Medicare Plan Options
Original Medicare is the basic health insurance program that the Centers for Medicare & Medicaid Services administers. It offers the same coverage to everyone and may be a cost-saving option for those with limited health needs. While this plan covers a lot of health-related expenses, it doesn’t cover everything. To help you control out-of-pocket costs, private health insurance companies provide alternatives such as prescription drug coverage, supplemental coverage, and Michigan’s Medicare Advantage program.
Original Medicare covers a broad range of health services, including inpatient and outpatient hospital care, skilled nursing services, preventative care, and mental health services. It’s a fee-for-service plan, meaning that you pay for individual health services as you receive them. Original Medicare has a deductible, which is the amount that you have to pay for health care before your plan pays for anything. After you meet your deductible, you generally pay 20% of the cost of health care services, and Medicare pays the rest. The deductible resets every year, and there is no annual out-of-pocket limit. You can go to any doctor that accepts Medicare, and you usually don’t need referrals to see specialists.
Medicare Advantage Plans
In addition to Original Medicare, Michigan has 83 Medicare Advantage Plans. These plans are sold by private health insurance companies and feature the same benefits as Original Medicare Parts A and B, along with additional benefits such as prescription drug coverage, vision and dental coverage, and homemaker services. There are several different plan types, including HMOs, PPOs, PFFS Plans, and SNPs, each of which has its own rules about choosing primary care doctors and getting referrals to see specialists. Many plans have no premium beyond the Part B premium that everyone pays, but some have additional premiums to cover extra benefits. Unlike Original Medicare, Medicare Advantage Plans usually have annual out-of-pocket limits, and many don’t have deductibles.
Medicare Prescription Drug Coverage Plans
Medicare prescription drug coverage helps you afford the prescription medications your doctor prescribes. While Original Medicare Part B covers a handful of outpatient drugs, such as injectables or drugs infused through a nebulizer, most medications aren’t covered under the basic plan. Private insurance companies sell prescription drug plans according to a standard level of coverage set by Medicare. Each plan has its formulary, or list of covered medications, including brand-name drugs and generics. Some costs associated with these plans include monthly premiums, copays or coinsurance, and in some cases, deductibles.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance is sold by private companies to help you handle some of the health care costs not covered by Original Medicare. These plans pay for copays, coinsurance, and deductibles depending on the plan you choose. Insurance companies decide which Medigap policies they want to sell, though if they sell any at all, they must sell Plans A and C or F, so you may not have access to all 10 plans. In addition to covering health care costs, Medigap plans may also pay for the emergency medical care you get when traveling outside the United States.
Medicare in Michigan by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending perbeneficiary||Spending per beneficiary compared to the national average|
|1,089,250||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Michigan
As you’re researching the right Medicare plans for your needs, it can be helpful to get support before signing up for a policy. Michigan is home to several agencies and programs that can help you evaluate your health expenses, medications, and budget to determine the best policy for you. These agencies also provide guidance and support for handling issues such as canceled policies and denied claims.
Michigan Medicare/Medicaid Assistance Program
The Michigan Medicare/Medicaid Assistance Program is a free statewide program that provides free health insurance options counseling for Medicare beneficiaries. It’s staffed primarily by trained volunteers who can answer questions regarding Medicare’s scope of coverage, determine whether you qualify for income-based financial assistance programs, and find Medigap or Medicare Advantage Plans with the coverage you need. Advisors also provide information on avoiding Medicare fraud and addressing issues such as denied claims, overcharges, or canceled policies.
Contact Information: Website | 800-803-7174
Michigan Department of Health and Human Services
The Michigan Department of Health and Human Services administers the Medicare Savings Program, which can help you reduce out-of-pocket health care expenses. Depending on your income, this program pays for certain Medicare costs such as premiums, coinsurance, and deductibles. The department may also refund you a portion of your Part B premium on an annual basis.
Contact Information: Website | 517-241-3740
Area Agencies on Aging Association of Michigan
The Area Agencies on Aging Association of Michigan oversees a network of 16 AAAs that serve the state’s 83 counties. These nonprofit organizations provide a broad range of services to older adults, including options counseling, legal advice, and referrals to local resources. You can connect with an MMAP advisor for free, unbiased health insurance options counseling through your local AAA. These advisors can answer questions regarding your Medicare coverage, available Medigap and Medicare Advantage Plans in your region, and cost-saving programs.
Contact Information: Website | 517-886-1029
Legal Services of South Central Michigan
Legal Services of South Central Michigan serves older adults in the Detroit region through free legal advice and representation. Through this nonprofit legal organization, you can get help with enrolling in Medicare, obtaining income-based prescription drug assistance, and determining which Medigap and Medicare Advantage Plans are available in your region. Legal professionals can also help you resolve issues related to your health insurance, such as denied claims or canceled policies.
Contact Information: Website | 734-665-6181
Learn More From Our Sources
- CMS | Medicare Program – General Information | Last accessed June 2021
- Medicare | Prescription drugs (outpatient) | Last accessed June 2021
- Medicare | Costs for Medicare drug coverage | Last accessed June 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed June 2021
- Medicare | How to compare Medigap policies | Last accessed June 2021
- Michigan Medicare/Medicaid Assistance Program | Last accessed June 2021
- Michigan Department of Health & Human Services | Last accessed June 2021
- Area Agencies on Aging Association of Michigan | Last accessed June 2021
- Legal Services of South Central Michigan | Last accessed June 2021