Medicare Advantage (Part C) offers at least the same coverages and benefits as Original Medicare (Parts A and B) , but is offered by private insurance companies.
Medicare Advantage plans may provide additional services, including prescription drug coverage and hearing, dental, and vision benefits.
The average monthly Medicare Advantage premium in Michigan is $21.23 in 2024.
About a fifth of Michigan’s more than 10 million residents are enrolled in Medicare, the government’s health insurance plan for people 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.
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Original Medicare consists two parts, Part A and B. 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 whether you have Original Medicare 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 coverage and benefits as Original Medicare and may also offer other services, including prescription drug coverage and hearing, dental, and vision benefits.
As of 2024, there 210 Medicare Advantage plans available in Michigan. While most enrollees 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.
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Michigan’s average monthly premium for Medicare Advantage for 2024 is $21.23. The availability of specific plans varies by ZIP code, but everyone enrolled in Medicare in Michigan has access to a $0 premium plan. However, 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.
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For many Michigan residents, the ability to bundle their prescription drug coverage into their Medicare Advantage plans can be a big selling point. But if you would like standalone Part D coverage, Michigan residents have 21 plans to choose from in 2024
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
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status