Medicare in Michigan

Medicare is a health insurance program for seniors and younger adults with certain disabilities, backed by the United States government. In 2020, almost 2.1 million Michigan residents enrolled in Medicare, representing a growth of more than 27% in the last decade. Medicare Advantage plans are gaining in popularity. In 2010, only 243,000 seniors in Michigan chose an Advantage plan compared with 947,000 in 2020. 

Original Medicare has several parts. Part A is a free plan for seniors who contributed enough to the Medicare program through taxes and covers inpatient services such as emergency care, hospital care, skilled nursing care and home-based health care services. Part B has a monthly premium with the starting cost of $170.10 in 2022. Part B covers outpatient services such as routine doctor appointments, medical transportation, approved medical procedures and equipment and diagnostic testing. 

Medicare Advantage, or Medicare Part C, is an alternative Medicare option that allows seniors to choose a private insurance plan from a Medicare-approved insurance company. Advantage plans cover most of the services covered under Parts A and B but allow seniors to add additional coverage for care such as dental, vision and prescription drugs. 

Medicare Part D offers prescription drug coverage and monthly premiums depend on the selected coverage level. Seniors can enroll in Part D if they have an Original Medicare plan. Part D is included in most Advantage plans and joining a separate Medicare drug plan is not an option in most types of Medicare Advantage plans.

Medigap policies allow Original Medicare enrollees to purchase additional coverage to offset their out-of-pocket expenses. Those enrolled in Advantage Plans don’t need and can’t buy Medigap. 

This guide reviews all of the coverage options Michigan residents have to personalize their insurance coverage. It also provides a list of resources available to assist seniors in understanding their benefits, reviewing coverage options, applying for Medicare and determining if they qualify for additional financial assistance. 

Options for Medicare Coverage in Michigan

Original Medicare offers basic coverage that meets many seniors’ needs, but some people need more coverage than what the original program provides. Michigan residents have a few options for creating custom insurance coverage suited to their unique needs. These alternatives are available through private insurance companies. Some residents may also be able to apply for financial assistance if they meet the right criteria. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage allows Michigan residents to get Medicare coverage through the private insurance company of their choosing. Advantage plans must offer the same benefits as Part A and B except for hospice care which remains covered under Original Medicare. Part C often provides extra coverage options such as prescription drugs, dental and vision care. Many Advantage plans have savings programs that allow enrollees to enjoy discounts on gym memberships and other wellness services. 

There are four kinds of Medicare Advantage plans, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee For Service (PFFS) and Special Needs Plans (SNPs). Each plan may have different rules regarding eligibility, monthly premiums, deductibles, network providers, copayments and coinsurance and whether enrollees need referrals to see a specialist. 

Who Should Consider Medicare Advantage

Medicare Advantage plans are ideal for people who:

• Are in good health overall
• Want to add custom coverage options such as vision or dental
• Wish to have more control over their out-of-pocket expenses

Top 10 Medicare Advantage Plans in Michigan

Michigan’s seniors have access to a growing number of Medicare Advantage plans due to their rising popularity over the last decade. The following table helps seniors narrow their list of plans by reviewing the top insurance companies in the state using enrollment numbers, ratings and costs as of April 2022. More information about Medicare C can be found on the Medicare Advantage Plans in Michigan page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later. Most Medicare Advantage Plans include prescription drug coverage; therefore, seniors don’t need to purchase a separate Plan D in many cases. 

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Michigan

Selecting the right coverage and understanding Medicare benefits can be frustrating and complicated for many seniors. Michigan residents have access to several resources when they have questions, want to find the best coverage options for their needs and require assistance applying for their benefits. The following agencies and programs can help seniors get one-on-one help when enrolling in Medicare and researching Medicare Advantage and Medigap plans in the state.