Medicare Advantage Plans in Michigan
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: November 19, 2020
Original Medicare is provided by the federal government and has two parts. Part A, which typically doesn't have a premium, covers hospital stays, and Part B, which generally has a modest monthly premium and standard copays, covers medical care. Medicare Advantage, on the other hand, is offered by private insurance companies. Like Original Medicare, Medicare Advantage plans provide hospital and medical care coverage. However, they often have additional benefits, such as coverage for long-term care, vision and dental services, and prescription drugs.
- 1 In 2019, there were 74 Medicare Advantage plans available in Michigan.
- 2 37% of the total Medicare population in Michigan is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $10,301 per beneficiary in Michigan, which is 2% higher than the national average.
- 4 Available Medicare Advantage plans range from 12 to 60 across Michigan’s 83 counties.
Similar to traditional private health insurance offered through employers or on the federal Marketplace, there are several different types of Medicare Advantage plans for enrollees to choose from. These plans vary widely in cost and benefits.
Some plans have provider networks, while others can be used at any health care provider that accepts payment from Medicare. The availability of a plan depends on your health insurance provider and your geographic location. When choosing a plan, it’s important to consider factors such as your budget, how often you travel, and your health care needs.
Medicare Advantage Plans in Michigan
Types of Medicare Advantage Plans
Michigan’s Medicare Advantage program features four types of plans, each with unique benefits and drawbacks. These plans cover all the services that Original Medicare does but may also pay for additional benefits, such as dental, hearing, and vision. Before selecting a plan, make sure that your doctor accepts the coverage and that its network includes hospitals, specialists, and pharmacies that are close to your home.
Health Maintenance Organizations (HMO)
With HMO plans, enrollees generally must get care from in-network doctors and hospitals, except for emergency care, out-of-area urgent care, and out-of-area dialysis. In some cases, these plans have a point-of-service option that covers services received from out-of-network providers, but seniors typically pay a greater portion of the cost of these services. Most HMO plans provide prescription drug coverage. Seniors are usually required to choose a primary care doctor, and referrals are often required to see specialists. Certain services that are administered regularly, such as mammograms, don’t need a referral.
Preferred Provider Organizations (PPO)
Similar to HMO plans, PPO plans have in-network physicians, hospitals, and health care providers that enrollees must receive services from to have the most affordable care. However, these plans give members the flexibility to receive care from any health care provider or hospital, although enrollees pay a higher portion of their care costs when they go out-of-network. Members don’t need to choose a primary care doctor, and they generally don’t need to get referrals to see specialists. Most, but not all, PPO plans have prescription drug coverage, so seniors who want this coverage should check whether the plan they’re considering has this benefit.
Private Fee-For-Service Plans (PFFS)
PFFS plans pay providers on a fee-for-service basis, meaning that they outline upfront exactly what they pay and what the patient pays for a given service. While some PFFS plans have networks, enrollees are generally free to go to any provider who’s eligible to receive payment from Medicare and accepts the plan’s payment terms and conditions. Enrollees don’t need to choose a primary care doctor, and they don’t need referrals to see specialists. While PFFS plans may cover prescription drugs, some do not. Enrollees whose plans don’t include this coverage may enroll in Medicare Part D, an option that isn’t available to those with HMO and PPO plans.
Special Needs Plans (SNP)
SNP plans are exclusively for seniors with certain characteristics or diseases, such as those who live in nursing homes, who are dually eligible for Medicare and Medicaid, or who have a chronic condition, such as diabetes. Benefits, drug formularies, and provider choices are tailored to meet the needs of the groups they serve. These plans have networks of doctors and hospitals that seniors must receive their care from, except in the event of an emergency or if they need out-of-network dialysis. Enrollees are typically required to choose a primary care doctor or have a care coordinator that helps them receive the health care services they need.
Enrollment & Eligibility for Medicare Advantage Plans in Michigan
To be eligible for Medicare Advantage plans in Michigan, applicants must be eligible for or already enrolled in Original Medicare Parts A and B. Most people qualify for Medicare upon turning 65 or when they’ve received Social Security disability benefits or Railroad Retirement Board benefits for 24 months.
Seniors enrolled in a Medigap policy must drop their policy before enrolling in a Medicare Advantage plan, as Medigap can’t be used towards the plan’s deductibles, copays, or premiums. Additionally, seniors must live within the service area of their chosen plan to be eligible for coverage. In general, those who have end-stage renal disease are ineligible for most Medicare Advantage plans, although an SNP for this disease may be available in their region.
Seniors can only enroll in Medicare Advantage plans or make changes to their existing coverage at certain times.
- The Initial Enrollment Period is a seven-month period that begins three months prior to the senior’s 65th birthday or on the 25th month they’ve collected disability benefits.
- Seniors may also enroll in Medicare Advantage after enrolling in Medicare Part B if they’ve delayed enrolling due to still receiving employer-subsidized health insurance. This is called the Part B Special Enrollment Period.
- There are two General Enrollment Periods every year. During the January through March period, seniors can sign up for Original Medicare if they didn’t sign up when they first became eligible, and they can switch to a Medicare Advantage plan beginning in April through June. During the Fall Open Enrollment Period, which lasts from October 15 to December 7, seniors can pick a new Medicare Advantage plan or switch from Original Medicare to Medicare Advantage.
Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs and is optional coverage for everyone who has Original Medicare. This coverage can’t be added to Medicare Advantage HMO or PPO plans, so seniors should make sure that the HMO or PPO plan that they choose covers prescription drugs if they don’t want to pay for prescribed medications out of pocket. Medicare Advantage plans that include drug coverage are often called MA-PDs. Seniors who have Medicare Advantage PFFS plans can add Part D coverage to their policy. All SNPs provide prescription drug coverage.
Medicare Advantage Resources in Michigan
With so many Medicare Advantage plans available across Michigan, it’s important to connect with experts who can provide guidance on choosing the best health insurance option for your unique needs. Fortunately, Michigan seniors have access to a variety of state-run and nonprofit resources that provide options counseling and legal advice. In most cases, options counseling is provided for free by volunteers who are trained on various aspects of health insurance for seniors, including comparing plans, filing claims, and disputing denied claims.
Michigan Medicare/Medicaid Assistance Program
Michigan Medicare/Medicaid Assistance Program is a free health benefits counseling service that helps seniors navigate the selection and application process for enrolling in Medicare Advantage. MMAP counselors are trained volunteers who are typically based out of local Area Agencies on Aging, county departments on aging, and senior services agencies. They help seniors identify resources for prescription drug coverage, compare Medicare Advantage plans, understand medical bills, and enroll in Medicare Savings Programs. They can also help identify and report Medicare and Medicaid fraud and abuse.
Contact Information: Website | 1-800-803-7174
Michigan Department of Health and Human Services
The Michigan Department of Health and Human Services helps connect seniors with an array of aging services to help them maintain their independence and get the medical care they need. While the department doesn’t provide direct services, its Aging and Adults Services Agency operates a hotline that seniors can call for information about long-term care options and local resources. The hotline is available seven days per week from 8:00 a.m. to 5:00 p.m and can be reached at 888-535-6136. MDHHS also has a Medicare Savings Program that covers certain Medicare costs for eligible seniors. Expenses that may be covered include premiums, deductibles, and coinsurance.
Contact Information: Website | 517-241-3740
Area Agencies on Aging Association of Michigan
Michigan is home to 16 Area Agencies on Aging, which are comprised of over 1,300 service partners that provide numerous services to more than 120,000 Michigan seniors. These local agencies, which serve all of the state’s 83 counties, are single points of contact for information regarding aging. In addition to services, such as homemaker services, personal care, and case management, AAAs provide options counseling for seniors researching Medicare, Medicaid, and other senior health insurance options.
Contact Information: Website | 517-886-1029
Legal Services of South Central Michigan
Legal Services of South Central Michigan is a division of the Michigan Advocacy Program and serves central Michigan seniors in 12 counties by providing free legal advice and representation. Its specialized services to older adults include assistance with securing medical services or coverage through Medicaid, Medicare, and county-based health plans, as well as help with access to public benefits, such as Supplemental Security Income and emergency relief programs. To be eligible for free services, seniors must meet income guidelines and live within the organization’s service area.
Contact Information: Website | 734-665-6181
- Sources [-]
https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.