Introduction to Medicare Advantage in Michigan (Part C)

Have you heard of Medicare Part C? It is more popularly referred to as a Medicare Advantage policy. It is also sometimes called a “Medicare replacement” policy due to the nature of how it works. Most supplements work by adding a separate private health insurance policy to your existing Medicare benefits. This helps protect you from expensive gaps which exist in Original Medicare (Medicare Parts A & B) coverage. But Medicare Advantage effectively replaces your Original Medicare, and also provides for extra coverage options to protect you against Medicare’s gaps.

Federal Regulations for Medicare Advantage

Signing over your federal Medicare benefits to be managed by a private company is a tricky business. To protect seniors, federal laws closely regulate Medicare Advantage policies. This ensures that you get the medical coverage which you are entitled to after retirement. By law, your Advantage plan must provide as much or better coverage than Original Medicare. Many Advantage providers actually go above and beyond, offering you as many medical benefits as you can afford on your policy.

Medicare Advantage Enrollment In Michigan

The grand total of seniors in Michigan currently relying on a Medicare Advantage program is around 34%. That means the other 66% Are relying upon an old employer plan, some other private health insurance option, or Original Medicare (with or without a Medicare supplement).

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Tobacco users, older seniors, and anyone who did not enroll in Medicare within their Initial Enrollment Period (more on that later) might expect to pay a substantially higher rate for their Advantage plan. In the chart below, you can see a list of estimated price quotes for seniors in your area:

Most Popular Medicare Advantage Plans in Michigan

Do you know what sort of Medicare Advantage plan you should be looking for? Ideally, you should look for a company with a strong financial standing, a good record of customer service, and high levels of competency when it comes to care management. We’ve done all the hard work for you so that you don’t have to research these things on your own. And we present this information to you in an easy-to-understand five star ratings system. The more stars, the better.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

One unique feature of Medicare Part C, which is different from most other supplements, is the provider network to which you are assigned when you enroll in a policy. Restrictive networks, such as HMOs, tend to give you fewer choices when it comes to getting medical care. They can also impose harsher restrictions towards getting that care. But HMO plans are usually the cheapest plans available. PPOs or PFFS plans, on the other hand, give you more choice with fewer restrictions – for a substantially higher price.

Where you generally need to get your care and services from for:

  • HMO Plans – HMO plans have the most network restrictions; but they also have some of the lowest costs out of any other private health insurance plan. With the exception of necessary emergency care, you cannot go out of network without paying for your medical costs out-of-pocket. Furthermore, you can only get referred to a specialist through your primary care doctor’s permission.
  • PPO Plans – If you want greater flexibility and choice, then you’ll probably want to choose a PPO plan. Just prepare yourself to pay a little bit more for things like co-pays or monthly premiums. PPO networks let you see any doctor or visit any facility you want; however, you will save a lot more money if you patronize one of your preferred providers. Keep that important fact in mind when making decisions about your health care and where to get it.
  • PFFS Plans – Some might say that a Private Fee For Service plan is halfway between an HMO and a PPO. You definitely have a greater selection of doctors and facilities than you would with an HMO network. but those doctors in facilities are more likely to reject your insurance company’s payment terms, and therefore refuse to treat you. if you have a preferred doctor and a Private Fee For Service plan, be prepared to contact them frequently to make sure but they haven’t changed their minds about payment agreements with your insurance provider.
  • Special Needs Plans – Special needs plans are a little bit closer to an HMO than a PPO. The network is more restrictive, but that’s only to mitigate costs associated with things like hospice care or chronic (and expensive) conditions like End-Stage Renal Disease. There are emergency care exceptions, just like there would be with an HMO plan. You may also be able to negotiate out-of-network care with your insurance provider if it is absolutely necessary.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – Lots of seniors like Medicare Advantage HMO plans because it takes an already affordable health plan and makes it that much more economical. Yes, it can be tricky to find the right treatment with such a restricted network. But emergency care and point-of-service negotiations can help you get the care you need – even if it is out-of-network.
  • PPO Plans – For most people, especially senior citizens, a PPO plan might be financially out of reach. But things are different with Medicare Advantage PPO plans. The government subsidies will lower overall costs, making these large, flexible networks of doctors and hospitals more easily accessible to the seniors who need them. Just keep in mind that you will save more money overall staying in-network. But unlike some other plans, that is not a requirement.
  • PFFS Plans – Despite the popularity of Medicare, having a Medicare Advantage PFFS plan doesn’t guarantee that you’ll get the care you want when you need it. Your doctor’s office could change their minds about the payment terms at any point, so make sure you double check before you go and get care from your preferred physicians or facilities.
  • Special Needs Plans – If you require a special needs plan, purchasing a Medicare Advantage SNP can help you save on your health care costs. Just remember that you have a narrow network of doctors and facilities to work with. But don’t worry about getting emergency care, because there are exceptions for that. if you need treatment from someone who is out of your network, it may be possible – but remember that the doctors and facilities picked out by your insurance provider were chosen because they think they can give you the best possible care at the most affordable cost.

Just because you are purchasing a Medicare Advantage plan doesn’t mean you should lose your doctor. Thankfully, you can use these Medicare.gov Physician Search Tool to check and make sure that the healthcare providers you want are already in the network of the Medicare Advantage plan you’re thinking about purchasing.

Drug, Vision and Dental Coverage

Sadly, neither Original Medicare nor many of the available Medicare supplements allow for ancillary coverage options, such as dental or vision care. And seniors who want prescription drug coverage usually have to enroll in Medicare Part D in order to get it. But with a Medicare Advantage policy, you can easily manage prescription drug benefits (a MAPD plan), vision, dental, and more. And you can do it conveniently all under the same policy. However, you should keep in mind that the more coverage you add, the more you will have to pay each month for your policy.

  • Most senior citizens will experience some decline in vision health over the years. Unlike most healthcare policies for the elderly, Medicare Advantage can give you the option to add vision coverage. But you might not be able to see just any eye doctor or get lenses from any crafter that you like. You might be restricted to a specific network of vision care providers, and you need to clear up any misconceptions with your insurance company before you start making appointments.
  • Dental coverage is very important for the elderly, especially considering how devastating gum disease and tooth decay can be later in life. But the good news is that you can choose to purchase dental coverage with a Medicare Advantage plan. Just make sure you sit down with your insurance agent and clarify any confusion about your dental insurance network, what your costs are, and what your plan will provide for.

Enrollment Options & Best Time To Enroll

Medicare Advantage policies can, under certain circumstances, be harder to obtain than Original Medicare or other forms of Medicare supplement insurance. Some providers may want to know more about your health history and current health status before approving you. Others may reject you based on serious pre-existing conditions (ESRD, for example). Even if you are rejected at first, you have options. Your state department of insurance has information on getting covered in the event that your pre-existing condition makes it difficult. You can also visit our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

Taking care of your health and wellness will become more expensive as the years go by. And handling those costs will be increasingly challenging at the same time. If you correctly anticipate your future healthcare needs, it’ll be easy for you to choose an affordable company who can provide you with the care you need.

We want to help you make this important decision. We’ll start by offering up the information you need to compare companies and quotes. Next, we can help you navigate the treacherous waters of the Medicare Advantage enrollment period. Our agents are expecting your call – so don’t hesitate to reach out and contact us.

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