Michigan Medicare Plans

Coverage and Benefits

Michigan residents, like all of the other 49 states, are eligible to enroll in the Federal Medicare Program if they meet certain eligibility requirements. These requirements are fairly simple: enrollees must be 65 years of age or older, and be legal US citizens. With that, you can apply to receive medical benefits from Parts A and B of Traditional Medicare. These benefits cover a wide range of medical treatment, from hospital services to outpatient and doctor visits. Part B requires some modest fees which are designed to be relatively affordable for retired individuals (learn more about them here), and Part A may require you to pay a deductible if you have an employment history which is shorter than 10 years. While some consider Traditional Medicare to be fairly comprehensive, there are some dangerous “gaps” which, if left unattended, could cost you thousands in the long run.

Qualifying for Medicare gives you the option to start paying for and enjoying benefits for Medicare Parts A & B. Part B takes care of the care you need before things become a medical emergency – like preventive care or outpatient services. If you do have to go to an emergency room or spend time in a hospital, your Part A benefits will help take care of those expenses. In order to stay on Medicare, you must except Part A benefits and pay your Part A premiums. This isn’t necessarily true for Part B.

Following Medicare Parts A & B is Medicare Part C, also known as Medicare Advantage. Part C is optional in its own right because it is a private health insurance plan which completely replaces Medicare Parts A & B. Part B benefits are optional while you stay on Medicare, but the exact same benefits will be a part of a Medicare Part C plan if you choose to purchase that type of coverage instead. You cannot ask for those same benefits that you would get with Part B to be taken off your Part C policy. Going back to Original Medicare, if you decide to stick with that instead of purchasing a Part C plan and also want Part D prescription coverage, you will need to accept Part B benefits and pay your premiums. You cannot accept Part A and add Part D without also paying for Part B.

Take a look at the chart below for info on Traditional Medicare benefits, as well as other Medicare options:

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

A Brief Introduction to Michigan Medicare Plans

In Michigan, there are a grand total of 1,728,338 individuals currently enrolled in the Medicare program. Of that number, 30% – which is just shy of one-third – have opted out of Traditional Medicare and into a Medicare Advantage program. Conversely, 355,692 Medicare recipients (just under 21%) are neutralizing the gaps in their coverage with a Medigap supplement insurance policy. The remaining 49% might feel that they do not need additional coverage beyond what Traditional Medicare provides, or they may have some sort of alternative supplement, such as one provided through an employer.

Are you currently looking for a Medicare supplement of your own? Are you enrolled in Medicare? If not, clicking that link can help you get the process started. It’s never too early to prepare yourself for enrollment.

Is Additional Medicare Coverage Really Necessary?

It might be, but not necessarily for everyone. The farther along you get in years, the more your health declines, and/or if you have chronic medical conditions which require frequent treatment, the more vulnerable you will be to the expensive gaps in Traditional Medicare coverage. Below is a helpful table which shows you the out-of-pocket expenses you might be expected to cover:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

And that is just the beginning. If you are relatively new to Medicare and think you might be healthy enough to not need additional coverage for a while, you can go ahead and take that risk. But many elderly individuals don’t want to leave their retirement savings to chance, and feel that supplemental coverage gives them peace of mind in their golden years. 

Medicare costs in Michigan are already higher than most of the rest of the country, but healthcare prices are likely to skyrocket faster than the national average in the near future. Things will be especially difficult for elderly people who are retired and living on a fixed income. But they don’t have to be. There are ways to mitigate future health care expenses so that you’re not bleeding your life savings into your medical care.

A great way to handle these rising costs is through a Medicare Supplement insurance policy. There are many different types, so you’re guaranteed to find a plan that’s right for you. But your perfect plan will vary based on things like where you live, how old you are, the current state of your health, and the type of coverage you need.

The main reason Medicare supplements exist is to protect seniors from the cost of medical services which Medicare won’t pay for. These uncovered services are known as Medicare coverage gaps. Now some of these gaps, like blood transfusions, may not seem that bad – but others, such as a 14+ day hospital stay, could financially ruin you if you aren’t prepared. But with a Medicare gap coverage insurance supplement, you will be.

The best plan you could choose to help you supplement your Medicare is either a Medicare Advantage plan or a Medicare insurance supplement known as Medigap. The size and scope of either type of policy can vary greatly depending on the type of coverage you need. Our goal is to help you understand the differences so that you can make a good decision about your health care.

Coverage Choice #1: A Medigap Supplement Policy

The “gap” in Medigap is designed to reflect the fact that these policies are tailored to protect you from the coverage gaps within Traditional Medicare. A Medigap supplement is a separate policy from your Medicare benefits which is underwritten by a private company. However, these companies work hand-in-hand with the government to make sure that the policy you choose meets your needs. Plans A, B, C, D, F, G, K, L, M, and N are available now; but plans E, H, I, and J were weeded out in 2010 due to improvements in the Medicare system. Each plan is the same from state to state. Whether you’re purchasing a Plan C policy in Michigan or Alaska, you will receive the same benefits. The only variances are price, and provider.

You can expect each plan to cover the following benefits:

 

Coverage Choice #2: Medicare Part C – Medicare Advantage

Medicare Advantage is more like a replacement of Traditional Medicare as opposed to a supplemental form of coverage. For all intents and purposes, you will still be receiving identical benefits to those in Medicare Parts A & B, because that is the bare minimum amount of coverage required by law. But a private health insurance company will be paying out your claims, and the US government will no longer be responsible for your benefits. You may also run the risk of having to switch doctors. Many Medicare Advantage plans offer their benefits at a lower price because of their restrictive networks.

Some prefer the convenience of only managing a single policy, as opposed to dealing with both the government and a private insurer. Others believe that the additional benefits which some Medicare Advantage policies offer (dental and eye care, for example) cannot be found at a better price. But if you are planning to take on a Medicare Advantage policy, you have to make sure that you are okay with losing the stability that government Medicare provides, as well as your current doctor (or network of doctors).

When you sign up with Medicare Advantage, you will be limited to doctors and hospitals within an approved Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).

Still Confused about Medigap Supplement vs. Medicare Advantage?

Medigap policies in general are smaller and easier to understand. This is because they are designed to give you the benefits you need to protect yourself from the gaps in Medicare. Beyond those gaps, your Medicare, prescription drug, and any other coverages you purchase should take care of your medical needs. There are 10 Medigap plans in total, and some are much more comprehensive than others. The plan you choose depends on how much you can afford for your monthly premium along with the type of coverage you actually need.

For some people, Medigap policies can be much more reliable than a Medicare Advantage counterpart. Qualifying for a policy is as easy as qualifying for Medicare itself. As long as you are qualified for Medicare you cannot be rejected by a Medigap insurance provider. You also don’t have to submit yourself to a pre-approval or pre-certification process. Once you have a Medigap policy you will have that policy for life unless you stop paying your premiums, the company is dissolved, or you switch plans.

Medicare Advantage, on the other hand, doesn’t have these assurances. Your coverage is granted by the discretion of your private insurance provider, not the government. This means that you will likely have to get certified, that you may be rejected for coverage upfront, or that your coverage may get cancelled at a later date for reasons beyond your control. Medicare Advantage also has restricted networks which if you live in a low population density area could severely cut off your access to the care you need at an affordable price.

But there are some benefits to Medicare Advantage which make it an attractive plan for certain seniors. To start, unlike a Medigap policy, you can add different types of coverage to help streamline and consolidate your health care needs. These include prescription drugs, vision, dental, and more. Many seniors like the convenience of having all of these coverages on the same policy. Furthermore, there is a chance that you may qualify for a $0 monthly premium with Medicare Advantage. Medigap will require a premium no matter what, although they are usually very affordable.

Still confused? We understand. And we want to help. We have a well-trained customer service department and all of our representatives are prepared to answer your questions. Contact us today to get your questions answered and we may even be able to help you find an affordable quote on a Medicare supplement insurance policy.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? The US government will pay for most or all of your monthly premium and may take care of certain other coinsurances or co-pays depending on other various circumstances. Expenses start getting covered when you start paying your low monthly premium. Your plan benefits will determine what else you must pay.
Will I still have to pay for Part B? Yes Yes
What will it cost me? Certain factors may, in fact, make it so that you don’t have to pay a premium at all; but this isn’t always the case. Aside from your monthly premium, you may have to pay for certain coinsurance or co-payment charges if your plan doesn’t cover them.
What will the plan cover? Medicare Advantage packages come with identical benefits to Medicare A and B. Additional coverage is up to you to purchase. A Medigap plan covers 100% of coinsurance costs for Part A and B and 3 pints worth of blood transfusions in a hospital. Medigap plans get even more comprehensive as you add more benefits.
Is it easy to budget my health care expenses? It can be more difficult to budget with Medicare Advantage because your costs may vary from one year to the next. If you get a very comprehensive plan, you will basically only need to worry about paying your monthly premium. This makes it very easy to budget.
Is my plan guaranteed? Or can it be cancelled? Your plan is not guaranteed, and in most cases can be cancelled at any time by your provider. All you need to do is get approved for Medicare and you will be approved for a Medigap policy. And your coverage will be guaranteed for as long as you pay your premium or the company goes under.
Do I have to clear a pre-approval or pre-certification process? It is extremely likely that your Medicare Advantage provider will ask you to go through a pre-approval or pre-certification process. There are no pre-approval or pre-certification requirements for a Medigap insurance policy.
Am I limited to specific doctors or hospitals? Yes, there are strict limits on the doctors and hospitals you are allowed to visit. There are no limits to specific doctors or hospitals. Medigap is accepted everywhere that accepts Medicare.
What type of plan is best for me? The better health you’re in, the higher the population of the area you live, the more coverage you actually need, and the younger you are, the more likely you are to find a good deal on a Medicare Advantage plan. Medigap plans tend to be more affordable for older seniors who only need Medicare gap coverage benefits and live farther away from a wide variety of healthcare choices.

Useful Contacts for Medicare Plans in Michigan

Please feel free to use our directory search tool below. With it, you can find valuable Medicare-related contact information to help you get in touch with experts in the field. With the help of representatives from your local Social Security office, your State Health Insurance Assistance Program, and many more, you can soon discover what options are best for you.

Helpful Medicare-Related Healthcare Definitions:

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

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