October 6, 2016
If you live in Michigan and have Original Medicare, you may have other coverage options as well, depending on your county and zip code of residence. Certain kinds of coverage, namely Medicare Part C (Medicare Advantage), and Medicare Part D (prescription drug coverage), are available only through Medicare plans offered by private insurance companies contracted with Medicare.
Original Medicare is a government program that provides health coverage to many people age 65 and older, and to certain disabled individuals under the age of 65. 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 participating in the Medicare program and accepts Medicare assignment.
Medicare eligibility requirements are the same for all states, including Michigan:
*People under age 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 continuous months from either the Social Security Administration or the Railroad Retirement Board.
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 has a premium, which most beneficiaries must pay.
Part A benefits include:
Part B benefits include:
Original Medicare generally doesn’t cover the following benefits:
Some of the benefits not covered by Original Medicare may be available through Medicare plans offered by Medicare-approved private insurance companies. For example, Medicare prescription drug coverage is available only through private insurance companies that offer stand-alone Medicare Part D Prescription Drug Plans or Medicare Advantage plans with prescription drug coverage.
In Michigan, as in the rest of the country, Medicare-eligible individuals can enroll in Original Medicare during the following periods:
You can enroll in Medicare through Social Security:
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.
Beneficiaries in Michigan may also have Medicare options that permit them to receive their Medicare coverage from plans offered by private insurance companies contracted with Medicare. The specific plans available to you will depend on your county and zip code.
Listed below is an overview of the Medicare programs and associated Medicare plans offered by private insurance companies.
Medicare Advantage with prescription drug coverage: Some Medicare Advantage plans come with prescription drug coverage, meaning you receive benefits of both the Medicare Part C and Part D programs in one plan.
You can enroll in a Medicare Advantage plan (with or without prescription drug coverage, switch to another Medicare Advantage plan, return to Original Medicare or enroll in a stand-alone Medicare Prescription Drug Plan during the Annual Election Period, from October 15 to December 7.
To enroll in a Medicare Advantage plan, you must have Medicare Part A and Part B and you must live in the plan’s service area. Typically you’re not eligible to sign up for a Medicare Advantage plan if you have End Stage Renal Disease (ESRD).
Medicare Supplement (Medigap): If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
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.
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.
Medicare/Medicaid Assistance Program (MMAP): Locate educational resources for older adults and disabled individuals, including free counseling for Medicare, Medicaid, and health insurance questions.
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.
Learn more about how Medicare plans work in Michigan, including:
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