Medicare Advantage in Michigan

Private Medicare Advantage Plans, also known as Medicare Part C, serve as an alternative to federally administered Original Medicare, offering the same services under Parts A and B while excluding hospice care. It’s worth noting that Medicare Advantage enrollees can still access hospice care through regular Medicare. Additionally, Part C covers other conditions and services unrelated to terminal illness.

Medicare Advantage Plans often go beyond Original Medicare by including dental, vision care, nutrition programs, and transportation for medical appointments. Prescription medication provisions are also common. However, Medicare Advantage typically mandates the use of a network of approved physicians, requiring approvals and referrals for services, in contrast to the wider choice of providers available in regular Medicare.

A primary advantage of Medicare Advantage is that seniors only need to pay one monthly premium for a bundled package of benefits as opposed to Original Medicare, where enrollees must pay separately for the different parts. Private companies can also set their own yearly out-of-pocket limits, deductibles and co-pay amounts. In some cases, individuals may be able to join a group plan through their employer or union. This arrangement can sometimes result in zero payable monthly premiums.

In Michigan, seniors aged 65 and older account for roughly 18.7% of the state’s population of around 10 million. In 2022, the state had some 2.1 million individuals who qualified for Medicare, 53% of whom had enrolled in Part C plans. In 2023, the number of Medicare-eligible residents had risen 2.4% to almost 2.2 million. Of these, 1.25 million signed up for Medicare Advantage. From 2022 to 2023, the percentage of people enrolled in Part C rose by 6.9%, with 57% of all qualifying individuals opting for Medicare Advantage over Original Medicare. For comparison, 51% of Medicare-eligible individuals nationwide have Medicare Advantage. Therefore, the take-up of Part C is a little higher in Michigan than in the rest of the country.

Gain insights into Medicare Advantage in Michigan and its operations through this guide. It outlines the top 10 Medicare Advantage Plans in the state, along with eligibility requirements and statewide resources.

The Top 10 Medicare Advantage Plans in Michigan

Michigan seniors can choose between many Medicare Advantage providers. Furthermore, most insurers offer a range of policies to suit diverse needs and budgets. The following table shows the total number of enrollees, combined across each provider’s plans, for the 15 most popular Part C companies in Michigan. Prices are shown as a range because of varying coverage options. Figures are current as of July 2023. Further details are available at the federal Medicare website, Medicare.gov.

How Medicare Advantage Plans Work in Michigan

Before comparing Medicare Advantage plans in Michigan, seniors should understand how these plans work. In Michigan, most Medicare Advantage providers offer one or more plans, including Health Maintenance Organizations (HMO), Preferred Providers Organizations (PPO), Private Fee-for-Service (PFFS) and Special Needs Plans (SNPs). Each plan has its own unique policies and regulations regarding factors, such as in-network and out-of-network providers, deductibles, copays and referrals. Some plans may also require seniors to select a primary care provider and seek prior authorization before some medical procedures. The following information provides more details about the most common plan options in Michigan.

What Medicare Advantage Plans Cover in Michigan

Medicare Advantage plans in Michigan must provide at least the same level of services available through Medicare Parts A and B, including doctor visits, lab tests and screenings, X-rays and emergency and hospital care. Many Medicare Advantage providers offer additional benefits, including prescription drug coverage, vision and dental care, hearing aids and wellness programs, such as gym memberships. Original Medicare always provides hospice care, even if the senior enrolls in a Medicare Advantage plan.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Michigan

Seniors living in Michigan who are aged 65 or older and are currently enrolled in Original Medicare or are eligible for Original Medicare may be able to enroll in a Medicare Advantage plan. The senior must also be a U.S. citizen or a permanent legal resident, currently live within the plan’s service area and meet all other plan requirements. It’s also important to note that seniors can only enroll in Medicare Advantage or switch from Original Medicare to Medicare Advantage during the annual open enrollment or election period or immediately following a qualifying life event. See the table below to determine when the open enrollment or election period for Medicare Advantage begins and ends in the state of Michigan.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state. Individuals younger than 65 with certain disabilities may also be eligible for Medicare Advantage.

How to Find & Choose a Medicare Advantage Plan in Michigan

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources