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Medicare Plans in Michigan – 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.

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 Medicare Plans in Michigan

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. For more information on the top choices for Traditional Medicare supplements, keep reading.

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:

[chart category=”supplement” name=”planTypes” state=”MI” zipcode=”48228″]

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).

[chart category=”advantage” name=”topHMOPlans” zipcode=”48228″ state=”MI”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”48228″ state=”MI”]

Still Confused about Medigap Supplement vs. Medicare Advantage?

Don’t feel bad if you are; it can be a fairly confusing process for most people. That’s why we’re here to help. Start by taking a look at the table below. In the far left column are some very important questions which highlight the differences between these two forms of coverage. In the middle and far right columns, the answers provided will help educate you on exactly how different each plan is:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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.

[chart category=”general” name=”usefulContacts”]

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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