How to find a Medicare plan that fits like a glove mitten.
Michigan has a top-rated healthcare system. And with good healthcare comes lots of Medicare options. Choosing the right plan is daunting—not only will you have a ton of health plans to choose from, but some options will be only slightly different from one another.
To help you get the right plan, we’ve created this easy and quick guide to getting Medicare in Michigan.
Michigan Medicare at a Glance
|Number of Original Medicare Enrollees||1,301,774|
|Number of Medicare Advantage Enrollees||762,932|
|Total number of Medicare Beneficiaries||2,064,706|
* Source: Kaiser Family Foundation
What Is Medicare?
Medicare is a public health insurance system designed for seniors and people with certain health conditions. It’s been in use since 1966 and has undergone many changes since then. The Medicare system is a little tricky and can be confusing to navigate. To make things easy, we break Medicare into four product groups:
- Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare plans are regulated and administered by the U.S. government.
- Medicare Advantage, a.k.a. Medicare Part C, is an alternative to Original Medicare. Medicare Advantage plans are regulated by the federal government but administered by private health insurance companies.
- Medigap, a.k.a. Medicare Supplement Insurance plans, covers some of the co-payment, coinsurance, and deductible costs of Original Medicare plans. Medigap plans cannot be purchased to work with Medicare Advantage plans.
- Medicare prescription drug plans, a.k.a. Medicare Part D, cover some prescription drug costs. Stand-alone plans can be purchased to accompany either Original Medicare or Medicare Advantage plans. However, some Medicare Advantage plans include prescription drug coverage.
The Centers for Medicare & Medicaid Services (CMS) is in charge of making Medicare rules and regulations. Every year, the CMS releases new changes and updates to how Medicare works, its costs, and its coverage.
Who Qualifies for Medicare in Michigan?
There are many ways for Michiganders to qualify for Medicare. To qualify, you must be an American citizen or permanent residence for at least five years. Additionally, you must meet one of the following criteria:
- You’re at least 65 years of age, OR
- You’ve been diagnosed with end-stage renal disease (ESRD), OR
- You’ve been diagnosed with amyotrophic lateral sclerosis (ALS), OR
- You’ve been receiving disability benefits for at least 24 months.
How Much Does Medicare Cost in Michigan?
The cost of Medicare In Michigan varies depending on the type of Medicare plan(s) you purchase and the private health insurance company administering the plan (if applicable). You should be prepared to pay out-of-pocket costs for Medicare premiums, co-pays, coinsurance, and deductibles.
The Cost of Original Medicare in Michigan
The cost of Original Medicare (a.k.a. Medicare Parts A and B) in Michigan has a standard pricing structure broken down into two parts. Medicare Part A is premium-free for most people. People who qualify for premium-free Part A must have completed 40 work credits.
If you don’t qualify for premium-free Medicare Part A, you can still get Part A coverage. But you have to pay for it. Enrollees with at least 30 work credits will pay $252 per month for their premium. Enrollees with less than 30 work credits pay $458 per month.
The premium for Medicare Part B in Michigan is $144.60 for most people. However, Medicare Part B premiums are on a sliding scale. Anyone making more than $87,000 a year for an individual or $174,000 a year as a couple will pay a little more for Part B. The maximum premium charge to Medicare enrollees is $491.60 for individuals making over $500,000 a year or for couples making over $750,000 a year.
Medicare Part A and Medicare Part B have separate deductibles. The deductible for Medicare Part A is $1,408 for hospital care for the first 60 days. After that, a daily coinsurance rate of $352 is required from the 61st to the 90th day of care. For every day after 90 days of care in a hospital, the deductible is $704 a day. There are additional rules and fee schedules for Medicare Part A, depending on the type of care you receive.
The deductible for Medicare Part B is $198. After the deductible is met, enrollees are responsible for 20 percent of their medical bills unless they have a Medigap plan to cover some costs.
The Cost of Medigap Plans in Michigan
There are 10 types of Medigap plans—and your access to them depends on the county you live in. Medigap plans are designated by letters—A, B, C, and so on. Each type of plan has its own rules, as regulated by the CMS. Different private health insurance companies can apply to carry Medigap plans.
You’ll likely have several options even once you’ve narrowed your search down to one Medigap plan. That’s because many health insurance companies have permission to offer that type of Medicare plan in your area. And, even though each plan is essentially the same in what it does, other variables can change, such as its:
- Customer service
When comparing your Medigap options, be sure to consider the differences between the companies administering the plans. Here’s an example:
|Medigap Plan N, Company X||
|Medigap Plan N, Company Y||
The Cost of Medicare Advantage in Michigan
Michigan Medicare Advantage plans at a glance:
|Total Number of Plans||2056|
|Average Monthly Premium||$94.88|
|Average Drug Deductible||$179.64|
As an alternative to Original Medicare, Medicare Advantage plans offer Medicare coverage, but from a private health insurance company. Medicare Advantage plans must cover anything that Original Medicare covers. What sets Medicare Advantage plans apart is that these plans can cover more than Original Medicare, including:
You should expect plans that offer more coverage to come at a higher price point, though that’s not always the case. Bear in mind that different plans have not only different premium costs but also additional carrying expenses like:
Some plans may cost less month to month, but cost more when using your insurance. Be sure to find the right balance between monthly premium costs and costs to use.
The Cost of Prescription Drug Plans in Michigan
Michigan prescription drug plans at a glance:
|Total Number of Plans||30|
|Average Monthly Premium||$38.72|
|Average Annual Deductible||$383.08|
Medicare prescription drug coverage has been in use since the turn of the century. These plans lower the cost of prescriptions. You can add a stand-alone prescription drug plan to Original Medicare or a Medicare Advantage plan that doesn’t offer prescription drug coverage.
Prescription drug plans don’t cover everything. You’ll still have to cover some costs in the form of deductibles and coinsurance. Additionally, your plan will have a formulary that breaks the medications it covers into four tiers:
- Tier 1: Generic coverage; low cost to you
- Tier 2: Expensive generics or inexpensive name brand medicines; medium cost to you
- Tier 3: Name brand and expensive medicines; higher cost to you
- Tier 4: Specialty medications; highest cost to you
When reviewing plans, be sure to note which plans put your medications in the lowest tier. Those plans will be more affordable for you.
How Do I Choose Between Original Medicare and Medicare Advantage?
Choosing between the public option and the private option is challenging. Unfortunately, it’s also not one-size-fits-all. Some people, such as those who spend half the year in another location, are better off using Original Medicare. Other people, such as those in need of special care, may be better off choosing a Medicare Advantage plan.
To help you choose, we’ve created this quick side-by-side comparison chart:
Switching and Switching Back
You’ll be happy to discover that your Medicare choices are not set in stone. You’ll have the option at least once every year to make changes to your Medicare plan. From October 15 to December 7—the Fall Open Enrollment also called the Annual Enrollment Period—you can make several changes:
- Enroll in a prescription drug plan
- Switch a prescription drug plan
- Switch from Original Medicare to Medicare Advantage
- Switch from Medicare Advantage to Original Medicare
You’ll also have the Medicare Advantage Open Enrollment Period to make changes if you meet specific criteria. You can’t do everything that you can do during the Fall Open Enrollment. During Medicare Advantage Open Enrollment, you can:
- Switch from one Medicare Advantage plan to another.
- Switch from a Medicare Advantage plan without prescription drug coverage to one with prescription drug coverage.
- Return to Original Medicare.
- Enroll in a prescription drug plan if you switch back to Original Medicare.
If you decide to switch from Original Medicare to Medicare Advantage, you will also be granted trial rights that protect you for 12 months. If you choose to switch back to Original Medicare within those 12 months, you can re-enroll in your Medigap plan without being subject to medical underwriting.
How Do I Apply for Medicare in Michigan?
You can apply for Original Medicare in one of three ways in Michigan:
- Over the phone
- In person
To apply online, log into your Social Security account. There, you’ll be able to fill out your application. You can also create an account with Medicare.gov and apply there.
You can apply over the phone by calling 1 (800) MEDICARE—TTY users can call 1 (877) 486-2048. If you worked for the railroad, you could apply with the Railroad Retirement Board by calling 1 (877) 772-5772, TTY: 1 (312) 751-4701.
Finally, apply in person at your local Social Security office. We recommend that you avoid applying in person, if possible, during the COVID-19 pandemic. We recommend that you limit your exposure as much as possible until you can get a coronavirus vaccine.
How Do I Apply for Medicare Advantage in Michigan?
Applying for Medicare Advantage plans in Michigan is easy. Once you’ve found the plan you like, you can apply either through that company’s website or by calling their customer service line. You’ll need to provide your Medicare number and some other information when you apply, so be prepared.
What’s the Best Medicare Advantage Plan in Michigan?
The best Medicare Advantage plan in Michigan depends on you. Your health needs, preferences, and budget all play essential roles in determining the right healthcare plan. Understanding your needs is crucial. Be sure to keep in mind:
- The medications you take
- The therapies you respond to
- How often you travel or plan to travel out of state—only Original Medicare can follow you around if you snowbird half the year
- Whether you prefer being able to use an online platform or app to access your healthcare information
- Whether your current doctors will accept Medicare or a Medicare Advantage plan
Knowing your needs and preferences will allow you to get the best plan for your budget.
If you have low income, you may qualify for assistance through the Medicare Savings Program in Michigan. This program is run by the Michigan Department of Health and Human Services (MDHHS) and may help cover premiums, coinsurance, or deductibles. How much it will cover depends on your income, and it works on a sliding scale. That depends on the type of Medicare plan you choose. Original Medicare typically costs $198 monthly, plus the cost of co-payments, deductibles, and coinsurance. You should expect to pay at least 80 percent of your medical costs unless you have a Medigap plan.
Medicare Advantage plan costs vary. You may find a plan with a $0 monthly premium, but be sure to review your plan’s other costs carefully—co-pays, deductibles, and coinsurance can add up. The average monthly premium for Medicare Advantage in Michigan is $94.88. The MMAP is a free counseling service provided to Medicare beneficiaries in Michigan. Beneficiaries can contact the MMAP to get answers to their questions about Medicare benefits and services. Just call 1 (800) 803-7174 to speak with a counselor. In short, you should sign up for Medicare as soon as you are eligible. Delaying your enrollment can result in penalties that increase the cost of your premiums for life. If you qualify for postponing your enrollment, be sure to do so by the book. If you are receiving disability or Social Security benefits, you will be automatically enrolled in Original Medicare. However, just because you should be automatically enrolled doesn’t mean you will be. You can always check on the status of your enrollment by calling 1 (800) MEDICARE.
Frequently Asked Questions: Michigan Medicare
What is the Medicare Savings Program in Michigan?
What is the cost of Medicare when you turn 65?
What’s the Michigan Medicare/Medicaid Assistance Program (MMAP)?
When should I sign up for Medicare in Michigan?
Will I be automatically enrolled in Medicare?
If you have low income, you may qualify for assistance through the Medicare Savings Program in Michigan. This program is run by the Michigan Department of Health and Human Services (MDHHS) and may help cover premiums, coinsurance, or deductibles. How much it will cover depends on your income, and it works on a sliding scale.
That depends on the type of Medicare plan you choose. Original Medicare typically costs $198 monthly, plus the cost of co-payments, deductibles, and coinsurance. You should expect to pay at least 80 percent of your medical costs unless you have a Medigap plan. Medicare Advantage plan costs vary. You may find a plan with a $0 monthly premium, but be sure to review your plan’s other costs carefully—co-pays, deductibles, and coinsurance can add up. The average monthly premium for Medicare Advantage in Michigan is $94.88.
The MMAP is a free counseling service provided to Medicare beneficiaries in Michigan. Beneficiaries can contact the MMAP to get answers to their questions about Medicare benefits and services. Just call 1 (800) 803-7174 to speak with a counselor.
In short, you should sign up for Medicare as soon as you are eligible. Delaying your enrollment can result in penalties that increase the cost of your premiums for life. If you qualify for postponing your enrollment, be sure to do so by the book.
If you are receiving disability or Social Security benefits, you will be automatically enrolled in Original Medicare. However, just because you should be automatically enrolled doesn’t mean you will be. You can always check on the status of your enrollment by calling 1 (800) MEDICARE.
Conclusion: Compare Michigan Medicare Plans Before You Buy
Choosing the right Medicare plan may be daunting, but you can do so easily with the right tools and resources. Remember to start with you:
- Your needs, like your medications and therapies you need
- Your preferences, like being able to use your mobile phone to access your insurance information
- Your budget and what you can reasonably afford for care when you need it
Being clear on that criteria will make choosing between plans—especially similar plans—much, much more manageable.