Thanks to expanding benefits and more plans becoming available, Medicare Advantage (MA) grows more popular every year. Nearly 31 million people had an Advantage plan in 2023, accounting for over one-half of eligible Medicare beneficiaries. This page explains Medicare Advantage plans in Michigan and how to compare your options to ensure you get the best plan for your unique needs.
What is Medicare Advantage in Michigan?
Also known as Medicare Part C, every Medicare Advantage plan must provide the same coverage you get with Original Medicare. This includes:
- Medicare Part A, hospital insurance (inpatient services)
- Medicare Part B, medical insurance (outpatient services)
Prescription drug coverage is available via standalone Medicare Part D plans. It is also included with around 90% of Advantage plans.
Medicare Advantage plans with prescription drug coverage in Michigan
Medicare Advantage Prescription Drug plans (MA-PD) combine the benefits of Medicare Parts A, B, and D.
Many Advantage plans – with or without prescription drug coverage – also offer additional benefits. Common items include:
- Routine vision care
- Routine dental care
- Hearing aids
- Fitness programs
Private insurance companies provide Medicare Advantage plans, which means that coverage and costs will vary depending on which plan you choose.
Who is eligible for Medicare Advantage in Michigan?
If you have Medicare Parts A and B, you're eligible for Medicare Advantage in Michigan.
American citizens and permanent legal residents aged 65 and older qualify for Medicare. For those who began collecting Social Security benefits at least 4 months before their 65th birthday, enrollment in Parts A and B is automatic. Everyone else must apply for Medicare.
You're also eligible for Medicare if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically in month 25.
When can you sign up for a Medicare Advantage Plan in Michigan?
You may join a Medicare Advantage plan in Michigan during specific enrollment periods.
Your Initial Enrollment Period (IEP) begins 3 months before your Medicare eligibility month and lasts for a full 7 months. For example, if your 65th birthday or 25th month of collecting disability occurs in February, your IEP starts on November 1 and ends on May 31.
If you fail to sign up for Part A and/or Part B during your IEP, you may do so during the General Enrollment Period from January 1 until March 31. You may then join a Medicare Advantage plan from April 1 until June 30.
You may also sign up for an Advantage plan during Medicare's Annual Enrollment Period (AEP), which runs runs from October 15 through December 7.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 and is for people currently enrolled in Part C. Options are limited to joining a new MA plan or returning to Original Medicare. You may also enroll in a standalone Part D plan if making that change causes you to lose your prescription drug coverage.
If you experience certain life changes, you can sign up for Part C during a Special Enrollment Period. Find the full list of qualifying circumstances on Medicare.gov.
Types of Medicare Advantage plans in Michigan
The four main types of Medicare Advantage plans in Michigan are:
- Health maintenance organizations: HMO plans require plan members to choose a primary care doctor and get a referral to see a specialist. They also have a provider network that may include any entity you rely on for healthcare services. Treatment received from an out-of-network provider is rarely covered by an HMO except in cases of emergency.
- Preferred provider organizations: PPO plans also have provider networks, but they allow members to go outside the network for a higher copay. PPO plan members also don't need a primary doctor or specialist referrals.
- Private fee-for service: PFFS plans establish cost guidelines for covered services, including what plan members pay. Most PFFS plans have a provider network but allow members to use an out-of-network provider for a higher cost. You also don't need a primary doctor or referrals to see a specialist.
- Special needs plans (SNPs) are limited to people who meet certain criteria. Guidelines vary by plan, but expect one of the following: having a chronic condition, living in an institution or requiring home-based care, or qualifying for both Medicare and Medicaid. Most SNPs also require beneficiaries to choose a primary doctor. If you qualify for an SNP, you may join the plan at any time.
How to choose a Medicare Advantage plan in Michigan
When comparing your Medicare plan options, consider the following:
- Costs: These may include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Benefit vary widely, so compare your options carefully. Don't forget the drug formulary for MA-PD plans.
- Network: Providers may include doctors, hospitals, labs, pharmacies, durable medical equipment (DME), and more.
- Ratings: Medicare rates plans on a 5-point scale and releases their findings every fall to help members compare their options during AEP.
It's easy to compare Medicare Advantage plans in Michigan with our Find a Plan tool. Just enter your location information and estimated coverage start date to review the Medicare plan options in your area.
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