When you’re ready for Medicare, you might have no fewer than 100 questions about how it works. Put simply, Medicare is a national health insurance plan available to U.S. residents who have paid Medicare taxes for at least 10 years.
You’ll be eligible for Medicare in Michigan 3 months before you turn 65 and have until 3 months after your 65th birthday to sign up without a late penalty. If you’re under 65 and have certain disabilities and illnesses you may also qualify for Medicare.
Medicare in Michigan Overview
Medicare is divided into 4 parts:
Part A covers hospital stays, skilled nursing care, hospice care and some home health care.
Part B covers outpatient care, doctor visits, preventive services and some medical supplies.
Part A and Part B together are referred to as Original Medicare.
Part C replaces Part A, Part B and sometimes Part D, and is also known as the Medicare Advantage plan. It’s provided by private national insurance companies. These plans are all-in-one plans and offer Part A and B coverage, as well as extras such as fitness plans, mental health programs and durable medical equipment. Medicare Advantage plans also offer prescription drug coverage as well as optional dental, vision and hearing plans.
Part D provides prescription drug coverage. These plans can be added to Part A and Part B plans, Part C plans or are offered as standalone drug coverage plans.
Note: There’s an exception to the sign-up window for Medicare known as the special enrollment period. You can enroll in a Medicare plan or change plans within 60 days of the following qualifying lifetime events:
- Marriage
- Death of a spouse
- COBRA coverage ending
- Moving to a different coverage area
- Gained U.S. citizenship
- Lost Medicaid coverage
Check with an insurance agent if you think you qualify for the special enrollment period.
You can purchase Medicare in Michigan as an individual or as part of a group. If you’re employed and turning 65, your employer may offer a group Medicare Advantage plan until you leave the company. Your employer may pay 100% of the plan or you may be required to contribute a certain amount each month.
If you have Original Medicare and want a plan to supplement your coverage, you can also buy a Medicare Supplemental Insurance plan from a private insurance company. These plans, also knowns as Medigap plans, supplement your Original Medicare benefits and fill in the gaps not covered.
Legalities of Medicare in Michigan
Medicare plans in Michigan are governed by the Centers for Medicare and Medicaid Services (CMS). This federal agency oversees Medicare Advantage plans in every state, ensures that plan fees are priced fairly, that services are high performing, meet consumer needs and providers are licensed and qualified.
Each Medicare Advantage plan must adhere to specific guidelines regarding sales, marketing, quotations and services. Plans are also rated on quality, performance, customer service and provider service using a 5-star rating system. Plans must advertise their star ratings publicly to comply with CMS rules.
Types of Medicare Advantage Plans
There are 2 types of Medicare Advantage plans:
Health maintenance organization (HMO) plans: These plans feature a network of doctors and hospitals you must use within a specific region. Your primary care doctor must give you a referral if you need to see a specialist. HMOs usually require you to maintain a healthy lifestyle, which includes maintaining a healthy weight and BMI, normal blood pressure and no smoking. HMOs are often cheaper than PPO plans but aren’t as flexible in provider choice.
Preferred provider organization (PPO) plans: PPOs have contracts with a wide network of doctors, specialists and hospitals that all agree to pay set amounts for their services. You have the freedom to choose your own doctor; referrals aren’t necessary. If you want to see a provider outside the PPO network, you can get one at a higher rate.
You can buy a Medicare Supplemental insurance plan to complement your Original Medicare plan. Many choose this Medigap plan to include extras such as dental, vision, hearing and prescription drug coverage.
Comparing Medicare Plan Costs in Michigan
One of the best places you can start your Medicare plan search is Medicare.gov. Its site includes a Medicare Advantage plan finder. You enter your zip code, answer a few questions and get 20 or more plans to consider. You’ll be able to preview plan types, features and costs. You can also sign up for a plan on the site — it’s a one-stop shop. Here are examples of search results we found:
| Plan Name | Company | Estimated Annual Health & Drug Costs | Star Rating (Out of 5 Stars) |
|---|---|---|---|
| HAP Primary Choice (HMO) | HAP | $2,980 | 3.5 |
| PriorityMedicare Key (HMO-POS) | Priority | $3,000 | 4.5 |
| Humana Gold Plus (HMO) | Humana | $3,110 | 3.5 |
| BCN Advantage HealthyValue (HMO) | Blue Care Network | $3,140 | 3.5 |
| PriorityMedicare Ideal (PPO) | Priority | $3,430 | 4.5 |
| HAP Senior Plus (PPO) | HAP | $3,680 | 3.5 |
These figures are estimates and may vary according to plan, your location and other factors. Check with an insurance sales agent or customer service representative to verify plan coverage, features and rates.
Best Medicare Insurance Providers in Michigan
There are many Medicare Advantage plans to choose from in Michigan, so how do you decide? Consider your health needs and budget when comparing plans. Is a fitness plan important to you? What about hearing and dental coverage? Do you take a lot of prescription drugs?
Not all Medicare plans are alike, so it’s important to find credible resources that can help you determine the plans best for you. We used Medicare.gov and CMS.gov to create this list so you can choose the best plan in Michigan.
1. Best Overall in Michigan: Priority
PriorityMedicare’s HMO and PPO plans both received 4.5 stars, an above-average rating, 2nd only to plans with 5 stars (excellent). Both are affordably priced and have extra benefits, including:
- Free fitness program memberships or at-home fitness kits
- Preventive dental services, including exams and cleanings
- Access to more than 68,000 pharmacies nationwide
- Virtual health visits
Priority’s plans are ranked high for Medicare Advantage 2019 for Michigan, so they’re both excellent choices.
2. Cheapest Medicare Plan in Michigan: HAP
HAP’s Primary Choice HMO plan is the cheapest in Michigan and features a $0 monthly premium and a 3.5-star rating. HAP plans also offer:
- Money-saving discounts on gym memberships and weight loss programs
- Easy-to-use mobile app to check your explanation of benefits, claims status and find a doctor
- Free identity theft coverage and emergency travel assistance
3. Best Coverage for Medicare in Michigan: BCN Advantage
BCN Advantage (a licensee of Blue Cross Blue Shield of Michigan) is the best choice for overall Medicare coverage in Michigan. The plan features a $0 monthly premium and received 3.5 stars and offers:
- Personal concierge services to give you individual attention
- Free fitness program membership with access to more than 17,000 facilities nationwide
- Optional hearing, dental and vision coverage for an additional $20 per month
The company has received numerous awards, including:
- J.D. Power Award for Highest Satisfaction for Commercial Health Plans in Michigan in 2018
- Honoree, Webby Award for Best Mobile Sites and Apps in 2018
- Digital Health Awards in 2014, 2015 and 2017
- Ragan’s Health Care PR and Marketing Award for Best Website in 2015
- Nationwide coverage
4. Best for Customer Experience: Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan offers many affordable HMO and PPO plans under the Blue Cross umbrella as well as through BCN Advantage. Many offer $0 monthly premiums, fitness memberships, enhanced hearing, dental and vision coverage and travel benefits. Blue Cross is known for providing exceptional customer experience, an eHealthcare Leadership Award and CX Innovation Award for its interactive customer experience room.
- Medicare Advantage Plans
5. Best for Member Perks: Humana
Humana’s plans are among the cheapest Medicare Advantage plans in Michigan and offer great member perks such as:
- Health and wellness member rewards program
- Nurse advice hotline available 24/7
- Meal delivery service after an inpatient hospital stay or chronic illness
Save on Medicare in Michigan
You’ll be inundated with marketing materials when you turn 65. Choosing the right plan is important, so take the time to research your options before you sign up. Compare plan features and pricing so you’re armed with information that can impact your health and well being.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Laura Hipshire
Expert-level knowledge of Medicare Advantage plans and regulatory guidelines