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When you become eligible for Medicare, you have two primary options for coverage. You could get Original Medicare, which includes Medicare Part A for hospital insurance and Part B for medical insurance. Or you could opt for a Medicare Advantage Plan.
Medicare Advantage Plans (also called Medicare Part C) are an all-in-one alternative to Original Medicare that provide the same coverage as Parts A and B. Plans also frequently include other benefits Original Medicare won’t cover, like prescription drug coverage, hearing, dental, and vision.
This article contains everything you need to know about Medicare Advantage Plans in Michigan.
Compare ratings of insurance companies offering Medicare Advantage Plans in Michigan:
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 207 Medicare Advantage Plans available in Michigan, you likely have a few options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With only 22% of Michigan residents choosing a Medicare Advantage Plan, Plan C isn’t as popular in the state as it is elsewhere in the country. This may be because there are fewer plans available in Michigan than in many other states, but these plans are still an option worth exploring.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Michigan, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Michigan Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Michigan Aging & Adult Services Agency||(517) 241-4100||The Michigan Aging & Adult Services Agency supports the state’s aging and adult services and helps residents live with dignity, meaning, purpose, and independence.|
|Michigan Application for Health Coverage and Help Paying Costs||(517) 241-3740||Apply for medical assistance programs you can qualify for based on income.|
|Michigan Department of Financial and Insurance Services||(877) 999-6442||This state department provides information about Medicare Advantage and Medigap policies, including explaining your rights. It also offers resources for reporting fraud.|
|Michigan Legal Services||(313) 964-4130||Legal help for low-income Michigan residents seeking assistance with civil legal needs.|
|Michigan Medicare / Medicaid Assistance Program (MMAP)||(800) 803-7174||MMAP is the State Health Insurance Assistance Program (SHIP) and Senior Medicare Patrol for Michigan. It focuses on delivering education so you can make informed health benefit decisions. MMAP also works through the state’s Area Agencies on Aging. MMAP is a great resource if you have questions or need guidance to understand Medicare Advantage options.|
|Michigan Department of Health & Human Services||(517) 241-3740||The Michigan Department of Health & Human Services offers the Medicare Savings Program to cover certain costs based on your income. For example, it can help pay for premiums, coinsurance, and deductibles|
|Michigan Medicaid Program||(517) 241-3740||Get in touch with Michigan Medicaid to learn if you qualify and sign up for benefits.|
|Resource||Contact||How they help|
|211Michigan||211||2-1-1 Michigan can connect you to critical resources (such as shelter availability childcare, or rent payment assistance) simply by dialing a three-digit number.|
|Michigan Area Agencies on Aging||(231) 947-8920||Area Agencies on Aging can connect you with one of its regional agencies, all of which provide a comprehensive selection of services for the region’s older adults. The agencies have programs designed to help seniors 60 and older maintain their health and independence, including resources to guide you through the Medicare enrollment process, and the counselors will help you understand the available benefits fully..|
|Detroit Area Agency on Aging||(313) 446-4444||The agency provides services and supports to older adults and caregivers, including help with Medicare, in-home care, nutrition, and more.|
|Area Agency on Aging 1B||(248) 357-2255||As part of the state’s network of AAAs, the 1B agency is resource central for aging adults and caregivers, and it can offer guidance on Medicare.|
|The Senior Alliance Incorporated||(734) 722-2830||You can turn to the Senior Alliance Incorporated for access to education, services and guidance for older adults.|
|CareWell Services Southwest||(269) 966-2450||CareWell promotes healthy aging and independence by providing access to resources including Medicare guidance.|
|Senior Resources||(231) 733-3585||The Area Agency on Aging serving Barry and Calhoun counties offers services to help older adults remain independent and stay healthy.|
|Resource||Contact||How they help|
|American Hospital Association – Medicare Advantage||1-800-424-4301||The AHA provides education for health care leaders and is a source of information on health care issues and trends.|
|CMS.gov – Medicare Advantage Applications||N/A||This page provides important information on the application process for Part C Medicare Advantage plans.|
|Medicare.gov – Medicare Advantage Plans||1-800-633-4227||This government website provides information on the Medicare Advantage program.|