If you’re a Medicare beneficiary living in the state of Michigan, you may be eligible to enroll in a Medicare health insurance plan through the Medicare Advantage (Medicare Part C) program. Medicare Advantage plans provide another option for beneficiaries enrolled in Original Medicare, Part A and Part B, and are required by law to offer at least the same benefits as Original Medicare (with the exception of hospice, which is still covered under Part A).
Like residents of other states, Michigan residents enrolled in a Medicare Advantage plan get their benefits administered through the individual health plan and not the federal Medicare program, and their health plan options depend on the Michigan zip code in which they live.
Whether you’re new to Medicare or looking to explore your other coverage options, here’s an overview of how Medicare Advantage plans work in Michigan.
How Medicare Advantage works in Michigan
As mentioned, Michigan Medicare beneficiaries can sign up for Medicare Advantage plans as an alternative way to get their Original Medicare coverage. As in other states, Medicare Advantage plans in Michigan are available through Medicare-contracted private insurance companies, and they are required by law to offer at least the same coverage as Original Medicare. Medicare Advantage plans often offer additional benefits, including routine dental or vision, hearing, and prescription drug coverage.
In Michigan, as in other states, you can enroll in a Medicare Advantage plan if you meet all the following requirements:
- You have both Part A and Part B.
- You live in the service area of the plan you want to enroll in.
- You don’t have end-stage renal disease (ESRD). There are exceptions, so if you have ESRD and want to enroll in a Medicare Advantage plan, you can contact Medicare about whether you qualify for an exception; the contact information is at the end of this article.
Like other parts of Medicare, you can enroll in or make changes to your Medicare Part C coverage during certain times of the year. There are a couple of election periods for Medicare Advantage plans. Your first opportunity to enroll in Medicare Part C is during your Initial Coverage Election Period (ICEP):
- If you sign up for Medicare Part A and Part B when you first qualify for Medicare, you can enroll in a Medicare Advantage plan at that time as well. Your ICEP is the seven-month period that starts three months before the month where you turn 65, runs through your birth month, and continues for the three months after that. It typically takes place at the same time as your Initial Enrollment Period for Part B.
- If you delay enrollment in Medicare Part B (for example, if you’re covered through employment), your ICEP is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your ICEP would be April 1 to June 30.
You can also enroll in a Medicare Advantage plan, switch plans, or disenroll from your current plan during the Fall Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. Also called the Annual Election Period, it runs from October 15 to December 7 each year. If you enroll in or change Medicare Advantage plans during the Fall Open Enrollment Period, in Michigan or anywhere else in the country, your new coverage generally begins on January 1 of the following year. You may also use this period to disenroll from your Medicare Advantage plan and go back to Original Medicare.
In certain cases, you can change Medicare plans during a Special Election Period, which can take place any time of the year that you have a qualifying situation. These circumstances include (but aren’t limited to) moving to a new address where your plan isn’t offered, losing current health coverage, qualifying for new coverage (such as Medicaid), or changes in your present plan that result in changes to your health benefits (for example, if Medicare terminates its contract with your Medicare Advantage plan). The dates and types of changes you can make vary according to the reason you qualify for a Special Election Period.
If you want to disenroll from your Medicare Advantage plan and switch back to Original Medicare, you can do so during the Medicare Advantage Open Enrollment Period , which in Michigan (like the rest of the country) runs from January 1 through March 31 each year. Because Original Medicare doesn’t include prescription drug coverage, you can also enroll in a stand-alone Medicare Prescription Drug Plan during this period. You can also switch from one Medicare Advantage plan to another during this period.
Types of Medicare Advantage plans in Michigan
As a Medicare Advantage beneficiary, you can choose from a variety of health plans. Be sure to understand exactly what each plan offers in order to select the one that’s best suited to your health and prescription drug needs:
- Your Medicare Advantage options in Michigan include Health Maintenance Organization (HMOs). Under an HMO plan, you may be required to visit doctors, health-care providers, and hospitals on the health plan’s provider network list in order to be covered, and you may also need a referral from your primary care doctor to get coverage for certain health services (such as specialist care). If you use non-network doctors, you may not be covered (with the exception of emergency or urgent care). For those seeking more flexibility, HMO Point-of-Service (HMO-POS) plans may be a good alternative. These plans allow you to go out of network for certain health services, generally at a higher cost.
- Medicare beneficiaries in Michigan can also select a Preferred Provider Organization* (PPO) plan. Under a PPO, you can visit doctors, health-care providers, and hospitals outside of the plan’s network, but you may end up paying more by exercising this option. Your cost sharing is lower if you use doctors from the plan’s preferred provider network. You don’t need referrals for specialist care.
- A Medicare Special Needs Plan (SNP) is another type of Medicare Advantage health plan that limits enrollment to people with special health needs, which may include those with certain chronic or disabling conditions; those with both Medicare and Medicaid; and those who live in institutions. A Medicare Special Needs Plan offers coverage customized to suit the health needs of specific beneficiaries, like HIV/AIDS patients, people with diabetes, those living in nursing homes, or beneficiaries who also qualify for Medicaid.
- Medicare Advantage plans in Michigan may also include Private Fee-for-Service (PFFS) plans, which independently decide how much each beneficiary pays for doctor, health-care provider, and hospital visits. A PFFS plan lets you see any provider that will accept the plan’s payment terms and agree to treat you on a case-by-case, service-by-service basis.
- Medical Savings Account (MSA) plans may be another option. These plans combine a high deductible plan with a medical savings account that beneficiaries can use to pay for their health-care expenses before they reach the plan’s deductible. Money withdrawn to pay for eligible medical expenses is tax free.
- Medicare beneficiaries who want prescription drug coverage can opt for a Medicare Advantage Prescription Drug plan in Michigan, which combines health and prescription drug coverage into a single plan. Many of the plans described above may include prescription drug benefits, but not all do; always check with the company offering the plan before you enroll in a Medicare Advantage plan if you want prescription drug coverage.
Medicare beneficiaries enrolled in a Medicare Advantage plan have to stay enrolled in Original Medicare and continue paying the Medicare Part B premium.
Comparing Medicare Advantage plans in Michigan
It’s important for you to compare the benefits available under each Medicare Advantage plan in Michigan. Plans generally charge different costs and often have different rules regarding services depending on where you live and on your specific health needs. These rules can change on a yearly basis, so it’s crucial for you to stay up-to-date with your current plan’s policy.
Premiums for a Medicare Advantage plan with the same coverage and benefits can vary between different service areas within the state of Michigan. Some Medicare Advantage plans may offer premiums as low as $0, but do keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose. Also, remember to always consider all of the costs you may have with a Medicare Advantage plan; some plans that offer $0 premiums may offset the monthly premium cost by having higher copayments or deductibles.
You also need to decide whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug plan and if there are other benefits you’d like coverage for (such as routine vision or dental). With all these options, you can see why it can be important to compare plans with the benefits and costs best suited to your health needs.
View the following page for more information on other types of Medicare coverage in Michigan:
- Medicare in Michigan
- Medicare Part D plans in Michigan
- Medicare Supplement (Medigap) Plans in Michigan
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.