Medicare in Michigan
Medicare Coverage in Michigan
If you live in Michigan and have Original Medicare, you may have private Medicare options as well, depending on your location and the county you reside in. Certain kinds of coverage, including drug coverage, are only available through private Medicare plans.
Original Medicare for Michigan beneficiaries
Original Medicare is a government program that provides health coverage to adults over 65 and certain disabled individuals. Original Medicare is administered by the federal government, so costs and benefits work the same way across the country. Generally, you'll be able to see any provider that is enrolled in the Medicare program and accepts Medicare patients.
Medicare eligibility requirements are the same for all states, including Michigan:
- You must be 65 and older*.
- You must be a United States citizen or a permanent legal resident.
*People under 65 may qualify for Medicare if they have amyotrophic lateral sclerosis (Lou Gehrig's disease) or end-stage renal disease (ESRD), or they have received disability benefits for 24 months.
Original Medicare comes with two parts, Part A (hospital insurance) and Part B (medical insurance). Most people automatically get Part A without a monthly premium if they've worked 10 years (40 quarters) and paid Medicare taxes. If you don't qualify for premium-free Part A, you can still enroll and pay a monthly premium. Part B always comes with a premium.
Part A benefits include:
- Inpatient care, including hospital and skilled nursing facility (SNF) stays
- Medications administered in hospital or SNF
- Home health care (limited)
- Hospice care
Part B benefits include:
- Medically necessary outpatient services
- Doctors' visits
- Preventive care
- Lab tests
- Durable medical equipment
- Mental health services
Original Medicare generally doesn't cover the following benefits:
- Prescription medications
- Long-term care
- Hearing aids
- Cosmetic surgery
- Overseas health coverage, except in limited situations
Some of the above benefits may be available through private Medicare plans. For example, Medicare prescription drug coverage is only available through private insurance companies.
In Michigan, as in the rest of the country, Medicare-eligible individuals can enroll in Original Medicare during the following periods:
- Initial Enrollment Period: This is the seven-month period when a person can first enroll in Part A and/or Part B. It starts three months before you turn 65, includes the month you turn 65, and ends three months later. If you have a disability, your Initial Enrollment Period is the seven-month period starting with your 22nd month of collecting disability benefits.
- General Enrollment Period: This is the annual enrollment for Original Medicare that occurs from January 1 to March 31 every year, and the effective date for your coverage would be July 1. Beneficiaries who don't sign up for Part A and/or Part B when they're first eligible may have to pay a late enrollment penalty.
- Special Enrollment Period: Some individuals can enroll outside of their Initial Enrollment Period and the General Enrollment Period if they delayed Part A and/or Part B because they had other health coverage through current employment (for example, a group health plan). If this is the case, you can enroll using a Special Enrollment Period when your coverage or employment ends and won't have to pay a late enrollment penalty.
You can enroll in Medicare through Social Security:
- Online at the Social Security website. You can apply for Medicare at the same time that you apply for retirement benefits. If you're not ready to retire, you can submit an application for Medicare only.
- By phone at 1-800-772-1213.If you are a TTY user, dial 1-800-325-0778. Call Monday through Friday, from 7AM to 7PM, to speak with a Social Security representative. If you worked for a railroad, you can call the Railroad Retirement Board (RRB) to apply for Medicare. The RRB can be reached at 1-877-772-5772; TTY users 1-312-751-4701. RRB representatives are available Monday through Friday, 9AM to 3:30PM.
- In person at a local Social Security office. To find local offices in Michigan, click here.
Medicare private insurance in Michigan
Original Medicare beneficiaries in Michigan may also have private Medicare options available. The specific plans available to you will depend on your county and zip code.
Here is an overview of some of the main kinds of Medicare private insurance:
- Medicare Part C: Commonly known as Medicare Advantage, these plans provide your Part A and Part B benefits through private insurers. Medicare Advantage includes all of the same Original Medicare benefits (besides hospice care, which is still covered by Part A even when you're in a Medicare Advantage plan). Some plans include extra benefits (for example, routine vision or dental). You're still in the Medicare program, and you must continue to pay your Part B premium.
- Medicare Advantage with prescription drug coverage: Some Medicare Advantage plans come with drug coverage, meaning you get both Part C and Part D benefits in one plan. If you want drug coverage and your Medicare Advantage plan doesn't include it, you generally cannot add a stand-alone Medicare Part D plan (the exceptions are Private Fee-for-Service and Medicare Savings Account plans). You can either switch to a Medicare Advantage Prescription Drug plan, or drop Medicare Advantage, return to Original Medicare, and add a Part D plan. You can do any of these during the Annual Election Period, from October 15 to December 7.
- Medicare Part D: Part D is optional prescription drug coverage. Original Medicare beneficiaries can buy this coverage by enrolling in a stand-alone Medicare Part D prescription drug plan.
- Medicare Supplement (Medigap): Medigap is extra coverage to help offset out-of-pocket costs in Original Medicare. Medicare Supplement plans help pay for expenses like copayments, coinsurance, deductibles, and foreign travel coverage. Medigap can only be used to pay Original Medicare costs; it doesn't work with Medicare Advantage.
Michigan resources for Medicare beneficiaries
According to Medicare.gov, Michigan beneficiaries can refer to the following resources for additional information:
- Michigan Department of Community Health: Get information on Medicare Savings Programs, which help limited-income beneficiaries pay for Medicare costs like premiums, coinsurance, and deductibles. Contact the department at 1-517-373-3740.
- Michigan Medicaid: Learn about the Michigan Medicaid State Plan and health coverage options for low-income individuals and families. You can apply through the Michigan Department of Community Health by calling 1-517-373-3740.
- Medicare/Medicaid Assistance Program (MMAP): This state program provides educational resources for older adults and disabled individuals, including free counseling for Medicare, Medicaid, and health insurance questions. Call MMAP at 1-800-803-7174.
- Michigan Department of Insurance and Financial Services: Find information on health insurance companies in the state, including insurer ratings and how to file a complaint. Contact the department at 1-517-373-0220 or 1-877-999-6442 (toll-free), Monday to Friday, 8AM to 5PM ET.
To find a Medicare Advantage plan, prescription drug plan, or Medigap plan in Michigan, you can:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as PlanPrescriber's parent company, eHealth.
- Call eHealth agents at 1-888-323-1149, TTY users 711; Monday through Friday, 8AM to 8PM ET, Saturday, 9AM to 6PM ET.
- Or enter your zip code where requested on this page to see a quote.
Medicare has neither reviewed nor endorsed this information.