Michigan Medicare Guide

Understanding the different parts and plan options that come with Medicare can feel overwhelming. Our licensed Michigan Medicare Advisors will help you understand, choose, and enroll in the best plan for your specific needs. Schedule a free consultation or call us at (888) 604-0055 to ask questions and get the most value from Medicare.

Learn about the basics of Medicare in Michigan below to understand the options available to you and when you should enroll.

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A Snapshot of Medicare in Michigan

There are 2.1 million Medicare beneficiaries in Michigan, making up 21% of the total population. 15% of Michigan Medicare beneficiaries also receive Medicaid support, making them dual eligible.

Enrollment for Medicare Advantage vs. Original Medicare in Michigan

When you first get Medicare, you enroll in Original Medicare (Part A & Part B). If you stay on Original Medicare, you have the option to add a Medicare Supplement plan and/or a prescription drug plan to help cover some of the costs that Original Medicare doesn’t pay. You also have the option to switch to a Medicare Advantage plan.

Deciding whether to go with Original Medicare or Medicare Advantage is a personal choice you should make after considering your current and future health and financial needs. In Michigan, 48% of Medicare beneficiaries are on Original Medicare. The other 52% are on a Medicare Advantage plan (source).

Michigan Medicare Advantage Plans

Medicare Advantage (aka Medicare Part C) plans are offered by insurance companies to provide an alternative to Original Medicare. 52% of Michigan Medicare beneficiaries are enrolled in one of the 106 Medicare Advantage plans available. Specific plan availability (and costs) varies and is determined by the county you live in. For example, in 2023, Wayne County has 71 Medicare Advantage plans from 14 insurance companies with monthly premiums ranging from $0 to $283. Richmond County has 47 from nine insurance companies with premiums from $0 to $244.

Medicare Advantage plans bundle together Part A and Part B (and often Part D). They must provide at least the same coverage as Original Medicare and also often provide other benefits that may include dental, vision, and hearing coverage, transportation services, and flex cards to be used for groceries or over-the-counter medicines. .

These extra benefits are attractive, but Medicare Advantage also has its disadvantages, including:

Limited provider networks
Prior authorization requirements for some covered services
Higher out-of-pocket costs when compared to Medigap plans

Our Michigan Medicare Advisors can help you choose the best Medicare plan to ensure you get the most value from your Medicare coverage. Schedule a free consultation at your convenience or call us at (888) 604-0055 to learn about Medicare Advantage plans in Michigan.

Michigan Medicare Supplement Plans

Original Medicare only covers about 80% of your costs for covered services, leaving you on the hook for the remaining 20%. If you’re healthy, this may not be a big deal, but if you need expensive or regular treatments, 20% of your medical expenses can seriously add up! Medicare Supplement (Medigap) plans don’t provide coverage for additional health services, but they do significantly reduce your out-of-pocket costs. Medicare Supplement plans also have no network restrictions and don’t have prior authorization requirements like most Medicare Advantage plans.

Nationwide, Medicare beneficiaries have ten Medigap plan options that are standardized and regulated by the federal government. This means that, while pricing may vary, coverage for a Medigap plan type (e.g., Plan N) is consistent across insurance companies.

It’s easiest to enroll in a Medigap plan during your Medigap Open Enrollment Period, which occurs in the first six months after your Part B effective date. During this period, you are guaranteed acceptance into a Medigap plan. This means insurance companies can’t reject your application or charge you more due to your age and health status. Outside of your Medigap Open Enrollment Period, insurance companies may ask you questions about your health history and are allowed to deny your application.

Michigan Part D Plans

Medicare Part D (prescription drug coverage) was introduced because Original Medicare does not cover prescriptions. Medicare beneficiaries have two ways that they can get their prescriptions covered:

Through a Medicare Advantage plan that includes Part D coverage (commonly called MAPD plans)
Through a stand-alone prescription drug plan

There are 24 stand-alone Part D plans in Michigan. Just like with Medicare Advantage, plan availability and pricing varies by county. Premiums matter, but when you look at prescription plans, it’s also important to be sure that all of your prescriptions are covered at the lowest cost.

If you don’t currently take any prescriptions, we generally recommend enrolling in one of the more affordable drug plans to avoid the Part D penalty.

Get help paying for Medicare in Michigan

There are three programs available to help those with lower incomes and resources pay for Medicare and healthcare-related expenses: Medicaid, SSI Benefits, and Extra Help.

Medicaid

Medicaid is a joint federal and state program that helps low-income individuals pay for medical costs and each state operates its Medicaid program a little differently.

Michigan has a Medicaid program for those who are aged, blind, or disabled (AD Care). If you are 65 or older, blind, or disabled and have limited income and resources, you may be eligible. The program offers a Medicaid health plan that includes vision, dental, and mental health services.

Medicare Savings Programs

Medicare Savings Programs are provided by Medicare for those who are eligible for both Medicare and Medicaid. They help Medicare enrollees with limited finances pay Medicare premiums (and sometimes deductibles and copayments). Michigan Medicaid services will determine if you qualify for one of the four levels of Medicare Savings Programs:

Qualified Medicare Beneficiary (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB) Program
Qualified Individual (QI) Program
Qualified Disabled and Working Individuals (QDWI) Program

If you receive Medicaid, you should double check that you’re enrolled in a Medicare Savings Program because people often are not! Learn more about eligibility and how to apply for Michigan Medicare Savings Programs here.

Medicare Extra Help Program

If you have limited income and resources, you may be eligible for Extra Help, which is also sometimes called the Part D Low-Income Subsidy (or LIS). Extra Help is a federal program that helps pay for costs associated with prescription drug coverage and costs.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Michigan
Michigan pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed and independent Michigan Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

Michigan Medicare Eligibility and Enrollment Steps

If you are a US citizen and meet one of the following criteria, you are eligible for Medicare:

You’re 65 or older
You have certain disabilities, including ALS and End-Stage Kidney Disease

Three simple steps for Michigan Medicare enrollment:

Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage
- Medicare Supplement (Medigap)
- Medicare Advantage (Part C)
- Part D (drug coverage)
Set yourself up for success by finding doctors, sharing your plan information with your pharmacy, and accessing additional benefits that come with your coverage.

If you’re enrolling in Medicare by way of turning 65, you can sign up during your Initial Enrollment Period (IEP). Your IEP is a seven-month period that starts three months before the month you turn 65 and extends until three months after. For example, if your birthday is August 16, then your IEP occurs from May 1 through November 30 during the year you turn 65. If you or your spouse is still working and receiving employer-provided health insurance, you may choose to delay Part B enrollment. We recommend considering the difference in cost and making sure you qualify for the delayed enrollment Special Enrollment Period before choosing to delay your enrollment.

If you have questions about your options or want support with Medicare enrollment, we’re here to help! Schedule a free consultation with one of our licensed Michigan Medicare Advisors or call us today at (888) 604-0055. Our advice is always free!

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