Medicare in Michigan

Enrollment in Original Medicare (Medicare Part A, for hospital coverage, and Part B, for outpatient/physician coverage) is the same in every state, and is done via the Social Security Administration. Medicare Part A and Medicare Part B benefits do not vary from state to state, and the coverage can be used anywhere in the country.

So your Medicare eligibility in Michigan will follow the same federal guidelines that are used nationwide. But if you want supplemental coverage or would prefer to get your primary Medicare coverage from a private health insurance company, your options for Medicare Advantage plans, Medicare Part D prescription drug plans, and Medigap plans do vary from one state to another.

Private Medicare Advantage plans are an alternative to Original Medicare. It provides all of the benefits of Original Medicare (hospital and outpatient/physician coverage), although out-of-pocket medical costs can vary considerably from what they’d be with Original Medicare. Most Medicare Advantage plans also include Medicare Part D prescription drug coverage and may offer extra benefits like fitness and dental/vision coverage.

But Medicare Advantage plans tend to have much more limited service areas and provider networks than the nationwide access provided by Original Medicare.⁷ There are pros and cons to either alternative, and no single solution that works for everyone.

Medicare Advantage plans are provided by private insurers, and plan availability varies considerably across the country. Michigan’s Medicare Advantage market is robust, with at least 26 plans available statewide and residents of some counties able to select from among more than 70 plan options.²

As of 2018, 40% of Michigan Medicare beneficiaries had Medicare Advantage plans,⁸ which was more than the nationwide average of 35% at that point.⁹ But 1,289,482 Michigan Medicare beneficiaries were enrolled in Medicare Advantage plans as of April 2023 (as opposed to Original Medicare; this does not count people with private plans to supplement their Original Medicare coverage), which amounted to 59% of the state’s Medicare population.¹

There has been a nationwide trend of increasing Medicare Advantage enrollment over the last several years, but Medicare Advantage still accounts for less than half of all Medicare beneficiaries nationwide (about 48%), whereas well over half of Michigan’s Medicare beneficiaries have Medicare Advantage plans. Michigan has among the nation’s highest percentage of Medicare beneficiaries with Medicare Advantage plan coverage.¹⁰

Original Medicare does not limit out-of-pocket healthcare costs, so most enrollees maintain some form of supplemental coverage. Nationwide, almost 86% of Original Medicare beneficiaries get their supplemental coverage through Medigap, an employer-sponsored plan or Medicaid in 2020.¹¹ But for those who don’t, Medigap plans (also known as Medicare Supplement Insurance plans or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare.

According to an America’s Health Insurance Plans (AHIP) analysis, there were 412,804 Michigan Medicare beneficiaries with Medigap coverage as of 2021,¹² down from 423,319 the year before.¹³ Medigap plans can only be used with Original Medicare (not with Medicare Advantage). And although overall Medicare enrollment has been increasing over time, Medicare Advantage enrollment has been growing much faster than overall Medicare enrollment. So the number of people with Medigap coverage in Michigan has actually declined slightly over the last few years.

Medigap plans are sold by private insurers, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer sells the plan. Pricing, however, varies from one insurer to another. Michigan enacted legislation in 2018 to ensure that Medigap plans sold in the state would comply with federal MACRA rules that prohibit the sale of Medigap plans that cover the Part B deductible to anyone who becomes eligible for Medicare after the end of 2019.

There were 45 insurers that were actively selling Medigap plans in Michigan as of early 2023.¹⁴ Michigan does not dictate how insurers adjust premiums based on enrollees’ ages, so insurers can use attained-age rating (the most common; premiums increase as the enrollee gets older), issue-age rating (premiums are based on the age the person was when they enrolled in the plan) or community-rating (premiums do not vary based on age).

Unlike other private Medicare coverage (Medicare Advantage plans and Medicare Part D prescription drug plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Medicare Part A and Part B to buy a Medigap policy).¹⁵

People who aren’t yet 65 can enroll in a Medigap plan if they’re disabled¹⁶ and have been receiving disability benefits for at least two years, and about 14% of Michigan Medicare enrollees are under age 65.¹ Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states, including Michigan, have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans.

For at least twenty years, Michigan has had rules in place to ensure access to at least some Medigap plans for people under age 65. Current rules in Michigan (see MCL 500.3831, updated as of March 2019, to MCL 500.3831.amended) require Medigap insurers that also sell major medical health insurance to make Medigap Plans A and G (prior to 2020 this was Plan C) continuously guaranteed-issue for Medicare beneficiaries under age 65, although they can charge these enrollees higher premiums. And if the applicant did not already have major medical coverage under a plan offered by that insurer, the insurer can impose a pre-existing condition waiting period of up to six months (see MCL 500.3831(2)). As of late 2022, there were five insurers in Michigan that offered Medigap policies (at least A and G) to people under age 65.

Disabled Medicare beneficiaries have access to the regular Medigap open enrollment period when they turn 65. At that point, they can select from among any of the available Medigap plans on the market, and get the lower premiums that apply to people who are aging into Medicare, rather than qualifying due to disability.

Disabled Medicare beneficiaries can choose instead to enroll in a Medicare Advantage plan. But Medicare Advantage plans have more limited provider networks than Original Medicare, requiring members to use providers within a fairly localized network. and total out-of-pocket costs can be as high as $8,300 per year for in-network healthcare,¹⁷ plus the out-of-pocket cost of prescription drugs.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Original Medicare does not provide coverage for outpatient prescription drugs. Almost 86% of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid,¹¹ and these plans often include prescription drug coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need to obtain Medicare Part D in order to have coverage for prescriptions. Part D can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Part D prescription drug coverage.

There are 24 stand-alone Medicare Part D prescription drug plans for sale in Michigan in 2023, with premiums starting at $3.20.⁴ Private insurers provide the Medicare prescription drug coverage.

1,833,258 Medicare beneficiaries in Michigan — nearly 84% of the state’s total Medicare population — had Medicare Part D prescription drug coverage as of early 2023.¹ Over a million beneficiaries had coverage under Medicare Advantage plans, and over 828,000 had stand-alone Medicare Part D prescription drug coverage.¹

Medicare Part D enrollment follows the same schedule as Medicare Advantage. Beneficiaries can enroll in a Medicare Part D prescription drug plan when they first enroll in Medicare, and then they have an opportunity during the Medicare Annual Election Period (October 15 to December 7) to switch to a different prescription drug plan. It’s important for enrollees to compare the available Medicare Part D prescription drug plans each year, to see how the various prescription drug plan options would cover their current prescription drugs and to determine whether they can save money by switching to a different Medicare Part D prescription drug plan for the coming year. If you sign up during the Fall Open Enrollment period, it will take effect on January 1.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Michigan includes overviews of these programs, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

To learn more about Medicare in Michigan, you can contact MMAP, the Michigan Medicare/Medicaid Assistance Program, with questions related to Medicare coverage in Michigan.

The Michigan Department of Insurance and Financial Services is a state resource that can provide information, assistance, and customer service for a variety of issues related to health insurance. The Department oversees and licenses the insurers that offer health plans in the state, as well as the brokers/agents who sell the policies.

The Medicare Rights Center is a nationwide service, with a website and call center, that can provide information and answer questions related to Medicare eligibility, enrollment, and benefits.

Learn about programs offered via Michigan Medicaid that can help Medicare beneficiaries who have limited income and assets.