The main reason that a Medicare beneficiary might select a Medicare Advantage plan in Michigan for 2022, 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 Medicare 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 through a private insurance company might offer some extra benefits that aren’t provided by Medicare Part A and Part B alone.
What is Medicare Advantage in Michigan?
Medicare Advantage in Michigan for 2022 is one of several Medicare coverage options. With all the benefits of Original Medicare (Medicare Part A and Medicare Part B) plus extra benefits, Medicare Advantage (Medicare Part C) is becoming more popular year after year.
To choose a Medicare Advantage plan in Michigan, one must be enrolled in Medicare Part A and Part B, pay the monthly Part B premium, and live in the area where the plan is sold.
Important facts about a Michigan Medicare Advantage plan include:
- Medicare Advantage plans known as ‘MAPD’ include Part D prescription drug plans
- Medicare Advantage plan beneficiaries have limitations like network providers from which to choose a primary care physician and select hospitals and other facilities
- Most MA plans offer additional coverage like vision, hearing, dental, gym memberships, over-the-counter wellness products, and more
What is the Best Medicare Advantage plan in Michigan in 2022?
Best network freedom: Medicare Advantage PPO
PPO Plans offer a larger network and no referrals.
PPO plan premiums range from $0 to $100 monthly.
Best for lowest out-of-pocket cost: Medicare Advantage HMO Plan
HMO premiums are generally $0 monthly.
HMO plans have lower out of pocket costs because they use the HMO referral network.
Best for low income or health conditions: Medicare Advantage D-SNIP
Medicare Advantage D-SNIP plans are best for those on very limited income or with chronic health conditions.
Enrollees in Medicare Advantage D-SNIP plans can have Medicare and Medicaid to lower out of pocket costs on things like, copays, coinsurance, premiums, etc. Deductibles may be little to nothing for those with special circumstances.
What Medicare Advantage plans are available in Michigan for 2022?
Local HMO – 46
Local PPO – 24
Regional PPO – 2
What’s changing with Medicare Advantage in Michigan for 2022?
Enhancements to the Part C and D Programs Beneficiary Real Time Benefit Tool (RTBT)
In 2022, people on Part C and D Medicare will have a new instrument to search for the most cost-effective prescription medication for their needs.
The Real Time Benefit Tool (RTBT) could search for a lower-price alternative drug that would be an effective substitute for the one prescribed. This would eliminate surprises of unexpectedly high charges at the pharmacy.
Permitting a Second, “Preferred,” Specialty Tier in Part D
The Centers for Medicare and Medicaid Services (CMS) will authorize the addition of a Second “Preferred” Specialty Tier with lower cost-sharing in Medicare Part D as of January 1, 2022.
Part D plans will have a new tool for arbitrating deals with drug manufacturers in exchange for listing their product on the “preferred” specialty tier.
Medicare Advantage (MA) and Part D Prescription Drug Program Quality Rating System
Starting January 1, 2022, CMS will require Part D plans to report Pharmacy Rating Measures to them for greater transparency.
Pharmacies have filed complaints with CMS that the Quality Rating System is unfair and unreachable.
More equitable Quality Ratings can positively affect the pharmacy’s reimbursement.
Establishing Pharmacy Performance Measures Reporting Requirements
Disclosing the above information will increase transparency. The industry will have guidance in developing a more balanced set of quality ratings.
Implementing Several Opioid Provisions of the SUPPORT Act
To improve clarity and consistency in the Opioid Recovery Program, CMS has decided to codify some measures previously described as sub-regulatory guidance measures outlined in the SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment).
Specifications will require Medicare Part D plans to educate beneficiaries on opioid risks, alternative pain treatments, and safe disposal methods for prescription medications.
Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements
By expanding the definitions of terms like, ‘supplemental benefit’ and ‘primarily health related’ (from Chapter 4 of the Medicare Managed Care Manual), previously established policy will become codified in 2022.
These changes assure that cost-sharing reductions will be allowable as supplemental benefits.
How much does Medicare Advantage cost in 2022?
Most States have an HMO plan available with a $0 per month premium.
Some states offer a PPO plan with a $0 monthly premium. It is increasingly common for PPOs to have premiums.
In 2019, there were 448 MA plans with $0 monthly premiums. One out of five Medicare beneficiaries were enrolled in $0 monthly premium plans.
The average MA monthly premium is $57.39.
When can I make changes to my Medicare Advantage plan?
Medicare offers an Open Enrollment Period from January 1 to March 31 for enrolling in a Michigan Medicare Advantage Plan, switching from one Medicare Advantage Plan to another, or disenrolling from a Medicare Advantage Plan and returning to Original Medicare.
Some enrollees qualify for Special Enrollment Periods (SNP) under circumstances defined by the Centers for Medicare and Medicaid Services.
Those who do not qualify for Special Enrollment Periods and are dissatisfied with their current insurance plans do not have to be locked in until the beginning of another year.
The Medicare Annual Election Period runs from October 7 to December 15 each year for further changes in coverage options to be made.
When can you enroll in a Michigan Medicare Advantage plan for 2022?
Initial Enrollment Period
Your first opportunity to enroll in a Medicare Advantage Plan in Michigan is during your Initial Enrollment Period (IEP). The IEP begins three months before the month you turn 65, includes your 65th birthday month, and extends for three months after your birthday month.
During your Initial enrollment Period, you can:
- Enroll in Original Medicare (Part A and Part B health plans)
- Buy a Medicare Supplement Plan (Medigap) to help cover the 20% out of pocket costs not covered by Original Medicare
- Enroll in a Medicare Part D prescription drug plan
Open Enrollment Period – AKA Annual Election Period
Medicare is an ever-changing environment. What was best for you one year might not be best the next.
During the fourth quarter, from October 7 to December 15, changes can be made to existing plans during the Annual Election Period (AEP).
Those who did not enroll during their Initial Enrollment Period can enroll in Original Medicare during the AEP. People with Medicare Advantage plans can change from one plan to another or drop the MA plan to return to Original Medicare.
Those with Original Medicare can enroll in their choice of prescription drug plans. Others may drop Part D without replacing it.
Changes made during the AEP take effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period
From January 1 to March 31 of each year, the Medicare Open Enrollment Period offers another chance to sign up for a Medicare Advantage plan or change from one Part C plan to another.
Changes made during the OEP take effect on July 1 of the same year.
Special Enrollment Periods – Special Circumstances
Situations that may qualify someone for a special enrollment period include:
- Relocating outside the current plan’s service area
- Moving to a place in the same service area that offers more Part C plans
- Moving back to the U.S. after living abroad
- Moving into or out of a long term care facility
- Loss of insurance coverage (employer-based, Medicaid, etc.)
5-Star Special Enrollment Period
Medicare rates plans yearly based on member satisfaction surveys, healthcare providers, and plan ratings.
Results are defined by the star rating received. Medicare Advantage plans that are rated as 5-Star are much in demand.
During the 5-Star Special Enrollment Period, if you locate a 5-Star Part C Medicare Advantage Plan, Cost Plan, or prescription drug plan available from an insurance company in your service area, you can change from your current plan to the 5-star plan.
This change can be made once between December 8 and November 30.
When opting for a 5-Star plan, be aware that:
- Enrolling in a 5-star Part D plan could mean losing your current Medicare Advantage plan and being returned to Original Medicare. You might need a Medigap plan for full coverage
- Dropping your current MA plan for a 5-Star MA plan could lead to losing your prescription drug coverage.
- If Part D coverage is lost, you may have to wait for another enrollment period to get coverage and there may be a penalty
Special Enrollment Periods if you get “Extra Help”
Most Medicare beneficiaries have set times to make changes in their prescription drug coverage. Those who are on Medicaid or have eligibility for Extra Help paying for Part D can apply for changes to their prescription drug coverage once during each of these periods:
- January – March
- April – June
- July – September
The Special Period for Extra Help enrollees does not occur in October through December, but all Medicare enrollees can make changes during that time.
Are Medicare Advantage plans in Michigan “bad”?
The ever-increasing numbers of enrollees prove that Medicare Advantage plans are not bad, but provide excellent health insurance coverage.
1. Number of lives enrollment in Medicare Advantage in Michigan
As of September 2020, 2,104,129 people were enrolled in Medicare in Michigan, almost 21% of the state’s population.
Nearly half of all Medicare beneficiaries in Michigan are enrolled in Medicare Advantage Plans in 2021.
2. Number enrolled by plan specifically the 3 plans below.
Local HMO – 271,496
Local PPO – 456,215
Regional PPO – 16,507
3. Percentage of Medicare beneficiaries enrolled in Medicare advantage in Michigan
Statistics show 51% of Medicare beneficiaries are enrolled in Medicare Advantage plans in Michigan, an 11% growth from 2020.
4. Number of lives enrolled in Medicare Advantage nationwide
Approximately 62 million people are enrolled in Medicare Advantage plans nationwide.
5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide
Across the. U.S., 42% of Medicare recipients are enrolled in Medicare Advantage plans.
Frequently Asked Questions about Medicare Advantage in Michigan
What's the downside to Medicare Advantage plans?
- Medicare Advantage plans create a network which limits your choice of hospitals, medical facilities, and doctors
- Specialist visits may require referrals (HMO Plan)
- Higher out of pocket costs may mean less financial predictability
- MA plans may need yearly review and possible plan changes
What are 4 types of Medicare Advantage plans in Michigan?
- HMO – Health Maintenance Organization plans
- PPO – Preferred Provider plans
- PFFS – Private Fee-For-Service plans
- SNP – Special Needs Plans
What are the top 3 Medicare Advantage plans?
Three Medicare Advantage plans account for 59% of total Medicare Advantage enrollment (24.1 million in 2020). These companies are:
- United Health Care – 26%
- Humana – 18%
- BCBS Plans – 15%
What Are Medicare Special Needs Plans?
People who qualify for Medicare Special Needs Plans may:
- Qualify for Medicare and Medicaid
- Have been diagnosed with a chronic condition like End-Stage Renal Disease
- Live in a skilled nursing facility or nursing home or need full time home nursing care
Does Medicare Advantage cover drugs?
The majority of Medicare Advantage plans are combo plans called ‘MAPD’ plans. Prescription drug coverage is included in the plan.
Do Medicare Advantage plans use the Silver Sneakers program in Michigan?
Many Medicare Advantage plans include the SilverSneakers program. If this is an ‘extra’ you want, be sure to confirm with your insurance agent that your plan covers this or a similar fitness/wellness benefit.
Michigan Medicare Resources
Michigan Medicare Plan Statistics
- 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
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