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Medicare in Michigan

The latest info on Medicare in Michigan, including stats, facts, and helpful guidance

Reviewed by: Selah Lee, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Michigan is available to legal U.S. citizens 65 or older.

  • When you are eligible for Medicare in MI, you can sign up during open or a Special Enrollment PeriodA Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs. Some Special Enrollment Periods can be up to 90 days..

  • The cost of Original MedicareOriginal 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). in Michigan depends on several factors. While there are regular Medicare costs, many are income-based.

 

From farmland to affluent urban areas to lake life, Michigan has something for everyone. And if you’re a U.S. citizen that’s 65 or older, that includes Medicare.

Before you enroll in a Medicare plan in Michigan, there are some details you’ll want to understand to get the most out of your plan. How does Medicare in MI work? Are there different Medicare plans in MI? How much does Medicare in MI cost? Whether you’re in the Upper Peninsula or down in Detroit, here is information to help you enroll in Medicare in Michigan.

Who Qualifies for Medicare in Michigan?

To be eligible for Medicare in Michigan, you must be:

  • 65 or older
  • A legal United States citizen

If you’re younger than 65 but have received disability-based Social Security or Railroad Retirement Board benefits for 24 months, you may be eligible. The same is true for people living with End Stage Renal Disease (ESRD) or Lou Gehrig’s disease.

What Does Medicare Cover in Michigan?

Medicare in Michigan covers medically-necessary and preventive services, as well as stays at hospitals, nursing homes and skilled nursing facilities. The limits of that coverage depends on your plan.

If you enroll in Medicare in MI, all plans cover 10 essential benefits. They are:

1. Outpatient care
2. Emergency service
3. Maternity and newborn care
4. Prescription drugs
5. Pediatric services

6. Laboratory services
7. Rehabilitation and habilitation services
8. Mental health and substance abuse
9. Preventive or wellness services
10. Hospitalization

What does Medicare in Michigan not cover?

Medicare plans in Michigan provide a good amount of healthcare services, but they don’t cover everything. You have the option to enroll in Part D for prescription drug coverage and Supplement insurance for things like eye exams, dentures and most dental care, long-term care, cosmetic surgery, acupuncture, some footcare and hearing aids

If you want a single plan to bundle Parts A and B with Part D, consider Medicare Advantage in Michigan.

What Is the Best Medicare Plan in Michigan?

The answer here is completely personal, as each person’s healthcare needs are unique. That means that a Medicare policy that is great for a friend may not work for you. To determine the Medicare plan in Michigan that will fit your needs, there are some things to consider:

  • Assess your needs. Check out our Enrollment Checklist page.
  • Medicare Star Ratings. This is also known as the Star Rating System.
  • Consider each plan’s pros and cons. Make sure you understand what each offers.
  • Learn little-known tips. Our Pro Tips page will help Medicare in Michigan make sense.
  • Contact GoHealth: If you are ready to enroll in Medicare in MI, start with GoHealth. Our licensed insurance agents discuss your needs and shop for plans in your area that fit what you’re looking for.

How Do I Apply for Medicare in Michigan?

To apply for Medicare in Michigan, you can do one of the following:

  • Apply online at with Social Security [1]
  • Visit a local Social Security office in Michigan [2]
  • Enroll over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).
  • Did you work for a railroad? You may be able to enroll through the Railroad Retirement Board. To find out, contact the RRB at 1-877-772-5772.

If you’re a Michigander who’s receiving Social Security, you may be automatically enrolled in Medicare Parts A and B by the Social Security Administration when you turn 65. If this is the case, you’ll receive your enrollment packet roughly three months before your 65th birthday.

Enrolling in Medicare in MI?

When it’s time for you to enroll in Medicare, whether you’re turning 65 or enrolling again, it’s important to know the enrollment periods.

Turning 65 and new to Medicare?

The Initial Enrollment Period (IEP) is when new enrollees sign up for Medicare the year they turn 65. Enrollees are able to apply for additional Medicare plans during this period.

Already enrolled in Medicare in MI

Medicare Part C & Part D Annual Enrollment Period (AEP) allows you to change from Original Medicare to Medicare Advantage (or vice versa). You may also switch Medicare drug plans. AEP happens each year from Oct. 15 to Dec. 7.

Medicare General Enrollment Period (GEP) is useful If you did not enroll in Medicare when you were first eligible. You can sign up for Original Medicare in Michigan during the General Enrollment Period each year from Jan. 1 to Mar. 31.

Medicare Advantage Open Enrollment Period (OEP) is held annually from Jan. 1 to Mar. 31, this is the time to enroll in a different Medicare Advantage plan, or switch back to Original Medicare. You must already be enrolled in a Medicare Advantage plan on the 1st of January to qualify for this enrollment period.

How Much Is Medicare in Michigan?

While there are some standard costs to share, it really depends on several factors. If you have Original Medicare, here are the costs you can expect to pay for Medicare in Michigan in 2021:

Medicare in MI: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years
  • You or your spouse worked between 7.5 and 10 years: $259 a month
  • You or your spouse worked fewer than 7.5 years: $471 a month

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in MI: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in MI: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

What Are the 4 Types of Medicare in Michigan?

The four types of Medicare work in different ways to provide services and care. Knowing the differences between Original Medicare and Medicare Advantage can give you the tools you need to make the right choice. The same is true of knowing about Medigap and Prescription Drug Plan (Part D). Here’s a rundown of the four types of Medicare:

Original Medicare (Part A and Part B)

Original Medicare is partially provided by the federal government and is made up of Part A and Part B.

  • Part A: Provides hospital coverage. This can include inpatient hospital stays, skilled nursing and nursing home stays, hospice and home health care
  • Part B: The portion of Original Medicare that covers medically necessary and preventive services.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Part D and Medigap

If you’re enrolled in Medicare in Michigan, it’s important to know that there may be services you need that aren’t covered by Parts A and B alone. You may want to consider the other two forms of Medicare coverage:

Medicare Prescription Drug Plan (Part D) is a stand-alone plan that provides prescription drug coverage. Original Medicare enrollees need to add Part D separately if they want their prescriptions covered. However, Medicare Advantage Plans often include Part D coverage.

Medicare Supplement Insurance, or Medigap policies are private insurance plans that help cover “gaps” in Original Medicare. These plans cover some of the out-of-pocket costs such as deductibles, coinsurance and copays.

What Is the Best Medicare Advantage Plan in Michigan?

Finding the best Medicare Advantage in Michigan comes down to which plans provide the best fit for your personal needs. There are various MA plan types to choose from and plans offered can vary based on where you live.

  • Health Maintenance Organization (HMO) plans use a network of doctors, hospitals and other providers to treat an insurance company’s customers.
  • Preferred Provider Organization (PPO) plans allow you to see any doctor in your provider network without a referral from your primary care physician.
  • Private Fee-for-Service (PFFS) plans pay healthcare providers separately for each service.
  • Special Needs Plans (SNPs) are designed specifically for beneficiaries with specific conditions, diseases, or other characteristics. [3] D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.

Who Qualifies for Medicare Assistance Programs?

Need help paying for your Medicare? Whether you’re prepping for your Initial Enrollment Period or looking to lower your out-of-pocket costs, there are several low-income resources for Medicare plans in Michigan. Here are a few examples:

Medicare Savings Program

With a Medicare Savings Program (MSP), you may be able to lower the out-of-pocket costs associated with your Part B coverage. The Michigan MSP is based on your income and resources. If you qualify, a MSP may pay part or all of your premium, deductible, and coinsurance. [3]

Medicare Extra Help

Also known as the Low Income Subsidy (LIS), Extra Help is financial assistance designed to help low-income Medicare enrollees afford their Part D coverage. If your income qualifies, you can get help paying for your premium, deductible, and prescription drug costs. [4]

Programs for All-Inclusive Care for the Elderly (PACE)

PACE is designed to provide nursing home-level care to those that aren’t ready to move into a facility. If you qualify, you may be able to receive that care at home and in your community. In Michigan, eligibility starts at 55 and you must live within a PACE service area. [5]

Did You Know?

Original Medicare is the same thing as Medicare Parts A and B.

Medicare Advantage is the same thing as Medicare Part C.

GoHealth offers help with no strings attached. Our licensed insurance agents provide answers and guidance without any obligation from you.

Forgetting to enroll in Part D will cost you. You may have to pay a 1% penalty for each month you went without creditable coverage. When you do enroll, the penalty cost is added up, rounded to the nearest $.10, and applied to your premium.

When you have Medicare Advantage (Part C), your Part C benefits ID card replaces your Medicare red white and blue card at every visit.

Along with receiving Part A and B benefits, Medicare Part C often bundle additional services like dental, hearing, vision and prescription drug coverage.

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare.

Since Jan. 1, 2021, patients with End Stage Renal Disease (ESRD) can now enroll in Medicare Advantage plans (Medicare Part C).

Many Medicare Part C (Medicare Advantage) plans include gym memberships and online fitness classes as covered benefits.

While you can enroll in a Medicare Part C plan during the Initial Enrollment Period (IEP), you must have Medicare Part A and Part B before choosing a Medicare Advantage plan.

Assistance from your state’s Medicare Savings Program may help pay for your premiums if you qualify.

A Medicare late enrollment penalty can be applied for every year you choose not to enroll in a plan but are eligible. Do you know when your initial enrollment period begins and ends?

Medicare does not offer group or family insurance plans. While it may consider your spouse’s income and work history in some cases, all Medicare plans are individual policies.

Some Medicare costs are income-based; if you earn more than $88,000 (or $176,000 as a couple) annually, you’ll pay more than the standardized monthly premiums for Part B and Medicare Part D. Social Security assesses these additional costs based on their tax return from two years prior.

You can delay Medicare enrollment without penalty if you have group coverage when you turn 65. When your group coverage ends, you have eight months to enroll in Medicare Part B during a special enrollment period (SEP).

You do not have Part A coinsurance payments for the first 60 days in a hospital (and 20 days in a skilled nursing facility).

You qualify for no-cost Part A coverage at age 65 if you paid Medicare taxes for 40 quarters or more – or if your spouse or ex-spouse did.

The Social Security Administration automatically signs you up for Medicare when you turn 65 – but only if you’re already receiving Social Security benefits. If you aren’t yet receiving benefits, you must contact the Social Security Administration to enroll in Medicare yourself.

The standard Medicare Part B premium can rise from one year to the next. In 2021, the premium is $148.50.

If you drop your Medicare coverage, you must repay all Part A benefits paid on your behalf.

Most states have several Medicare Supplement Insurance (Medigap) policies to choose from. They help cover out-of-pocket costs from Original Medicare (Parts A and B) and are priced differently.

Medicare and Medicare Advantage plans may help you pay for weight loss programs if they are a necessary part of treatment for diseases like diabetes, hypothyroidism, and cardiovascular disease (among others).

Original Medicare (Parts A and B) does not cover dental or vision care. Most Medicare Part C plans cover dental, vision, and hearing services.

Medicare Supplement Insurance is also called Medigap.

If you live overseas at 65, coverage in a foreign health system is not creditable coverage. You must choose to enroll in and pay for Part B and not use it, or pay enrollment penalties if you return to the U.S. and enroll in Medicare.

Medicare coverage is only valid in the United States. You may need to consider short-term coverage if you’re 65 or older and travel overseas often.

Even though you can’t contribute to a health savings account (HSA) after you enroll in Medicare, you can continue to take tax-free distributions from your HSA to pay for medical expenses.

If you withdraw from Medicare and enroll again, your Part B premiums can be higher the second time around.

Each day, 10,000 Americans turn 65 and become eligible for Medicare.

If you withdraw from Medicare and enroll again, your Part B premiums can be higher the second time around.

Original Medicare isn’t your only option at 65, the alternative is called Medicare Advantage or Medicare Part C.

You can have both Medicare and Medicaid at the same time. It’s called dual eligibility.

Medicare in Michigan by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,963,032 people are enrolled in Medicare in Michigan. The total number of beneficiaries enrolled in Medicare Advantage in Michigan is 855,366. The previous year, 763,499 enrolled in Medicare Advantage. Medicare Advantage participation in Michigan went from 39.63% to 43.57% year over year. If you’d like to dive deeper into how Medicare in Michigan breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Michigan
1,963,032
Beneficiaries with Part A & Part B
855,366
Medicare Advantage Beneficiaries
43.57%
Medicare Advantage Participation Rate
55.31%
% Female
44.69%
% Male
1.06
Average HCC Score
$10,690.74
Actual Per Capita Costs
22.07%
% Eligible for Medicaid
34.21%
% of Beneficiaries with an Emergency Department Visit
18.90%
Hospital Readmission Rate
82.72%
% Non-Hispanic White
11.18%
% African American
1.90%
% Hispanic
4.21%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Michigan Medicare Resources & Contacts

Beneficiaries spend an average of $10,690.74 each year on Medicare in Michigan. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Michigan-based resources, like these, may be able to help:

Michigan Department of Insurance and Financial Services (DIFS)

1-877-999-6442

https://www.michigan.gov/difs/

What should I know about the Michigan Department of Insurance and Financial Services (DIFS)?

DIFS can help if you have questions or complaints about insurance companies and HMOs.

Michigan Department of Health and Human Services

517-241-4100
COVID-19 questions: call 888-535-6136

https://www.michigan.gov/osa/

What should I know about the Michigan Department of Health and Human Services?

Visit MDHHS to sign up for Medicaid and find resources for caregivers and seniors in your community

Michigan Department of Military & Veterans Affairs

517-481-8001
Fax: 1-984-204-8343

https://www.michigan.gov/dmva/0,9665,7-402-100580_83194—,00.html

What should I know about the Michigan Department of Military & Veterans Affairs?

The MDMVA can help with housing assistance, employment resources, benefits, and claims

Nationwide Resources

Speak with an insurance agent that is licensed in Michigan about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in MI, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.