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What is Medicare Advantage in Michigan?

If you’re going to be eligible for Medicare soon or if you have recently enrolled in Medicare Part A and Medicare Part B, you are missing out if you haven’t yet done some research on some of the best Medicare Advantage plans in Michigan for 2022. Many people find that it is a mistake to rely on Original Medicare (Medicare Part A and Medicare Part B) alone since they can end up with so many copayments (copays), deductibles and coinsurance. Luckily, a Medicare Advantage plan in Michigan offer a great replacement.

What is Medicare Advantage in Michigan?

Medicare Advantage in Michigan, also known as Part C or MAPD plans, is a plan for individuals who need a prescription drug plan in addition to their hospital and medical insurance.

Medicare Advantage is made up of the following:

Medicare Part A (hospital insurance)
Medicare Part B (medical insurance)
Medicare Part D (prescription drug coverage).

Part A and Part B make up Original Medicare, whereas Medicare Part C is made up of A, B, and D and is the preferred all in one plan when compared to Original Medicare.

A Medicare Advantage plan in Michigan has additional coverage and benefits that are provided by private health insurance companies. Benefits include vision and hearing, dental coverage, gym expenses (silversneakers), delivery of meals, appointment transportation to the doctor, and an over the counter prescription allowance.

Medicare beneficiaries will have a network in their service area to choose their primary care physician, hospital, and any other facilities from.

To note, If you should have a disability or End-stage Renal Disease, you can enroll for a Michigan Medicare Advantage plan; even if you are under 65.

What is the Best Medicare Advantage plan in Michigan in 2022?

The Best for Network Freedom: Medicare Advantage PPO Plan

PPO Plans have larger networks and no referrals.

Monthly premiums: $0 to $100 per month

The Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

HMO Plans have an HMO referral network. Because referrals are needed, monthly costs generally have $0 premiums.

Monthly premiums: $0

The Best for Low Income or Health Conditions: Medicare Advantage D-SNP

Dual eligible SNP is for those that have the following:

– You have Medicare and Medicaid
– You have a severe, disabling, or chronic condition
– You are entering a facility that qualifies you for SNP coverage, or you need nursing home care

This plan works with an individual’s Medicaid plan and helps with expenses related to Part B premium, copays, coinsurance, deductibles, and monthly premiums.

What Medicare Advantage plans are available in Michigan?

Local HMO plans: 46

Local PPO plans: 24

Regional PPO plans: 2

What’s changing about Medicare Advantage in Michigan in 2022?

For 2022, The Centers for Medicare and Medicaid Services has released contract changes that will affect the Part C Program, Medicare Prescription Drug Benefit, and the Medicare Cost Plan Program.

These changes are brought on as part of the Patients Over Paperwork initiative so to increase efficiency and a beneficiary’s experience.

Enhancements to the Part C and D Programs

Beneficiary Real-Time Benefit Tool (RTBT): There is access to real-time benefits information, enrollees can see cost-sharing, and shop for lower-cost alternatives for wellness0

Example: When your doctor suggests a particular drug/therapy, you can use the tool to research the copay and find a similar, more affordable option if one is available.

Permitting a Second, “Preferred,” Specialty Tier in Medicare Part D

This change will give Part D plans a tool for negotiation, lower your out of pocket costs, and will exchange products and place them on a preferred specialty tier.

Medicare Advantage (MA) and Part D Prescription Drug Plans Program Quality Rating System

This rating system measures and codes routine updates for star ratings and technically clarifies scores calculated for Medicare contracts.

Establishing Pharmacy Performance Measures Reporting Requirements

Pharmacy performance will be measured from Medicare Part D and will have to be disclosed to CMS. This will allow CMS to better understand how the measures are applied. For transparency to the public, all measures will be reported.

Implementing Several Opioid Provisions of the SUPPORT Act

SUPPORT stands for Substance Use-Disorder Prevention that Promotes, Opioid, Recovery and Treatment.

The SUPPORT Act will:

– Expand drug management programs
– Give Part D the ability to review statistics of opioid utilization with providers

Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements

Expansion and reinterpretation of “primary health-related” will include that cost-sharing reductions will now be an allowable supplemental benefit.

How much does Medicare Advantage in Michigan cost?

HMO plans and PPO plans in most states cost $0 per month. However, it’s more common to see PPOs with premiums. In Michigan, plans vary from one area to another.

Average Medicare Advantage plan with a prescription drug plan: $57 a month

Part D drug deductible: $68

When can you enroll in a Michigan Medicare Advantage plan?

Enrollment can only occur at certain points during the year.

Initial Enrollment Period

– Eligibility occurs at 65
– You can join Medicare Part A and Part B
– Enrollment occurs within three months of turning 65

Open Enrollment Period/Annual Election Period

Open Enrollment Period: October 15th until December 7th

During this time, you can:

– Join a plan
– Drop a plan
– Make changes to a plan

Coverage for Part C starts: January 1rst

Note: Plan must me completed by December 7th

Medicare Advantage Open Enrollment Period

Medicare Advantage Open Enrollment Period: January 1st through March 31st

During this enrollment period you can:

– Switch plans
– Join Original Medicare
– Join a Medicare Supplement plan

Special Enrollment Periods: Special Circumstances

Special circumstances could include address changes due to a move, your plan with Medicare changes, you lose your current coverage, or you are covered through your employer(VA/Tricare/PACE).

Other special considerations may include:

– Eligibility for both Medicare and Medicaid Extra Help
– Dropping a Medigap plan
– State Pharmaceutical Assistance Program enrollment
– Special needs or a disability

5-star Special Enrollment Period

5-star Special Enrollment Period: December 8th until November 30th

– This five star rating enrollment can only be used once
– Plans are rated with satisfaction surveys that compare plans based on quality and performance
– The 5-star rating is the highest given

Special Enrollment Periods if you get “Extra Help”

This enrollment applies if you are:

– Eligible for Extra Help
– Eligible for Medicare or Medicaid
– Enrollment into the State Pharmaceutical Assistance Program

When can I make changes to my Medicare Advantage plan?

Medicare Advantage Open Enrollment Period: January 1st through March 31st

During this enrollment period you can:

Switch plans
Join Original Medicare
Join a Medicare Supplement plan

Are Medicare Advantage plans in Michigan “bad”?

Medicare Advantage plans might not be for everyone, however, for many they are a great fit.  For this reason, they continue to gain popularity from year to year.  Medicare Advantage enrollment has increased by 10% from last year. Penetration in the state of Michigan is 51%, with a growth of 11% as of 2021.

1. Number of lives enrollment in Medicare Advantage in New York: 660,480

2. Number enrolled by plan, specifically the three 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: 51%

4. Number of lives enrollment in Medicare Advantage nationwide: 24.1 million

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide: 39%

Common Questions on Medicare Advantage in Michigan

Are there disadvantages to Medicare Advantage?

1. Network Providers Have Limitations:

Plans are with offered through an insurance company, which means they have networks with certain physicians, health care specialists, wellness facilities, and hospitals you can go to.

2. Financially Unpredictable:

A Michigan Medicare Advantage plan has lower premiums and is more affordable when compared to a Medicare Supplement plan. Over time though, expenses can grow as you use the plan. You can experience more out of pocket costs from expenses like coinsurance and copayments.

3. Requires Involvement:

Medicare Advantage plans will require your attention. A Medicare beneficiary will have to confirm that they stay in-network, know their coverage options, pay bills and copays on time, and know when their plan changes.

4. Lacks Long Term Stability:

Medicare Advantage Plans renew every year and face changes with its benefits, the drugs covered, network reduction or expansion, and premiums. A Medigap plan is standardized and will not go through changes like a Part C plan.

What are the four types of Medicare Advantage policies available in Michigan?

The four types of Medicare Advantage plans are:

HMO – Health Maintenance Organization
PPO – Preferred Provider Organization
PFFS – Private Fee for Service
SNPs – Special Needs Plans

Which companies are the top three Medicare Advantage plan providers?

Most Medicare Advantage enrollees are in plans with one of the following:

Blue Cross Blue Shield – 15%

Humana – 18% 

United Healthcare – 26%

What are Medicare SNPs?

An SNP is a Special Needs Plan that is a type of Michigan Medicare Advantage Plan. It is for individuals who have a disease, syndrome, or specific characteristics.

These plans are set up with the following Medicare coverage, which are suited for them:

Healthcare providers
Drug formulations
Benefit choices

Do Medicare Advantage plans include prescription drug coverage?

Yes. Most Medicare Advantage plans in Michigan include a prescription drug plan (MAPD). MAPD plans are combo plans with built-in prescription drug coverage.

Do Medicare Advantage plans cover the SilverSneakers program in MI?

Most plans have the popular Silver Sneakers program. To be sure of these extra benefits being included in your plan, speak with your insurance agent.

Related Topics

Michigan State Links

Michigan Medicare Resources

These resources can help you when you first sign up for Medicare. You may find that you qualify for extra help, too, if you’re a low-income individual:

Ready to learn more?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In Michigan, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.