Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). offers at least the same coverages and benefits as Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance)., but is offered by private insurance companies. Because of this, it can also include other services, including prescription drug coverage and hearing, dental and vision benefits.
Medicare Advantage comes in several plan types. Two of the most popular in Michigan are Preferred Provider Organizations (PPO)A Preferred Provider Organization (PPO) is a health insurance plan that doesn't require you to get a referral from a primary care physician to see other doctors. Most PPOs allow you to see any doctors or providers in their network. and Health Maintenance Organizations (HMO)A Health Maintenance Organization (HMO) is a type of plan that uses a network of doctors, hospitals, and other providers to treat an insurance company's customers..
The average monthly Medicare Advantage premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. in Michigan is $28.74 in 2022.
Whether you call yourself a Michigander or a Michiganian, there are nearly 10 million Michigan residents. About one-fifth are enrolled in Medicare, the government’s health insurance plan for those age 65 and older, and those with qualifying medical conditions.
When you’re eligible for Medicare in Michigan, you have the choice to stay with Original Medicare or participate in Medicare Advantage plans. With Medicare Advantage plans, a private insurance company fulfills your Medicare benefits. Keep reading to learn more about Medicare Advantage offerings, costs and coverage in Michigan.
Find a local Medicare plan that fits your needs
Medicare coverage consists of different parts, e.g., Part A, Part B, Part C and Part D. If you paid Medicare taxes for 40 quarters, you could receive Medicare Part A (hospital insurance) without paying a premium. However, there is a monthly premium for Medicare Part B (medical insurance) that you will pay regardless of whether you have Original Medicare (Parts A and B) or Medicare Advantage (Part C).
Medicare Advantage is an alternative to Original Medicare offered by private insurance companies. Medicare Advantage offers at least the same coverages and benefits as Original Medicare and may also offer other services, including prescription drug coverage and hearing, dental and vision benefits.
Different Medicare Advantage plan types exist. While most Medicare Advantage enrollees in Michigan participate in local Preferred Provider organizations (PPOs), there are other plan types.
A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan that requires beneficiaries to choose from providers within a provider network to receive coverage. If they choose an out-of-network provider, their insurance may not cover their costs. This plan type is slightly different from a PPO, where the insurance company will usually pay at least a portion of the medical costs, even if the provider is out of network.
Are you eligible for cost-saving Medicare subsidies?
Some Medicare Advantage enrollees in Michigan will pay a $0 premium for their Medicare Advantage plan. While it may seem unusual not to pay a premium, remember that insurance companies receive funds from Medicare to provide enrollees with health services. By negotiating for lower rates with in-network providers, Medicare Advantage companies can charge $0 premiums.
Medicare Advantage plans tend to be available by regions in the state. However, all persons enrolled in Medicare in Michigan have access to a $0 premium plan if they would like to have one. However, the average monthly Medicare premium in Michigan for 2022 is $28.74. Some people prefer to pay a monthly premium in return for a more extensive covered prescription drugs list, lower deductibles or lower out-of-pocket maximums.
Most people who qualify for Medicare in Michigan do so based on their age. When a person turns 65, they qualify for Medicare. However, other health-related circumstances can qualify a person to receive Medicare early. These include:
- You have received disability benefits from the Social Security Administration or Railroad Retirement Board for 24 months
- You’re living with Lou Gehrig’s disease (amyotrophic lateral sclerosis)
- You’re living with end-stage renal disease (ESRD)
Michigan residents can enroll in Medicare during their Initial Enrollment Period (IEP). Your IEP is the three months before, the month of, and the three months after you turn 65. If you are collecting Social Security benefits, you’ll be automatically enrolled. If you are not, you can sign up for Medicare during this time with the Social Security Administration.
You can join a Medicare Advantage plan when you first sign up for Medicare. Because many Medicare Advantage plans in Michigan also offer prescription drug (Part D) coverage, you can choose Part D coverage when you enroll without adding a premium — unlike what happens when you sign up for a stand-alone Part D to go with your Original Medicare.
If you don’t sign up for Medicare during your IEP, you still have options to enroll in Medicare. You can enroll during the General Enrollment Period. During this time from January 1 to March 31, you can enroll in Original Medicare. After that, you can switch to a Medicare Advantage plan.
Because you may have to pay penalties if you enroll late, it’s best to sign up for a Medicare plan in Michigan when you initially qualify.
What extra benefits and savings do you qualify for?
Yes, and for many Michigan residents, the ability to bundle their prescription drug coverage into their Medicare Advantage plans, without having to pay a separate monthly premium, can be a big selling point. But if you like your plan and would like to add stand-alone Part D coverage in Michigan, there are 23 plans to choose from in 2022. There are also several options — both stand-alone and as part of a Medicare Advantage plan — that offer reduced insulin costs thanks to the Part D Senior Savings Model.
No matter how you receive your Part D coverage, your prescription drug plan must cover a range of drugs, some of which fall into a “protected class” because they help to treat serious conditions, such as cancer. To see if your medications are covered while shopping for Part D coverage, check the plan’s drug formulary. This is a list of all the drugs it has agreed to cover. These drugs are organized by “tier,” and this helps determine how much of the cost the insurance company will cover.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement