If you need help paying for out-of-pocket expenses related to Original Medicare, you may consider signing up for a Medicare Supplement (Medigap) plan. These plans aren’t meant to provide stand-alone coverage, but may cover certain costs in Original Medicare, such as emergency travel coverage and cost-sharing expenses. There are various Medigap plans available in Michigan, depending on your zip code, so it’s a good idea to understand what Medigap in Michigan covers to choose the plan that best fits your individual health and budget needs.
As mentioned, Medigap plans in Michigan are designed to help Medicare beneficiaries pay for costs associated with Original Medicare, Part A and Part B, including copayments, coinsurance, and deductibles. These plans can’t be used to pay for Medicare Advantage (Medicare Part C) costs. There are 10 standardized Medicare Supplement plans available in 47 states, including Michigan, and each plan is identified by one of 10 letters (A, B, C, D, F, G, K, L, M, and N), with plans of the same letter offering the same benefits. Three states – Massachusetts, Minnesota, and Wisconsin – offer different types of standardized Medigap plans.
To be eligible for Medigap in Michigan, you must already be enrolled in Original Medicare, Part A and Part B. Your Medigap Open Enrollment Period is usually the best time to enroll in a plan and starts the first day you are both age 65 or older and enrolled in Medicare Part B. This enrollment period lasts for six months. During your Medigap Open Enrollment Period, you have a guaranteed-issue right to enroll in any Medigap plan available in your service area. You cannot be denied coverage altogether because of your health status or required to undergo medical underwriting; however, insurance companies may require a six-month waiting period before covering your pre-existing conditions. If you try to enroll in or switch plans outside of your Medigap Open Enrollment Period, there’s a chance you may be denied coverage or charged more for your insurance plan unless you have guaranteed-issue rights. There are a few situations where you can still enroll in or change plans with guaranteed issue (for example, if your Medigap insurance company misled you or broke the rules).
It’s important to understand that Medigap in Michigan is meant to supplement Original Medicare, not replace it. You have to remain enrolled in Original Medicare for your hospital and medical coverage, and you’ll need to keep paying your Medicare Part B premium keep this coverage. In addition, be aware that Medigap plans in Michigan do not offer prescription drug coverage, so if you want to receive such coverage, you may want to consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan.
Here’s a look at the 10 standardized Medicare Supplement plans to help you understand what kind of benefits Medigap in Michigan offers. In this chart, X indicates that the service (or item) is 100% covered; a percentage indicates what percent of the service/item is covered; and a blank cell indicates it is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B excess charges||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Out-of-pocket limits apply.**|
*Medicare Supplement Plan F offers a high-deductible version in which beneficiaries pay a certain deductible amount before the plan begins coverage. This amount may change from year to year.
**Once you reach the out-of-pocket limits (including the Part B deductible), both Medicare Supplement Plans K and L pay 100% of covered services in the above chart for the remainder of the calendar year.
***Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, except for a copayment of up to $20 on doctor visits and up to $50 on emergency room visits that don’t result in an inpatient admission.
Medicare Supplement plans in Michigan with the same letter designation don’t vary in coverage or benefits, as explained above. However, each independent insurance company that offers Medicare Supplement plans can set its own premiums, so costs may vary. This means that a resident of Detroit in Wayne County may pay more or less than a resident of Ann Arbor in Washtenaw County for an identical Medicare Supplement plan. Keeping the differences in costs in mind, it may be a good idea to compare all Medicare Supplement plans available in your area to choose a Medigap plan in Michigan that fits your individual requirements.
For more information on other types of Medicare coverage in Michigan, see:
Want to learn more about choosing a Medigap plan in Michigan that suits your individual needs? Call the phone number on this page to speak with a licensed insurance agent and get started.