- In 2019, There were 74 Medicaid Advantage Plans available in Michigan.
- 37% of the total Medicare population in Michigan was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,301 per beneficiary in Michigan, which is 2% higher than the national average.
- Available Medicare Advantage Plans range from 12 to 83 across Michigan’s 60 counties.
If you’re already enrolled or are about to enroll in Original Medicare, you can switch to a Medicare Advantage Plan during one of the annual enrollment periods. Michigan has a robust Medicare Advantage market. There are four different types of Medicare Advantage Plans, each offering different in-network or out-of-network services, financial arrangements, and benefits. You need to choose the one that best meets your health care needs and financial situation.
Medicare Advantage Plans in Michigan
Types of Medicare Advantage Plans
When you’re considering joining Michigan’s Medicare Advantage program, remember that not every Medicare Advantage Plan is available in every county. There are four main kinds of Medicare Advantage Plans available in Michigan. You need to carefully review each available plan in your county and select the most appropriate one for you.
Health Maintenance Organizations (HMO)
HMOs are the most frequently selected Medicare Advantage Plans. You’ll need to obtain your care from in-network doctors and hospitals, but you’ll pay less for their services than with other plans. You might still need to pay premiums for Medicare Part B and Part A if applicable. You’ll need to select a primary care physician, and you’ll need referrals for most visits to a specialist. Some HMOs include prescription drug coverage, but not all do.
Preferred Provider Organizations (PPO)
PPOs are more flexible than HMOs. These plans offer in-network doctors but also provide coverage for the use of out-of-network health care providers. However, if you choose to seek care from outside of your network, you’ll pay more than you would for in-network providers. You won’t need to choose a primary care physician, and you won’t need a referral to make an appointment with a specialist. Most PPOs include prescription drug coverage and other benefits, such as vision, dental and hearing.
Private Fee-For-Service Plans (PFFS)
With a PFFS plan, your insurance company determines how much it, and you, will pay for your health care needs. Some PFFS plans offer access to a partial or full network, while other plans have no network. You can use any provider who accepts your plan’s terms. Not all providers accept these terms, so it’s a good idea to ask before receiving care. However, all providers must provide service during an emergency. Most PFFS plans provide prescription drug coverage, but if your plan doesn’t, you can purchase a separate Medicare Part D plan.
SNPs are designed for individuals with specific diseases or conditions. If you’re eligible for both Medicare and Medicaid, live in a nursing home, or have a specific disease or illness, such as cancer, dementia, or HIV/AIDS, you are eligible for an SNP plan. These plans adapt coverage to suit the needs of a specific group, and all SNPs are legally required to provide prescription drug coverage.
Enrollment and eligibility for Medicare Advantage Plans in Michigan
To enroll in Medicare Advantage, you must meet the following eligibility requirements:
- You must be aged 65 or older or have a disability
- You must be a U.S. citizen or a permanent resident for at least five years
- You must be enrolled in Original Medicare Parts A and B but not in Medigap
- You must live in the county in which your Medicare Advantage Plan is available
- In 2021, seniors with end-stage renal disease (ESRD) will be eligible for a Medicare Advantage Plan for the first time
You can only enroll in Medicare Advantage Plans during the scheduled enrollment periods unless you qualify for a special enrollment period. Loss of coverage due to retirement or moving out of a qualified region frequently initiates a special enrollment circumstance.
- The Initial Enrollment Period includes the three months before your 65th birthday, your birth month, and the three months after your birthday.
- The Open Enrollment Period runs from October 15th to December 7th. During this period, you can enroll in a Medicare Advantage Plan or switch to a new plan.
- The Medicare Advantage Open Enrollment Period takes place from January 1st to March 31st. You can change Medicare Advantage Plans or return to Original Medicare during this period.
Prescription drug coverage
Most HMO and PPO plans include prescription drug coverage, but you’ll probably need to pay a separate premium for it. If it is included with your plan, the overall price will be higher. If your HMO or PPO plan doesn’t include prescription drug coverage, you aren’t permitted to purchase a separate Medicare Part D drug plan. You’ll be automatically unenrolled from your Medicare Advantage Plan and returned to Original Medicare if you do. However, if your PFFS plan doesn’t include prescription drug coverage, you can purchase a separate Part D plan. Under the law, all SNPs must provide prescription drug coverage.
Medicare Advantage Resources in Michigan
Selecting the right Medicare Advantage Plan can be like buying a new car. You want the right color, horsepower, and fit for your family and good gas mileage. It’s not easy keeping all these factors in mind. Selecting a Medicare Advantage Plan can be just as confusing if you don’t have the right information. Many resources in Michigan can help ease the process of selecting a Medicare Advantage Plan.
Michigan Medicare/Medicaid Assistance Program
This program educates and counsels seniors and people with disabilities to help them make informed choices about Medicare and Medicare Advantage. Experienced counselors walk you through your options about plans, benefits, and fees, to help you find a plan that provides the best coverage available in your county. Michigan residents can access the program for free.
Contact Information: Website |800-803-7174
Michigan Health Insurance Consumer Assistance Program
Offered by the Michigan Department of Insurance and Financial Services, this program assists seniors who need help making decisions about their health care, including whether to remain with Original Medicare or enroll in a Medicare Advantage Plan. You can receive assistance with finding a Medicaid Advantage Plan, comparing plans and switching between plans. You can also find information about long-term care insurance and Medicare supplements.
Contact Information: Website | 877-999-6442
Medicare Rights Center
This up-to-date national resource has information on Medicare and Medicare Advantage programs across the country. If you have any questions about Original Medicare or Medicare Advantage in Michigan, you can call the national helpline. Trained staff and volunteers can help you understand Medicare benefits, explain how and when to enroll in a Medicare Advantage Plan, and discuss your eligibility for cost-saving programs in the state.
Contact information: Website | 800-333-4114
Learn More from Our Sources
- Medicare | Medicare Advantage HMO Plans | Last accessed June 2021
- Medicare | Medicare Advantage PPO Plans | Last accessed June 2021
- Medicare | Medicare Advantage PFFS Plans | Last accessed June 2021
- Medicare | Medicare Advantage SNP | Last accessed June 2021
- Medicare | Who can join a Medicare Advantage plan? | Last accessed June 2021
- Medicare |Joining a Health or Drug Plan | Last accessed June 2021
- Health Insurance | Medicare in Michigan | Last accessed June 2021
- Medicare| How Medicare Special Needs Plans (SNPs) Work | Last accessed June 2021
- Medicare | Understanding Medicare Advantage and Medicare Drug Plan Enrollment Periods | Last accessed June 2021
- Michigan Medicare/Medicaid Assistance Program |Navigating Healthcare | Last accessed June 2021
- Michigan Department of Insurance and Financial Services | Michigan Health Insurance Consumer Assistance Program | Last accessed June 2021
- Medicare Rights Center | Getting Medicare Right | Last accessed June 2021