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Medicare in Michigan

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A Look at Medicare in Michigan

According to Centers for Medicare & Medicaid Services (CMS) data, the total number of Medicare beneficiaries in Michigan enrolled in Medicare Part A and/or Part B and Medicare Advantage and other health plans totaled 2,004,184 in 2018.

Whether you’re already a Medicare beneficiary in Michigan, or you’re planning ahead or helping a loved one, it may be useful to understand what Medicare is all about. Here’s a brief summary to help you understand the basics of the program and what other Medicare plan options you may have.

Many beneficiaries in Michigan are enrolled in Original Medicare (Part A and Part B). Original Medicare is the government-sponsored health insurance program for United States citizens and permanent legal residents aged 65 or older or those who qualify by disability. (Permanent legal residents must have lived in the U.S. for at least five years in a row to qualify for Medicare.)

You’re enrolled in Medicare Part A and Part B automatically if any of the following applies to you:

  • You’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65.
  • You reach your 25th month in a row of receiving disability benefits from Social Security or the Railroad Retirement Board.
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS). You’ll start getting Medicare benefits the same month that you start receiving disability benefits.

If you don’t qualify for automatic enrollment, you can sign up for Medicare during your Initial Enrollment Period, which usually starts three months before you turn 65 and lasts for a total of seven months. If you’re disabled and under 65, your IEP is also typically seven months, starting when you’ve been receiving disability benefits for 22 months.

It’s important to understand that Original Medicare may not be your only option for Medicare coverage in Michigan. You can add to your coverage, or receive it through a Medicare Advantage plan.

Adding to your Original Medicare coverage

Original Medicare doesn’t cover prescription medications in most situations. Medicare Part A may cover prescription drugs during your treatment as a hospital inpatient, and Part B covers certain prescription drugs, such as some drugs administered to you as an outpatient. If you need coverage for the prescriptions you take at home, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan, available from private insurance companies approved by Medicare.

You can also buy a Medicare Supplement (Medigap) insurance plan if you want coverage for Medicare’s out-of-pocket expenses, such as copayments and deductibles. There are 10 standardized Medigap insurance plans in most states, including Michigan, and they’re available from private insurance companies.

Medicare Advantage

Another way to get your Original Medicare coverage is through Medicare Advantage (Medicare Part C).Offered by private, Medicare-approved health insurance companies, Medicare Advantage plans provide the same coverage you get from Original Medicare, except for hospice care, which Medicare still covers. Medicare Advantage plans may include extra benefits, like dental and vision care, and prescription drug coverage. With a Medicare Advantage Prescription Drug plan, you get the convenience of all your Medicare benefits in one plan.

With any type of Medicare Advantage plan, you must keep paying your Medicare Part B premium, along with your plan premium if there is one.

Medicare resources in Michigan

Office of Services to the Aging (OSA): The state of Michigan set up this office to serve the needs of the senior population. Through the past 40 years, the Office of Services to the Aging has provided resources and advocacy for Michigan’s aging population. The office offers information to seniors about a variety of programs available to them, including their Medicare options. In addition, OSA offers legal services to seniors, such as counseling, education, and representation.

Michigan Medicare/Medicaid Assistance Program (MMAP): This program provides free counseling and education for Michigan Medicare beneficiaries. The office is funded by a grant from the Office of Services to the Aging and is not affiliated with any part of the insurance industry. Within this office is Michigan’s State Health Assistance Program (SHIP), which offers financial assistance to qualifying seniors who are unable to pay their Medicare premiums. Information about Michigan Medicare plans and other coverage options are also provided through this office, as well as resources for reporting Medicare fraud, waste and abuse.

Michigan Department of Health and Human Services: MDHHS is the go-to resource for Michigan Medicare beneficiaries who also qualify for Medicaid services based on eligibility. This office provides information about the state’s Medicare Savings Programs, which can help cover the cost of Medicare premiums, deductibles and coinsurance costs. The services are available to Michigan Medicare beneficiaries that qualify for Medicare Part A, and eligibility is based on income and current assets. In addition, this department offers information to seniors about home and nursing care, including the MIChoice Waiver program that allows seniors to receive care in their home, rather than a nursing center.

Medicare statistical trends in Michigan

Here are some 2018  statistics regarding Medicare in Michigan from a CMS report:

  • There were 127  Medicare Advantage plans available.
  • All Michigan Medicare beneficiaries have access to a Medicare Advantage plan in their service area.
  • 81% of beneficiaries with Medicare Part D have access to a Medicare Prescription Drug Plan with a lower premium than what they paid in 2018.

Statistical data from the Centers for Medicare & Medicaid Services, Medicare Enrollment Dashboard and “2018 MA Part D Landscape State-by-State Fact Sheet”

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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