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Medicare in Michigan

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 for Michigan beneficiaries

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:

  • You must be age 65 or older*.
  • You must be a United States citizen or a legal permanent resident of at least five continuous years.

*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:

  • 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 (except during an inpatient hospital stay)
  • Long-term care
  • Acupuncture
  • Dentures
  • Vision
  • Dental
  • Hearing aids
  • Cosmetic surgery
  • Overseas health coverage, except in limited situations

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:

  • 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 period for Original Medicare that occurs from January 1 to March 31 every year. If you enroll in Original Medicare at this time, the effective date for your coverage is 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 their own or their spouses’ current employment (for example, a group health plan) or a former employer’s retirement benefit 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 plan options in Michigan

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 Part C: Commonly known as Medicare Advantage, plans under this program provide your Part A and Part B benefits through private, Medicare-approved Medicare Advantage plans provide all of the benefits of Original Medicare Part A and Part B (except 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).  However, 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 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 Part D: provides for optional prescription drug coverage. Individuals who have Medicare Part A and/or Part B may enroll in a stand-alone Medicare Part D Prescription Drug Plan available where they live. Some people may choose to enroll in a Medicare Advantage Prescription Drug plan if they have both Part A and Part B coverage and would prefer to receive their health and prescription drug coverage from a single plan available in the community where they live.

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.

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.

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:

The product and service descriptions, if any, provided on these PlanPrescriber Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.