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Medicare Advantage Plans in Michigan Overview

The main reason that a Medicare beneficiary might select Medicare Advantage plans in Michigan is to have a cost-effective way to control medical expenses better than Original Medicare does. When people only are enrolled in Medicare Part A and Part B, they might still receive a lot of medical bills because of the deductibles, coinsurance, or copayments. In addition, a Michigan Medicare Advantage plan might offer some extra benefits that aren’t provided by just Medicare Part A and Part B.

When to Enroll in a Medicare Advantage Plan in Michigan

Almost everybody who has enrolled in Medicare Part A and Part B can decide to switch to a Michigan Medicare Advantage plan. The only real exception to this is the special plans for End-Stage Renal Disease ESRD. With that said, timing is very important.

These are some time periods when you can enroll in a Michigan Medicare Advantage plan, also known as Medicare Part C:

  • Initial Coverage Election Period: Your Initial Coverage Election Period gives you the first chance to compare and enroll in a Medicare Advantage plan. Most people will decide to select this coverage right around their 65th birthday. Some folks may have a different ICEP because they delayed Medicare Part B or enrolled early because of a disability.
  • Annual Election Period: Most beneficiaries use the time between October 1 and December 7 to review changes or select a new Medicare Advantage plan in Michigan.
  • Special Election Period: You might also have circumstances that trigger a Special Election Period that lasts for about two months. Things like moving away from the network your old insurance company has or losing job-related health insurance might give you an SEP.
  • Medicare Advantage Disenrollment Period: This period gives people a chance to drop their Medicare Advantage plan for six weeks at the beginning of each year. If so, these people can simply resume Medicare Part A and Part B. They may also choose Medicare Advantage Prescription Drug plans at this time.

Popular Kinds of Medicare Advantage Plans in Michigan

You will have different kinds of Medicare Advantage plans in Michigan. These are the most common kinds:

Health Maintenance Organization HMO plans: An HMO plan may be attractive because of a low or even a $0 premium. It’s important to understand the network restrictions. About 39 percent of all MA members choose a Michigan HMO Medicare Advantage plan.

  • Preferred Provider Organization PPO plans: A PPO has more flexibility than an HMO, but it might have higher premiums. This kind of Medicare Advantage plan in Michigan is fairly popular and has about 60 percent of enrollment.
  • Private Fee-for-Service PFFS plans: These non-network Medicare Advantage plans in Michigan only have about one percent of enrollments.
  • Special Needs Plans SNPs: These Special Needs Plans are usually HMOs that have been customized for people who need to manage institutional conditions and/or chronic health conditions.
  • Dual-Eligible: People who get benefits from both Medicaid and Original Medicare might enroll in one of these plan options. They typically have a $0 premium.

Michigan Medicare Advantage Plan: Enrollment Statistics

When it is time to compare options and choose a Medicare Advantage plan in Michigan, it might help to learn what other people in the state do:

  • Enrollment in a Medicare Advantage plan in Michigan: Over 673,000
  • Percent of all people with Original Medicare who opt for Medicare Part C in Michigan: 34 percent
  • Most popular kind of Michigan Medicare Advantage plans: Local PPOs

This highlights the largest Michigan counties by total population:

  • Wayne County,MI: 1,753,616
  • Oakland County,MI: 1,250,836
  • Macomb County,MI: 871,375
  • Kent County,MI: 648,594
  • Genesee County,MI: 407,385

How Michigan Medicare Advantage Plans Cover Prescriptions

One of the good things about most Medicare Advantage plans in Michigan is that they include Part D Benefits without additional premiums. Original Medicare won’t help pay for most prescriptions; however, Part C will. Just as with any Medicare Advantage Prescription Drug plans, a beneficiary should be aware that these can vary by insurer or plan.
These are a couple of things to understand any of the Medicare Advantage plans in Michigan you decide to compare:

  • The plan’s formulary: This is simply a list of covered drugs.
  • Prescription Drug tiers: The insurer may also cover brand-name, specialty, or generic prescriptions at different rates.

Understanding Network Restrictions for Medicare Advantage Plans in Michigan

Since most MA plans in Michigan use networks, it’s important for beneficiaries to understand network restrictions. For instance:

  • With an HMO, an out-of-network doctor or hospital may not be covered unless the service was provided because of an emergency. The primary care doctor, or PCP, will need to give the patient a referral to see a covered specialist too.
  • With a PPO, in-network providers will get more favorable benefits.

It’s obviously smart to make sure that a nearby hospital and favorite doctor are included as in-network healthcare providers. If you travel within the US, urgent healthcare will probably be covered as exceptions to these network restrictions. Some Medicare Advantage PPOs may have national networks, but these will usually have higher premium rates than local network options. If you travel outside of the country, you probably won’t have coverage from Medicare Part C in Michigan or Original Medicare, so you may need travel health insurance.

If you decide to move, you may need to change your plan. However, moving outside of your plan area should generate a Special Enrollment Period for Medicare Part C in Michigan. This SEP gives you 63 days from your move to make a new choice.

Other Benefits of Medicare Advantage Plans in Michigan

The best reasons to consider Medicare Part C might include low rates and additional benefits over Medicare Part A and Part B. For instance, Medicare Part A and Part B only pay for prescription medication in certain circumstances, but most of the state’s Part C options have drug benefits.

Some additional perks that might come with a Medicare Advantage plan in Michigan could include some help with hearing care, routine vision and dental care, and even fitness and wellness programs. These kinds of services won’t be included in Medicare Part A and Part B.

Best Medicare Resources for Michigan

These authority sources can help inform your search for Medicare Advantage:

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