Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage is an Original Medicare alternative health care program available to seniors and other eligible individuals. While the federal government manages Original Medicare, private insurance providers offer Medicare Advantage. However, these providers must be Medicare-approved and provide at least the same level of care and services as Original Medicare. The one exception to these regulations is hospice care, which Original Medicare provides, even for seniors enrolling in a Medicare Advantage plan.
Medicare Advantage, also known as Medicare Part C, is a bundled health care package that combines the benefits of Medicare Part A, which covers hospital care and Medicare Part B, which covers medical care like doctor visits. In many cases, Part C includes Medicare Part D (prescription drug plan) into one singular plan. Additionally, many Medicare Advantage providers include additional benefits, such as dental and vision care, wellness programs and hearing aids. Some Medicare Advantage plans may also require seniors to seek medical services from providers within the plan’s specific network. In Michigan, just under 1 million out of the nearly 1.8 million eligible seniors are enrolled in a Medicare Advantage health care plan, according to data from 2020. This number represents about 45 % of the total Medicare users, which is slightly higher than the national average of 42%.
This guide provides more information about Medicare Advantage in Michigan and how it works. It also offers detailed information regarding the top 10 Medicare Advantage plans in the state, along with eligibility requirements.
The Top 10 Medicare Advantage Plans in Michigan
There are more than a dozen Medicare Advantage providers in Michigan, with many companies offering multiple plan options. This variety gives seniors the opportunity to compare their options to find the plan that best meets their specific needs. Michigan seniors can view the table below to learn more about their Medicare Advantage plan options. This table lists the top 10 Medicare Advantage providers in the state based on enrollment numbers. It provides various information, including plan type, total enrollment number, Medicare star rating and monthly costs. Since many providers offer multiple plan options, it lists monthly costs as a range and combines plan enrollment numbers for each provider. The facts listed in the table below are up to date as of April 2022. For additional plan information or to see any updated information, you can visit Medicare.gov.
Blue Cross Blue Shield of Michigan
Priority Health Medicare
HMO, PPO, PFFS
Blue Care Network
HAP Senior Plus
Molina Healthcare of Michigan
HAP Senior Plus (PPO)
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.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*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.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
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.
The Michigan Medicare/Medicaid Assistance Program (MMAP) provides education and counseling to help empower older adults and people with disabilities so that they can make informed health insurance decisions. Counselors are available to help seniors navigate health care options through a range of services, including reviewing insurance needs, enrolling in programs and explaining health plans. Combined, this helps seniors find a plan that provides the best coverage for their situation. MMAP counselors can also identify Medicare fraud and abuse and help seniors make relevant reports. The service is free for Michigan residents, and family members who live out-of-state can also contact counselors.
The Health Insurance Consumer Assistance Program (HICAP) offers free help to Michigan residents who need assistance with their health insurance. Seniors can receive assistance with finding a health care plan, switching plans and filing complaints. Additional information is available on the HICAP website, including information about health insurance for people with Medicare, long-term care insurance and Medicare supplements.
Elder Law of Michigan (ELM) is a nonprofit organization created to promote and protect the rights, economic stability and health of older adults. ELM provides education, advocacy and professional services. It runs Michigan’s Coordinated Access to Food for the Elderly (MiCAFE), which assists seniors to apply for a range of government benefits, including Medicare. ELM can also provide eligibility information for a range of health care programs including Medicaid, the Medicare Savings Program and Medicare Extra Help Part D.
Seniors can call 877-664-2233 to find their nearest MiCAFE Network site for assistance with applications. For other services and information about advocacy, ELM can be reached at 866-400-9164.
Local Medicare Advantage Resources
The Senior Alliance
The Senior Alliance is a local Area Agency on Aging for southern and western Wayne County. It provides a range of services for older adults in the area, including the Information and Assistance Call Center. This free service connects seniors with Information Services Specialists who can provide answers to questions on a range of topics, including Medicare and Medicaid. Specialists assess the needs of callers and provide accurate information, as well as referrals to programs and services available in The Senior Alliance service area.
Information Services Specialists can be reached by calling 800-815-1112. The service is available Monday to Friday, from 8:30 a.m. to 4:30 p.m.
Kalamazoo County Older Adult Services Division
The Kalamazoo County Older Adult Services Division is the Area Agency on Aging for Kalamazoo County. The agency offers programming that helps older adults access services and provides support, advocacy and more. The Information & Assistance program has clinical social workers available to provide free, unbiased assistance to seniors and their caregivers. These social workers can evaluate needs, provide options for support and assist in navigating care and benefit programs. The program also has up-to-date information on health insurance programs such as Medicare, and can refer seniors to other resources.
The Valley Area Agency on Aging provides advocacy, action and information about the care of the elderly in Genesee, Lapeer and Shiawassee counties. Its Information & Assistance program makes certified resource specialists available to provide information about resources in the area. The service is available to older adults aged 60 and over, persons with disabilities and family caregivers, and it is free of charge. Information is available on a range of different topics, including Medicare and Medicaid. A listing of resources, information and tip sheets can be mailed to callers. The Valley Area Agency on Aging is HIPAA compliant, so any information provided is confidential.