare Advantage and Part D plans. As of April 2020, about 52% of Medicare Michigan enrollees signed up for Original Medicare and 48% were in a Medicare Advantage plan.

If you’re receiving benefits from Social Security when you turn 65, you’ll be automatically  enrolled in Original Medicare. Unless you have coverage for prescription drugs from another source, you’ll also need to add a standalone Part D plan.

Original Medicare Costs

Some people mistakenly believe Medicare pays 100% of their healthcare costs, but there are actually a lot of out-of-pocket costs associated with Medicare. If you choose Original Medicare, the chart below shows what you can expect with Medicare costs.

Michigan Original Medicare Costs

Part A Part B
Monthly premium Most people qualify for premium-free Part A The standard premium is $144.60 in 2020 (those with higher incomes may pay more)
Deductible $1,408 per benefit period (you can pay this multiple times a year) $198 annual deductible
Coinsurance $352 per day for hospital inpatient days 61-90; $704 per day for lifetime reserve days; $176 per day for days 21-100 in a skilled nursing facility 20% of allowable charges; additional 15% of allowable charges for providers that do not accept Medicare assignment

Do You Need a Michigan Medicare Supplement Plan?

As the chart above shows, the out-of-pocket costs with Original Medicare can be unpredictable. A Medicare Supplement plan (also known as Medigap) helps pay your costs with Part A and Part B, making it much easier to budget for health care.

All Medigap plans have these core benefits:

  • 100% of Part A hospital coinsurance, plus an additional 365 days of coverage
  • 100% of Part B coinsurance
  • 100% Part A hospice coinsurance
  • First three pints of blood per calendar year

Some plans cover additional costs, such as 50% to 100% of your Part A deductible and your Part B excess charges. Some also pay up to $50,000 in lifetime benefits for foreign travel emergencies.

You can use your Medigap plan with any provider that accepts Medicare, unless you buy a Michigan Medicare SELECT plan. These are special low-cost Medigap plans that can only be used within the plan’s provider network.

Medicare SELECT may not be available in every county in Michigan, however, and there may be other coverage restrictions. As such, it’s important to compare your Medicare Supplement options before buying a plan.

You can use your Medigap plan with any provider that accepts Medicare, unless you buy a Michigan Medicare SELECT plan. These are special low-cost Medigap plans that can only be used within the plan’s provider network.

Michigan Medicare Advantage Plans

Medicare Advantage plans are an alternative way to get your Medicare benefits. These private plans cover everything that Original Medicare covers, but many offer additional benefits. For example, nearly all Medicare Advantage plans include Part D coverage for prescription drugs.

Many also offer supplemental benefits for routine dental, vision, and hearing care. Some even help pay for in-home meal delivery, over-the-counter medications, and non-medical transportation.

If you choose Medicare Advantage, you must continue to pay your Part B premium plus any additional premium charged by your plan. According to data from the Centers for Medicare and Medicaid Services (CMS), every Medicare Michigan beneficiary has access to a zero-premium plan.

Medicare Advantage Features at a Glance

Average monthly premium Over 60% of enrollees pay no premium. Of those that do pay a premium, the average monthly premium is $63
Maximum out-of-pocket costs $6,700 limit set by Medicare for 2020. The average for all Medicare Advantage plans in 2020 is $4,925 
Additional benefits • 91% include Part D prescription drug coverage • 79% cover vision care • 74% cover dental care and fitness memberships • 72% cover hearing care • 61% help pay for over-the-counter medication and devices • 39% pay for in-home meal delivery • 34% cover non-medical transportation
Provider network Over 90% of enrollees are enrolled in plans that require members to use a provider network
Require prior authorization 99% of enrollees are in a plan that requires prior authorization for high-cost services

*Data from Kaiser Family Foundation

How to Sign Up for Medicare in Michigan

You’re automatically enrolled in Original Medicare if you’re in one of the following situations:

  • You’re turning 65 and are already receiving retirement benefits from Social Security or the Railroad Retirement Board
  • You’re under age 65, but have been receiving Social Security disability payments for at least 24 months
  • You have end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) and qualify for Social Security disability payments

If the above criteria applies to you, you don’t need to do anything to get your Medicare card. It will be mailed to you a few weeks before the date that your Medicare goes into effect.

If you’re not automatically enrolled, you can sign up for Medicare online at SSA.gov or go in person to your local Social Security office. You can also apply by phone by calling Medicare at 1-800-772-1213.

Other important things to know are that your Initial Enrollment Period (IEP) begins three months before your 65th birthday month and lasts for seven months thereafter, and you can apply for Medicare in Michigan at any time during this IEP.

Over 1 million Michiganders are enrolled in a standalone Part D prescription drug plan. You can sign up for Part D during your Medicare Initial Enrollment Period.

Enrolling in a Part D Plan

Over 1 million Michiganders are enrolled in a standalone Part D prescription drug plan. You can sign up for Part D during your Medicare Initial Enrollment Period and will need to apply with the insurance company offering the specific plan that you like.

Although you can’t be turned down for coverage, you can be charged a late enrollment penalty if you go without coverage for more than 63 consecutive days. For this reason, if you don’t have creditable drug coverage, it’s important to sign up when you first become eligible.

Enrolling in Michigan Medicare Advantage

Once you’re signed up for Part A and Part B, you can join a Medicare Advantage plan. Your Initial Coverage Election Period for Medicare Advantage coincides with your IEP. This means that you have seven months from when you first become eligible to switch to a Medicare Advantage plan from Original Medicare. During this window of time, you can buy any plan sold in your service area.

Medicare Advantage Special Needs Plans, however, are limited to people with certain health conditions, or to those who qualify for both Medicare and Medicaid.

If you don’t choose Medicare Advantage when you first become eligible, you can enroll during the fall Annual Election Period. This period runs from October 15 through December 7 each year.

Enrolling in Michigan Medigap

Medigap is different from other Medicare Michigan plans. You only have “guaranteed issue” rights in certain situations. For example, you can buy any plan sold in your state during your Medigap Open Enrollment Period (OEP). This six-month period begins the month you are both age 65 or over and enrolled in Part B.

Once you are outside your Medigap OEP, you may have to pass medical underwriting before the insurer will sell you a plan. In this case, if you have a serious or chronic health condition, there is a risk that you could be turned down for the plan that you want.

Medicare Michigan Resources

If you have low income, you may qualify for a Medicare Savings Program (MSP). If you meet the income and assets requirement, the state helps by paying for some or all of your Part A and Part B premiums, deductibles, and copayments. In order to access this benefit, you will need to apply for Michigan Medicare Savings Programs with the state Department of Health and Human Services.

Another helpful resource is the Michigan Medicare/Medicaid Assistance Program (MMAP), which provides counseling and assistance with state health insurance programs. If you’re not sure how to sign up for Medicare in Michigan, call your local Area Agency on Aging to speak to someone at MMAP. Your local Michigan Medicare broker is also a good source of information.

With so many plans to choose from, it’s easier than ever to find a Medicare plan that suits your specific health needs and budget. Take advantage of your local resources to help you make the right choice for you.