Medicare is a federal program that helps older adults and younger people with disabilities pay for healthcare. Across the country, nearly 62.1 million people get their health coverage from Medicare, including almost 2.1 million people in Michigan.
If you’re shopping for Medicare plans in Michigan, you may be wondering what options are available and how to choose the plan that’s right for you.
In Michigan, there are two main options for Medicare coverage: original Medicare and Medicare Advantage. Original Medicare is managed by the federal government, while Medicare Advantage plans are offered by private companies.
Original Medicare has two parts: Part A and Part B. Most people sign up for both parts.
Part A (hospital insurance) helps you pay for services such as inpatient hospital stays and skilled nursing facility care.
Part B (medical insurance) helps you pay for many medical services, including doctors’ services, health screenings, and outpatient care.
If you choose original Medicare, there are some optional benefits you can sign up for. Medicare prescription drug plans (Part D) can help you pay for prescription drug expenses. Medicare supplement insurance, sometimes referred to as Medigap, can help you pay for your Medicare copayments, coinsurance, and deductibles.
Medicare Advantage plans are the other way to get your Medicare coverage. They’re sometimes called Part C. These bundled plans must cover all Medicare parts A and B services. Often, they include Part D, too. Medicare Advantage plans may also offer many extra benefits, such as vision, dental, and hearing care.
As a Michigan resident, you have many Medicare Advantage options. As of 2020, the following insurance companies offer Medicare Advantage plans in Michigan:
- Blue Cross Blue Shield of Michigan Mutual Insurance Company
- Priority Health
- Blue Care Network of Michigan
- Health Alliance Plan of Michigan
- Humana Insurance Company
- Meridian Health Plan of Michigan Inc.
- Humana Dental Insurance Company
- Sierra Health and Life Insurance Company Inc.
- Alliance Health and Life Insurance Company
- Upper Peninsula Health Plan LLC
- HAP Midwest Health Plan Inc.
- UnitedHealthcare Community Plan Inc.
- AmeriHealth Michigan Inc.
- PHP Medicare
Carriers vary by county, so you may not be able to receive coverage by all of these providers in your area.
You may be eligible for Medicare if you’re turning 65 and meet one of the following requirements:
- You currently receive or are eligible for Social Security retirement benefits
- You live in the United States, and are a U.S. citizen or permanent resident
You may qualify for Medicare if you’re younger than 65 and meet one of these requirements:
- You have been diagnosed with end stage renal disease (ESRD)
- You have a disability and have been on Social Security Disability Insurance (SSDI) for at least two years
There are some more eligibility rules if you want to sign up for Medicare Advantage. To join one of these plans, you need to live in the plan’s service area and have Medicare parts A and B. Usually, you can’t join a Medicare Advantage plan if you have been diagnosed with ESRD.
If you receive Social Security retirement benefits, you’ll most likely be automatically enrolled in Medicare when you turn 65. You may also be automatically enrolled at the start of your 25th month on SSDI if you’re a younger adult with a disability.
If you aren’t automatically enrolled in Medicare, you can sign up at certain times during the year. The following enrollment periods are available:
- Initial enrollment period. If you’re eligible for Medicare at 65, you can sign up during the 7-month initial enrollment period. This period starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after your birthday month.
- Medicare open enrollment period. If you have Medicare, you can make changes to your coverage between October 15 and December 7 every year. This includes joining a Medicare Advantage plan.
- Medicare Advantage open enrollment period. Between January 1 and March 31 every year, people with Medicare Advantage plans can change their coverage. At this time, you can switch to a new Medicare Advantage plan or go back to original Medicare.
- Special enrollment periods. You can sign up at other times of the year if you experience certain life events, such as losing your employer-based health plan or volunteering in a foreign country.
Choosing a Medicare plan in Michigan is a big decision. Here are some things you may want to think about as you shop around:
- Provider network. If you choose to enroll in a Medicare Advantage plan, you generally need to get your care from in-network providers. Before you sign up, find out if the doctors, hospitals, and facilities you visit are part of the plan’s network.
- Service area. Original Medicare is available nationwide, but Medicare Advantage plans serve smaller service areas. Find out what each plan’s service area is, as well as what coverage you have if you go outside of the service area.
- Out-of-pocket costs. You may need to pay premiums, deductibles, or copayments for your Medicare coverage. Medicare Advantage plans have an annual maximum out-of-pocket cost. Make sure the plan you choose will fit into your budget.
- Benefits. Medicare Advantage plans need to cover the same services as original Medicare, but they may offer extra benefits, such as dental or vision care. They may also offer perks such as wellness programs and over-the-counter drugs.
- Your other coverage. Sometimes, signing up for a Medicare Advantage plan means losing your union or employer coverage. If you already have coverage, find out how it’ll be affected by Medicare before you make any decisions.
If you want to learn more about Medicare plans in Michigan, the following resources may be helpful:
If you’re ready to sign up for Medicare, or if you want to learn more about Medicare Advantage plans in Michigan:
- Contact the Michigan Medicare/Medicaid Assistance Program to get free health benefit counseling and help navigating Medicare.
- Complete an online benefits application on the Social Security website, or apply in-person at a Social Security office.
- Compare Medicare Advantage plans at Medicare.gov, and enroll in a plan.